US-Guided Nerve Blocks: Procedure Technique

  • Filomena PuntilloEmail author
  • Laura Bertini
  • Mario Bosco
  • Mario Tedesco
  • Marco Baciarello


The introduction of ultrasound guidance has been a marked advance in the practice of regional anaesthesia, and has gained popularity as an adjunct or alternative to nerve stimulation technique. Ultrasound-guided nerve blocks consist of the identification of the target nerve, visualization of the surrounding anatomy (such as blood vessels, lymph nodes, and other important structures), needle tip, and real-time observation of the local anesthetic spread. Peripheral nerves can be identified and traced to alternative sites where local anaesthetic can be safely injected without the risk of neurovascular injury. Direct visualization of the target nerve and deposition of local anesthetic has been shown to improve block operating efficiency while decreasing placement complications and patient discomfort.


Ultrasound Peripheral nerves Musculoskeletal system Peripheral nerve block Regional anahestesia Nerve stimulation Anahestetic drugs 

Suggested Readings

  1. Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010;28(1):76–81.CrossRefPubMedGoogle Scholar
  2. Ben-Ari A, Moreno M, Chelly JE, Bigeleisen PE. Ultrasound-guided paravertebral block using an intercostal approach. Anesth Analg. 2009;109:1691–4.CrossRefPubMedGoogle Scholar
  3. Casati A, Baciarello M, Di Cianni S, Danelli G, De Marco G, Leone S, Rossi M, Fanelli G. Effects of ultrasound guidance on the minimal effective anaesthetic volume required to block the femoral nerve. Br J Anaesth. 2007;98:823–7.CrossRefPubMedGoogle Scholar
  4. Demirelli G, Baskan S, Karabeyoglu I, Aytac I, Ornek DH, Erdogmus A, Baydar M. Comparison of ultrasound and ultrasound plus nerve stimulator guidance axillary plexus block. J Pak Med Assoc. 2017;67(4):508–12.PubMedGoogle Scholar
  5. Dufour E, Toussaint A, Liu N, Fischler M, Nourry G, Vercoutère M. Ultrasound-guided perineural circumferential median nerve block in carpal tunnel syndrome. Anaesthesia. 2013;68(4):434–6.CrossRefPubMedGoogle Scholar
  6. Falyar CR. Ultrasound-guided ankle blocks: a review of current practices. AANA J. 2015;83(5):357–64.PubMedGoogle Scholar
  7. Franco CD, Williams JM. Ultrasound-guided interscalene block: reevaluation of the “stoplight” sign and clinical implications. Reg Anesth Pain Med. 2016;41(4):452–9.CrossRefPubMedGoogle Scholar
  8. Guirguis MN, Abd-Elsayed AA, Girgis G, Soliman LM. Ultrasound-guided transversus abdominis plane catheter for chronic abdominal pain. Pain Pract. 2013;13(3):235–8.CrossRefPubMedGoogle Scholar
  9. Gurnaney H, Ganesh A. Incidence and effects of unintentional intraneural injection during ultrasound-guided subgluteal sciatic nerve block. Reg Anesth Pain Med. 2013;38:72.CrossRefPubMedGoogle Scholar
  10. Hara K, Sakura S, Nomura T, Saito Y. Ultrasound guided thoracic paravertebral block in breast surgeries. Anesthesia. 2009;64:223–5.CrossRefGoogle Scholar
  11. Hara K, Sakura S, Shido A. Ultrasound-guided lateral femoral cutaneous nerve block: comparison of two techniques. Anaesth Intensive Care. 2011;39:69–72.PubMedGoogle Scholar
  12. Henshaw DS, Kittner SL, Jaffe JD. Ultrasound-guided continuous superficial radial nerve block for complex regional pain syndrome. J Pain Palliat Care Pharmacother. 2016;30(2):118–23.CrossRefPubMedGoogle Scholar
  13. Herring AA, Stone MB. The accuracy of a handheld ultrasound machine in locating the sciatic nerve in the popliteal fossa. Reg Anesth Pain Med. 2004;29:413–6.CrossRefGoogle Scholar
  14. Herring AA, Stone MB, Fischer J, Frenkel O, Chiles K, Teismann N, Nagdev A. Ultrasound-guided distal popliteal sciatic nerve block for ED anesthesia. Am J Emerg Med. 2011;29(6):697.e3–5.CrossRefGoogle Scholar
