The American Journal of Medical Sciences and Pharmaceutical Research
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TYPE
Original Research
PAGE NO.
35-43
10.37547/tajmspr/Volume07Issue08-06
OPEN ACCESS
SUBMITED
15 July 2025
ACCEPTED
05 August 2025
PUBLISHED
21
August 2025
VOLUME
Vol.07 Issue 08 2025
CITATION
Dobrenko Olga. (2025). Features of Ultrasound Techniques in
Performing Peripheral Regional Blocks. The American Journal of
Medical Sciences and Pharmaceutical acResearch, 7(8), 35
–
43.
https://doi.org/10.37547/tajmspr/Volume07Issue08-06
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Features of Ultrasound
Techniques in Performing
Peripheral Regional Blocks
Dobrenko Olga
Resident doctor in anesthesiology and intensive care
medicine, Siegen Medical Center Germany, Siegen
Abstract
The article reviews the development and modern
features of ultrasound techniques in the performance of
peripheral regional blocks. As requirements steadily
mount for effectiveness and safety in perioperative
analgesia, this study finds relevance in efforts directed
toward optimizing views of both neural structures and
the needle, with lowered risks for complications to
occur. The purpose is to enumerate the main physico-
technical characteristics of ultrasound systems, together
with improved transducer manipulation techniques,
that play a role in increasing the level of accuracy and
informativeness regarding peripheral blocks. The
novelty of the research lies in the comprehensive
comparison of linear and convex probes according to
penetration depth and resolution criteria, the
systematic analysis of basic transducer movements
(slide, tilt, rotate, fan) and the optimal sequence of
settings (depth, overall gain, TGC, dynamic range), as
well as in the discussion of modern needle
‑
visibility
enhancement technologies
—
from echogenic needles
and beam
‑
steering to passive magnetic tracking and
deep
‑
learning algorithms. Additionally, the integration
of triple monitoring
—
ultrasound, nerve stimulator, and
manometric pressure control
—
is proposed as a rational
safety standard. The main conclusions demonstrate that
selecting a probe based on nerve depth, sequentially
optimizing image parameters, and employing additional
technological solutions significantly enhance the
nerve/fascial-plane
contrast,
improve
needle-tip
tracking, and reduce the incidence of intraneural and
vascular injections. A multilevel control system ensures
the timely detection of hazardous situations without
prolonging procedure time, and the implementation of
computer technologies opens prospects for further
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improvement of precision and operator training. This
article will be useful to regional anesthesiologists,
educators, and researchers engaged in the development
and implementation of ultrasound methods in
peripheral regional anesthesia.
Keywords:
ultrasound navigation, peripheral regional
blocks, transducer, safety, echogenic needle, triple
monitoring
Introduction
Since the first experiments by P. La Grange in 1978,
when a Doppler transducer was used solely to locate the
subclavian artery during a supraclavicular block,
ultrasound has gradually evolved from an auxiliary
landmark into a fully fledged method for direct
visualization of the needle and nerve (Grange et al.,
1978). The real breakthrough occurred in the
mid
‑
1990s: Kapral
’
s group in Vienna was the first to
perform a block under continuous B
‑
mode guidance,
and a few years later, Canadian researchers provided a
detailed description of the sonoanatomy of the brachial
plexus, which accelerated the adoption of the technique
into training programs and clinical protocols (Orebaugh,
2018). Over the subsequent two decades, the
miniaturization
of
scanners,
improvements
in
resolution, and the advent of echogenic needles have
rendered the methodology truly bedside: today,
portable devices are available in most operating rooms
and emergency departments.
