BJA Advance Access originally published online on January 26, 2009
British Journal of Anaesthesia 2009 102(3):408-417; doi:10.1093/bja/aen384
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials
Department of Anesthesiology and Perioperative Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
* Corresponding author. E-mail: abrahama{at}ohsu.edu
Background: Despite the growing interest in the use of ultrasound (US) imaging to guide performance of regional anaesthetic procedures such as peripheral nerve blocks, controversy still exists as to whether US is superior to previously developed nerve localization techniques such as the use of a peripheral nerve stimulator (PNS). We sought to clarify this issue by performing a systematic review and meta-analysis of all randomized controlled trials that have compared these two methods of nerve localization.
Methods: We searched Ovid MEDLINE®, the Cochrane Central Register of Controlled Trials®, and Google Scholar databases and also the reference lists of relevant publications for eligible studies. A total of 13 studies met our criteria and were included for analysis. Studies were rated for methodological quality by two reviewers. Data from these studies were abstracted and synthesized using a meta-analysis.
Results: Blocks performed using US guidance were more likely to be successful [risk ratio (RR) for block failure 0.41, 95% confidence interval (CI) 0.26–0.66, P<0.001], took less time to perform (mean 1 min less to perform with US, 95% CI 0.4–1.7 min, P=0.003), had faster onset (29% shorter onset time, 95% CI 45–12%, P=0.001), and had longer duration (mean difference 25% longer, 95% CI 12–38%, P<0.001) than those performed with PNS guidance. US guidance also decreased the risk of vascular puncture during block performance (RR 0.16, 95% CI 0.05–0.47, P=0.001).
Conclusions: US improves efficacy of peripheral nerve block compared with techniques that utilize PNS for nerve localization. Larger studies are needed to determine whether or not the use of US can decrease the number of complications such as nerve injury or systemic local anaesthetic toxicity.
Keywords: anaesthetic techniques, regional; neuromuscular transmission; ultrasound, nerve stimulation
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in BJA:
- In the March 2009 BJA ...
BJA 2009 102: NP.[Extract] [Full Text]
This article has been cited by other articles:
|
|
 |
|
  D. Jochum, A. Bondar, L. Delaunay, M. Egan, H. Bouaziz, M. Abrahams, M. Aziz, and J.-L. Horn One size does not fit all: proposed algorithm for ultrasonography in combination with nerve stimulation for peripheral nerve blockade Br. J. Anaesth., November 1, 2009; 103(5): 771 - 774. [Full Text] [PDF]
|
|
|
|
|
|
C. Gonano, S. C. Kettner, M. Ernstbrunner, K. Schebesta, A. Chiari, and P. Marhofer Comparison of economical aspects of interscalene brachial plexus blockade and general anaesthesia for arthroscopic shoulder surgery Br. J. Anaesth., September 1, 2009; 103(3): 428 - 433. [Abstract] [Full Text] [PDF]
|
|
E-letters:
Read all E-letters
- A questionable review will not change facts about neurostimulation compared to ultrasound technique
- Jose Aguirre, et al.
- British Journal of Anaesthesia, 12 Mar 2009 [Full text]
- Meta-analysis for Ultrasound v PNS - the final curtain
- Andrew T Wilson
- British Journal of Anaesthesia, 1 Apr 2009 [Full text]
- Author’s Reply: Our review will not change the facts, it has only reported them
- Matthew S. Abrahams
- British Journal of Anaesthesia, 1 Apr 2009 [Full text]
- More studies evaluating inexperienced ultrasound users are now needed
- Colin Sinclair, et al.
- British Journal of Anaesthesia, 14 Apr 2009 [Full text]
- One size does not fit all: Proposal of an algorithm for the practice of ultrasonography in combination with nerve stimulation for peripheral nerve blockade
- Hervé Bouaziz, et al.
- British Journal of Anaesthesia, 7 Aug 2009 [Full text]
- Author's Reply
- Matthew S. Abrahams, et al.
- British Journal of Anaesthesia, 14 Aug 2009 [Full text]
- One size does not fit all: Proposal of an algorithm for the practice of ultrasonography in combination with nerve stimulation for peripheral nerve blockade
- Hervé Bouaziz, et al.
- British Journal of Anaesthesia, 9 Sep 2009 [Full text]