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Special Article
The ASRA Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia and Pain Medicine: Executive Summary
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  1. Joseph M. Neal, MD*,
  2. Richard Brull, MD†,
  3. Vincent W. S. Chan, MD†,
  4. Stuart A. Grant, MBChB‡,
  5. Jean-Louis Horn, MD§,
  6. Spencer S. Liu, MD∥,
  7. Colin J.L. McCartney, MBChB,
  8. Samer N. Narouze, MD, MSc#,
  9. Anahi Perlas, MD†,
  10. Francis V. Salinas, MD*,
  11. Brian D. Sites, MD** and
  12. Ban Chi-ho Tsui, MD††
  1. From the *Virginia Mason Medical Center, Seattle, WA;
  2. †Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada;
  3. ‡Duke University School of Medicine, Durham, NC;
  4. §Oregon Health Sciences University,Portland, OR;
  5. ∥Hospital for Special Surgery, Weill College of Medicine of Cornell University, New York, NY;
  6. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;
  7. #Cleveland Clinic Foundation, Cleveland, OH;
  8. **Dartmouth Medical School, Hanover, NH; and
  9. ††University of Alberta Hospital, Edmonton, Alberta, Canada.
  1. Address correspondence to: Joseph M. Neal, MD, 1100 Ninth Ave (B2-AN), Seattle, WA 98101 (e-mail: anejmn{at}vmmc.org).

Abstract

Objectives: The American Society of Regional Anesthesia and Pain Medicine charged an expert panel to examine the evidence basis for ultrasound guidance as a nerve localization tool in the clinical practices of regional anesthesia and interventional pain medicine.

Methods: The panel searched, examined, and assessed the literature of ultrasound-guided regional anesthesia (UGRA) from the past 20 years. The qualities of studies were graded using the Jadad score. Strength of evidence and recommendations were graded using an accepted rating tool.

Results: The panel made specific literature-based assessments concerning the relative advantages and limitations of UGRA relative to traditional nerve localization methods as they pertained to block characteristics and complications. Assessments and recommendations were made for upper and lower extremity, neuraxial, and truncal blocks and include pediatrics and interventional pain medicine.

Conclusions: Ultrasound guidance improves block characteristics (particularly performance time and surrogate measures of success) that are often block specific and that may impart an efficiency advantage depending on individual practitioner circumstances. Evidence for UGRA impacting patient safety is currently limited to the demonstration of improvements in the frequency of surrogate events for serious complications.

http://dx.doi.org/10.1097/AAP.0b013e3181d22fe0

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    Footnotes

    • The American Society of Regional Anesthesia and Pain Medicine provided travel support for faculty members to present this work at the Spring ASRA meeting in Phoenix, AZ, May 2, 2009.

    • An unrestricted educational grant from Philips Healthcare (Andover, MA), which had no input into the project, plus gifts-in-kind from ASRA and our publisher, Wolters Kluwer/Lippincott Williams & Wilkins, supported the cost of publishing this Regional Anesthesia and Pain Medicine supplement.