Meta-analyses have consistently confirmed the clinical
benefits of ultrasound guidance. A Cochrane review of
32 randomized trials (2,844 patients) demonstrated that
the likelihood of achieving a block adequate for surgery
is nearly three times higher with ultrasound guidance
(OR 2.94; 95% CI 2.14–
4.04), while the need for
supplemental anesthesia is reduced by more than 70%
(OR 0.28; 95% CI 0.20–
0.39) (Lewis et al., 2015). Safety
is also enhanced: according to another meta-analysis,
the risk of inadvertent vascular puncture decreases
when guidance is provided by nerve stimulation alone
(Abrahams et al., 2009). These figures illustrate the
sustained interest in the technique, which increases
first-attempt success rates, accelerates block onset,
allows for reduced volumes of local anesthetic, and
concurrently lowers the incidence of bleeding, LAST, and
conversion to general anesthesia. Together, these
factors make ultrasound-guided peripheral regional
blocks an indispensable tool in modern perioperative
analgesia, positioning their further development as a
key growth area in regional anesthesiology.
Materials and Methodology
The materials and methodology of the present study are
based on an extensive analysis of 19 key publications,
including phantom experiments, clinical randomized
trials, meta
‑
analyses, and technical guidelines. The
theoretical framework comprised classic studies that
traced the evolution from Doppler-based devices
(Grange et al., 1978) to modern, high-resolution,
portable ultrasound scanners (Orebaugh, 2018). Meta-
analyses have broadly validated the clinical benefits of
ultrasound guidance in peripheral blocks, providing a
detailed description of how effective and safe the
technique is. Technical parameters identified as critical
and affecting image quality have been discussed by
Lewis et al. (2015) and Abrahams et al. (2009).
Several approaches were incorporated in this study. A
comparison analysis of ultrasound probes, linear (10
–
15 MHz) and convex (2–5 MHz), was adopted from the
works of Delvi (2011) and NYSORA (2022) regarding
nerve depth and resolution requirements. A systematic
review of manipulation techniques for the transducer
was also conducted, based on data from Mao et al.
(2021), who demonstrated that tilt and rotation angles
significantly affect needle visibility. Image-adjustment
settings, including depth, overall gain, TGC, and dynamic
range,
were
content
analyzed
through
recommendations by Pescatore (2024) and NYSORA
(2022) to sequence controls optimally for clear
visualization of fascial planes. Fourth, an evaluation of
needle-visibility
enhancement
technologies
was
undertaken, including reviews by Chin et al. (2008), Ruíz
et al. (2014), and Hebard & Hocking (2011), as well as
phantom experiments by Johnson et al. (2017), which
demonstrated the advantages of magnetic tracking.
Results and Discussion
Against the backdrop of proven clinical efficacy of
ultrasound
navigation,
it
is
precisely
the
physico
‑
technical parameters of the device that
determine whether the operator will visualize the nerve
and needle as clearly as expected. For most superficial
blocks, when the target structure lies no deeper than
3
cm, a 10
–
15
MHz linear transducer is preferred: at the
upper limit of this range, the lateral resolution reliably
distinguishes the epineurium and small
‑
caliber vessels
(Delvi, 2011). For deeper nerves (> 4
–
5 cm), a 2
–
5 MHz
convex probe is more logical. However, the lower
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frequency reduces detail; it is compensated for by
increased penetration depth and a larger field of view
(NYSORA, 2022). Regardless of the transducer type, the
focal zone should be set 1
–
2 cm deeper than the target.
In this way, the main beam narrowing coincides with the
target zone, thereby increasing nerve/fascial-plane
contrast.
After probe selection, transducer manipulation
techniques play a pivotal role. The four basic
movements
—
slide, tilt, rotate, and fan
—
constitute a
three
‑
dimensional scanning of tissues without changing
the skin contact point. Sliding along the presumed nerve
path helps locate the primary anatomical landmark; a
slight tilt aligns the acoustic beam axis perpendicular to
the structure, increasing returned echoes; rotation
switches the image between transverse and longitudinal
projections;
and
fan
‑
shaped
oscillation,
while
maintaining the same contact point, allows illumination
of the nerve at different depths. Experimental data
indicate that excessive tilt (> 45°) impairs alignment of
the needle with the ultrasound beam and reduces the
success of in
‑
plane punctures. In contrast, moderate
rotation
enhances
nerve
‑
contour
visibility,
as
schematically illustrated in Figure
1 (Mao et al., 2021).
