招聘講演（１）

Dual Guided Nerve Block

Paul Kessler, MD, PhD

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

Dual guidance refers to the use of the two modalities, peripheral nerve stinmulation (NS) and ultrasound (US) guidance, in combination to act synergistically. The aim of dual guidance is to achieve optimal nerve location and injection pattern while avoiding perineural structures and untargeted nerves, maximizing success and minimizing complications. Rather than being biased toward one given modality, best overall results can be obtained by utilizing the advantages offered by each, used together when possible. Although it is too early to form definitive conclusions, publications to date coupled with clinical experience supports this concept of dual guidance.

The advantages of US-guided blocks are that the needle, peripheral nerve and the spread of the local anesthetic can be visualized during the procedure. Logically, as the results of the current research efforts seem to indicate, this should make US-guided peripheral nerve blocks (PNB) more reproducible and possibly more time-efficient. It should be noted however, that peripheral NS has been extensively studied and therefore universally accepted as a standard PNB technique for more than 30 years. Consequently, NS is still being used as a “reference technique” in many studies of US-guided blocks, although this may change depending on how the US technology, its ease of use and necessary training required for its successful application evolve.

US and NS are complimentary and not mutually exclusive monitoring technologies. When used in conjunction with US, the functional information obtained by NS may add additional beneficial nerve localization and safety information.