Regional anesthesia - are the standards changing?

Abstract

Regional anesthesia has undergone many changes over the years and the increasing use of ultrasound has certainly played an important role in this. Apart from individual case reports in the literature of very different blocking options, some new procedures seem to have become established and can be broadly applied. Among these are blockades, by which ultrasound-guided injection of local anesthetics is carried out in fascial or muscular layers rather than around target nerves (e.g. cervical plexus blocks and truncal blocks). In addition, the precision with which ultrasound can be used to identify nerve structures led to an increasingly better definition of targets exemplified for interscalene or femoral nerve blocks. The use of ultrasound also seems to be helpful in the performance of neuraxial blocks, particularly in obese patients or patients with adifficult anatomy. With the implementation 10 years ago of aregistry for safety in regional anesthesia and acute pain therapy by the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthesiologists (BDA), it has been possible to answer important safety questions and define protective measures (e.g. tunnelling, antibiotic prophylaxis and sedation). Moreover, this registry can be used as abenchmark to compare the quality of regional anesthesia in individual hospitals with all other participating centers.