Fig. 1. A schematic drawing of the four insertion views in the phantom study (Mao et al., 2021)
(a) Neutral view, the long axis of ultrasound probe was along the operator’s visual axis and ultrasonic beam was
vertical to the surface of gel phantom; (b) 45°-rotation view, there is a 45° angle between the long axis of probe
and the operator’s visual axis (or sagittal plane); (c) 45°
-tilt view, there is a 45° angle between the ultrasonic beam
and the vertical line (or the surface of gel phantom); (d) 45°-rotation plus 45°-tilt view, there is 45° angle between
the long axis of probe and the operator’s visual axis (or sagittal plane), while there is another 45° angle between
the ultrasonic beam and the vertical line. Yellow dashed line: Vertical/horizontal reference line; Blue solid line:
direction of ultrasonic beam; Green angle: rotation angle; Red angle: tilt angle.
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Even the optimal transducer position will not yield an
informative image without proper
signal‐processing
settings. The imaging depth should be set so that the
nerve lies in the middle or lower third of the screen; in
this configuration, most scanners will automatically
optimize gain and frame rate. The overall gain is
adjusted until the vessels appear hypoechoic, and the
nerve exhibits a uniform gray-white honeycomb texture.
Excessive gain generates noise and blurs the fascial
boundaries. A dynamic range of 60
–80 dB provides a
sufficiently gradated gray scale to distinguish the
epineurium, whereas over
‑
compression of the range
produces a high
‑
contrast but less informative image
(NYSORA, 2022). Console TGC sliders enable the
selective brightening or darkening of deeper layers,
thereby equalizing brightness across the entire tissue
column. This sequential optimization
—
depth
→
overall
gain
→
TGC
→
dynamic range
—
takes mere seconds yet
renders critical details conspicuous (Pescatore, 2024).
Once depth, gain, and dynamic range are optimized, the
primary
challenge
becomes
the
simultaneous
visualization of the needle and the spread of local
anesthetic. The needle acts as a metallic specular
reflector, so its contrast depends on the angle between
its axis and the ultrasound beam; even slight deviation
induces anisotropy, causing the needle to disappear. In
practice, this necessitates continuous adjustment of the
needle trajectory or transducer tilt to maintain
perpendicular insonation of the shaft, preserving
continuous depiction of the tip and minimizing blind
segments of the needle path, as detailed in
needle
‑
visibility reviews for ultrasound guidance (Chin
et al., 2008).
The choice of the puncture plane determines control
over this geometry. With an in
‑
plane approach, the
entire needle shaft is imaged, facilitating tip tracking and
reducing the likelihood of paraneural contact. A
randomized trial of femoral nerve blocks demonstrated
intraneural contact in only 9% of in
‑
plane procedures
versus 64% of out
‑
of
‑
plane procedures (Ruíz et al.,
2014). At the same time, analgesic efficacy and catheter
dwell time did not differ, underscoring that safety is
governed by tip visibility rather than by plane selection
alone.
Hardware innovations can further improve needle
visibility. In a randomized controlled trial, the use of the
Sonoplex echogenic needle increased the median
proportion of needle-tip visibility from 40
–
60% to 80
–
100% of the total needle path, despite a steeper
insertion angle (Hebard & Hocking, 2011). Additional
techniques described in the NYSORA technical guide
include beam-steering (virtual electronic beam tilting)
and speckle-reduction filtering, which all enhance the
signal-to-noise ratio and needle-tissue contrast
(NYSORA, 2022).
