European Guideline for Ultrasound Guided Nerve Block

Paul Kessler, MD, PhD

Department of Anesthesiology and Intensive Care Medicine, Orthopedic University Hospital, Friedrichsheim Foundation, Frankfurt, Germany

Ultrasound-guided  anaesthesia of peripheral nerves is a new challenge for anaesthesiologists. The number of ultrasound users in this field has increased over the last 10 years because of improved high frequency ultrasound technology and increased mobility of machines.

A visual control of needle advancement in real time should improve our practice and increase both patients’ comfort and safety. Ultrasound-guidance is a method, which may help us to reach these goals. However, it requires both personal skills, which are not so easy to learn and high quality, expensive ultrasound machines.  Even if these machines are available, the inter-individual variability in patient’s anatomy and the echographic appearance of the nerves can make the ultrasound-guided block a challenge for both patient and anaesthesiologist.

Therefore, to optimize the quality of ultrasound-guided regional anesthesia (UGRA) practice and to support interested clinicians in learning and integrating this technology into their practices the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) have joined and published in 2009 recommendations for education and training in ultrasound-guided regional anesthesia (UGRA). Primary aims are:

1. to structure the common tasks used when performing an ultrasound-guided nerve block,

2. to articulate the core competencies and skill sets associated with UGRA,

3. to suggest a training process for both established practitioners and residents, and

4.  to recommend the establishment of a quality improvement process for UGRA.