Concerns Regarding Ultrasound-guided Regional Anesthesia

Abstract

Although nerve injuries, including plexopathies, have long been reported, it is time to reflect on situations in which ultrasonic guidance has been used.1 We are seeing reports of plexopathies after ultrasound-guided regional anesthesia and surgery, despite visualization of the injecting needle tip well away from neural elements.2,3 At our institution, a case of brachial plexopathy after ultrasound-guided regional anesthesia recently occurred, resolving without sequelae. This disquiet has been increased by the knowledge that ultrasonic guidance for regional anesthesia is being accepted without any safety studies, efficacy studies, or equivalence studies for this particular application. For those of us involved in medical device development, these three steps are essential in assuring patient safety. So, we ask, are there effects heretofore unrecognized in exposing nerves—as in the case of panplexopathies, in particular—to the combination of ultrasound and regional anesthesia?