Computer‐assisted
technologies
extend
these
capabilities. In a phantom study, passive magnetic
tracking of the needle reduced the mean positioning
error from 3.5 mm to 1.5 mm (
–
57%). It increased the
first-pass success rate from 76% to 89%, with the
optimal insertion angles illustrated in Figure 2 (Johnson
et al., 2017).
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Fig. 2. Photographs of the NGT interface showing the correct needle angle relative to the beam for the IP
approach (Johnson et al., 2017)
(A) and correction based on the NGT solid-to-dotted green lines, indicating that the operator should alter the
needle position relative to the beam. Needle guidance technology can help anesthesiologists recognize common
technique issues that occur when the angle is inadvertently altered by ergonomic issues, operator fatigue, or
inadvertent movement of the transducer (B). A solid green line represents the needle segment in the beam, and
calculated positions of anterior and posterior segments are represented by dotted green lines. The NGT interface
facilitates visualizing the needle position relative to the beam cross-section (A, B: left). The corresponding
appearance of the needle IP and OOP relative to the linear array probe is demonstrated in the diagram (C).
Deep-learning algorithms, according to a scoping
review, can identify anatomical landmarks and needle
contours in real-time, facilitating operator training and
potentially reducing complication rates (Viderman et al.,
2022).
Finally, block success is confirmed by monitoring the
spread of the injectate. Hydrodissection creates a fluid
cushion that visibly expands the fascial plane before
anesthetic administration. A circumferential spread
around the nerve
—
the donut sign
—
correlates with
faster onset and longer block duration (Huang et al.,
2018). Continuous ultrasound monitoring of these
patterns enables the timely adjustment of needle
position or injection volume, transforming the
procedure from semi-intuitive to fully controlled.
Even with accurate ultrasound visualization, block safety
depends on prompt recognition of nerve contact,
excessive injection pressure, and proximity to vessels;
accordingly, triple monitoring
—
combining ultrasound,
nerve stimulation, and pressure sensing
—
is increasingly
utilized. A prospective study demonstrated that this
combination identified 33 potentially hazardous
situations that would have otherwise gone unnoticed
with ultrasound alone, and no postoperative
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neurological complications occurred in any patient
(Pascarella et al., 2021).
Use of the peripheral nerve stimulator remains the
simplest adjunctive test of needle position. In vivo and
phantom experiments have confirmed that a motor
response at ≤ 0.2 mA almost invariably indicates
intraneural tip placement, whereas the absence of
response at ≥ 1 mA reliably excludes intraneural
positioning but does not guarantee optimal perineural
proximity (Bigeleisen et al., 2009). Thus, a low
stimulation threshold has high specificity but low
sensitivity; a negative stimulation test should not
replace visual control, while a positive response
warrants adjustment of the trajectory.
The second component
—
manometric monitoring
—
has
likewise been validated. Animal and clinical studies
demonstrate that injection pressure above 15
–20 psi
correlates reliably with needle placement inside a nerve
trunk or root (Rambhia & Gadsden, 2019). In human
observat
ions, when the needle tip was more than 1 mm
from a brachial plexus root, initial pressures remained
below 15 psi, whereas intentional subepineurial
positioning consistently raised pressures to 30 psi or
more (Smith et al., 2021). Simple disposable pressure-
indicator manometers, connected between the syringe
and extension tubing as shown in Figure 3, do not
encumber the operator’s hand and provide an
immediate visual alert when thresholds are exceeded,
which is especially valuable during training.
Fig. 3. Assembly of equipment (Smith et al., 2021)
Third line of defense — Doppler modes. Color or power
Doppler is engaged before puncture to distinguish small
vessels, which often course through neurofascial
bundles. In healthy volunteers, their presence in the
brachial plexus region reaches 86
–
90% (Hahn & Nagdev,
2014). A meta-analysis of 13 randomized studies
demonstrated that adding ultrasound guidance, which
included routine Doppler screening, reduces the risk of
vascular puncture nearly sixfold (RR 0.16; 95% CI 0.05
–
0.47) compared with nerve stimulation alone (Abrahams
et al., 2009). Continuous monitoring of the color map
during anesthetic injection helps to promptly detect
turbulent flickering of the jet in the event of inadvertent
intravascular needle placement and to cease the
injection before the development of LAST.
