The Use of Ultrasound in Regional Anesthesia: The Game Changer

From a historical perspective, the first application of ultrasound in anesthesia was, in fact, an indirect one. In 1978, P. La Grange published a paper describing the use of Doppler ultrasound to identify the subclavian artery as a landmark for supraclavicular plexus block. A significant breakthrough followed in 1994, with a study by Kapral et al., in which the brachial plexus was anesthetized using a supraclavicular ultrasound-guided approach. This moment represented a significant step forward, opening up extensive opportunities for peripheral regional anesthesia with ultrasound guidance. Over the following 31 years—up to the present day—ultrasound has profoundly transformed the practice of regional anesthesia, and ultrasound-guided regional anesthesia has become the standard of care. The main benefits include the addition of a powerful real-time imaging tool for needle guidance and delivery of local anesthetics, a more accurate understanding of nervous structures and their responses to local anesthetics, improved acute pain management with reduced volumes of anesthetic, enhanced safety and patient recovery, tailored patient-specific analgesia with reduced opioid requirements, and the expansion of ultrasound-guided interventions for chronic pain. Furthermore, a new range of techniques employing fascial plane blocks has been incorporated into the analgesia armamentarium. Artificial intelligence-assisted ultrasound is now available on modern ultrasound platforms, representing a new frontier in this field. Machine-learning algorithms facilitate the identification of nervous structures and needle guidance, thereby reducing human error. Meanwhile, 3D ultrasound and real-time imaging enable more accurate evaluation, particularly in challenging or atypical patient anatomies.