  15. Honnannavar KA, Mudakanagoudar MS. Comparison between conventional and ultrasound-guided supraclavicular brachial plexus block in upper limb surgeries. Anesth Essays Res. 2017;11(2):467–71.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Ilfeld BM. Continuous peripheral nerve blocks: an update of the published evidence and comparison with novel, alternative analgesic modalities. Anesth Analg. 2017;124(1):308–35.CrossRefPubMedGoogle Scholar
  17. Jenstrup MT, et al. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. ActaAnaesthesiol Scand. 2012;56(3):357–64.CrossRefGoogle Scholar
  18. Kim BG, Han JU, Song JH, Yang C, Lee BW, Baek JS. A comparison of ultrasound-guided interscalene and supraclavicular blocks for post-operative analgesia after shoulder surgery. Acta Anaesthesiol Scand. 2017;61(4):427–35.CrossRefPubMedGoogle Scholar
  19. Moritz T, Prosch H, Berzaczy D, Happak W, Lieba-Samal D, Bernathova M, Auff E, Bodner G. Common anatomical variation in patients with idiopathic meralgia paresthetica: a high resolution ultrasound case-control study. Pain Physician. 2013;16:E287–93.PubMedGoogle Scholar
  20. Nwawka OK, Miller TT, Jawetz ST, Saboeiro GR. Ultrasound-guided perineural injection for nerve blockade: does a single-sided injection produce circumferential nerve coverage? J Clin Ultrasound. 2016;44(8):465–9.CrossRefPubMedGoogle Scholar
  21. O Riain SC, Donnell BO, Cuffe T, Harmon DC, Fraher JP, Shorten G. Thoracic paravertebral block using real-time ultrasound guidance. Anesth Analg. 2010;110:248–51.CrossRefPubMedGoogle Scholar
  22. Rahiri J, Tuhoe J, Svirskis D, Lightfoot NJ, Lirk PB, Hill AG. Systematic review of the systemic concentrations of local anaesthetic after transversus abdominis plane block and rectus sheath block. Br J Anaesth. 2017;118(4):517–26.CrossRefPubMedGoogle Scholar
  23. Redborg KE. Ultrasound improves the success rate of a tibial nerve block at the ankle. Reg Anesth Pain Med. 2009;34(3):256–60.CrossRefPubMedGoogle Scholar
  24. Shteynberg A, Riina LH, Glickman LT, Meringolo JN, Simpson RL. Ultrasound guided lateral femoral cutaneous nerve (LFCN) block: safe and simple anesthesia for harvesting skin grafts. Burns. 2013;39:146–9.CrossRefPubMedGoogle Scholar
  25. Strakowski JA. Ultrasound-guided peripheral nerve procedures. Phys Med Rehabil Clin N Am. 2016;27(3):687–715.CrossRefPubMedGoogle Scholar
  26. Tammam TF. Ultrasound-guided infragluteal sciatic nerve block: a comparison between four different techniques. Acta Anaesthesiol Scand. 2013;57:243–8.CrossRefPubMedGoogle Scholar
  27. Tumber PS, Bhatia A, Chan VW. Ultrasound-guided lateral femoral cutaneous nerve block for meralgia paresthetica. Anesth Analg. 2008;106:1021–2.CrossRefPubMedGoogle Scholar
  28. Turner AL, Stevenson MD, Cross KP. Impact of ultrasound-guided femoral nerve blocks in the pediatric emergency department. Pediatr Emerg Care. 2014;30(4):227–9.CrossRefPubMedGoogle Scholar
  29. Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:2752876.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Yoshida T, Nakamoto T, Kamibayashi T. Ultrasound-guided Obturator nerve block: a focused review on anatomy and updated techniques. Biomed Res Int. 2017;2017:7023750.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Filomena Puntillo
    • 1
    Email author
  • Laura Bertini
    • 2
  • Mario Bosco
    • 3
  • Mario Tedesco
    • 4
  • Marco Baciarello
    • 5
  1. 1.Assistant Professor of Anaethesia and Pain Therapy, Department of Emergency and Organ TransplantationUniversity of BariBariItaly
  2. 2.Anaethesia and Pain UnitSanta Caterina HospitalRomeItaly
  3. 3.Anaesthesia and Intensive Care UnitSanto Spirito HospitalRomeItaly
  4. 4.Pain Therapy UnitMater Day HospitalBariItaly
  5. 5.Assistant Professor of Anaethesia and Pain Therapy, Department of Medicine and SurgeryUniversity of ParmaParmaItaly

Personalised recommendations