Collectively, these three complementary signals — the
visual image, the electrical response, and pressure
dynamics — form a multilevel error
‑
warning system. It
adds virtually no time to the procedure but significantly
reduces the likelihood of intraneural injection,
hematoma, and systemic local anesthetic toxicity,
making it a rational safety standard for most peripheral
blocks.
When applying the principles of triple monitoring to
specific clinical situations, the operator must remember
that each block has its own sonoanatomy and imaging
characteristics. It is precisely the combination of proper
transducer selection, probe
‑
manipulation techniques,
and accurate interpretation of the spread pattern of the
solution that determines whether the on
‑
screen image
will translate into a reliable analgesic effect.
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In the supraclavicular block of the brachial plexus, a
high
‑
frequency linear transducer is used, positioned
parallel to the clavicle to simultaneously visualize the
subclavian artery, the contour of the first rib, and the
cluster of nerve trunks. After a small hydrodissection,
the needle is advanced into the lateral pocket adjacent
to the artery; uniform encirclement of the bundle by the
solution indicates correct positioning and minimizes the
risk of pneumothorax.
For the transverse abdominis plane block, the probe is
placed along the mid
‑
axillary line, sequentially revealing
the external and internal oblique muscles, behind which
the thin fascial layer of the transversus abdominis is
identified. Injection into this layer produces a linear
echo signal between the fasciae, extending cranially and
caudally over a significant distance, providing reliable
analgesia after abdominal interventions.
The erector spinae plane block in the region of the spinal
extensors is performed with a low
‑
frequency convex
probe, guided by the transverse
‑
process shadow and
the bright fascial plane superficial to the muscles. After
tissue separation with solution, it distributes
longitudinally
in
both
directions,
ensuring
multisegmental
analgesia
during
thoracic
and
abdominal surgeries.
For the sciatic block via the infrapiriformis approach, the
probe is positioned between the sciatic notch and the
greater trochanter, requiring deep visualization and
continuous monitoring of the gluteal vessels. The
popliteal variant, by contrast, is performed with a
high
‑
frequency linear transducer. At the level of the
nerve bifurcation, the needle is advanced in the
longitudinal plane, and a ring
‑
like spread of the solution
around both branches is confirmed. This approach
increases the likelihood of a complete sensorimotor
block and significantly reduces the risk of vascular
puncture.
Although the general principles of imaging and pressure
monitoring are universal, nuances — from the
choice of
imaging plane to the volume of injectate and the desired
echo pattern — vary among different blocks. The ability
to recognize these subtle differences transforms the
ultrasound image from a static picture into a predictable
clinical outcome.
Thus, the successful performance of peripheral regional
blocks largely depends on the harmonious combination
of three key components: correct selection and
adjustment of the ultrasound transducer, refined
probe
‑
manipulation technique, and use of adjunct
monitoring tools (nerve stimulator and manometry).
Minimization of anisotropy during needle visualization,
along with optimization of depth, gain, and dynamic
range, ensures a clear depiction of the nerve and fascial
planes. Additionally, triple monitoring reliably detects
potentially dangerous situations. The interplay of
modern technologies — from echogenic needles and
beam steering to machine
‑
learning algorithms and
magnetic tracking
—
allows the procedure to be
transformed from semi
‑
intuitive to strictly controlled,
increasing the efficacy and safety of blocks. Below, we
discuss practical recommendations and algorithms for
selecting the optimal technique in specific clinical
scenarios.
Conclusion
This review highlights the key role of the physico-
technical parameters of ultrasound systems and the
mastered probe manipulation techniques in achieving
optimal visualization of peripheral nerves and the
needle. Adjusting the frequency and geometry of the
transducer according to the depth of the nerve trunk
ensures a balance between resolution and penetration.
Precise tuning of depth, overall gain, TGC, and dynamic
range allows for clear delineation of delicate anatomical
structures and fascial boundaries. At the same time, a
streamlined sequence of image optimization occupies
minimal time and significantly enhances the
informativeness of the scan.
Mastery of basic movements — sliding, tilting, rotation,
and
fan
‑
like
rocking
—
creates
a
volumetric
three
‑
dimensional representation of the anatomy
without the need to change the contact point. The
correct selection of the puncture plane (in-plane vs. out-
of-plane) and the use of echogenic needles further
augment the operator
’
s capabilities, minimizing blind
spots and improving needle-tip tracking. The
incorporation of beam steering and other software
filters additionally enhances needle
–
tissue contrast and
reduces the impact of anisotropy.
Particular attention is given to the multilevel safety
system — triple
monitoring,
which
integrates
ultrasound imaging, nerve stimulation, and manometric
pressure control. This combination enables the timely
detection of dangerous situations related to paraneural
or intravascular needle placement, significantly reducing
the risk of complications (intraneural injections,
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hematomas, LAST) without prolonging procedure time.
Finally, the integration of computer technologies —
from passive magnetic tracking to deep
‑
learning
algorithms
—
opens prospects for further improving
accuracy and operator training. These developments are
capable of automating the recognition of anatomical
landmarks and needle trajectory, which in the future will
render the procedure even more controllable and safe.
In summary, the successful execution of peripheral
regional blocks today is determined by the harmonious
integration of ultrasound equipment selection and
settings, refined scanning techniques, and modern
monitoring
tools.
Further
development
and
implementation of innovative technologies promise
even greater improvements in the efficacy and safety of
the method, reinforcing its status as an indispensable
tool of modern regional anesthesia.
References
1.
Abrahams, M. S., Aziz, M. F., & Fu, R. F. (2009).
Ultrasound guidance compared with electrical
neurostimulation for peripheral nerve block: a
systematic review and meta-analysis of randomized
controlled trials.
British Journal of Anaesthesia
,
102
(3),
408
–
417.
https://doi.org/10.1093/bja/aen384
2.
Bigeleisen, Paul E., Moayeri, N., & Groen, Gerbrand
J. (2009). Extraneural versus Intraneural Stimulation
Thresholds
during
Ultrasound-guided
Supraclavicular Block.
Anesthesiology
,
110
(6), 1235
–
1243.
https://doi.org/10.1097/aln.0b013e3181a59891
3.
Chin, K., Perlas, A., Chan, V., & Brull, R. (2008).
Needle Visualization in Ultrasound-Guided Regional
Anesthesia: Challenges and Solutions.
Regional
Anesthesia and Pain Medicine
,
33
(6), 532
–
544.
https://edus.ucsf.edu/sites/edus.ucsf.edu/files/wys
iwyg/Needle%20Visualization%20in%20US%20Guid
ed%20Nerve%20Blocks.2008.%20%20.pdf
4.
Delvi, M. (2011). Ultrasound-guided peripheral and
truncal blocks in pediatric patients.
Saudi Journal of
Anaesthesia
,
5
(2),
208.
https://doi.org/10.4103/1658-354x.82805
5.
Grange, L., Foster, P. A., & Pretorius, L. K. (1978).
Application Of The Doppler Ultrasound Bloodflow
Detector In Supraclavicular Brachial Plexus Block.
British Journal of Anaesthesia
,
50
(9), 965
–
967.
https://doi.org/10.1093/bja/50.9.965
6.
Hahn, C., & Nagdev, A. (2014). Color Doppler
Ultrasound-guided Supraclavicular Brachial Plexus
Block to Prevent Vascular Injection.
Western Journal
of
Emergency
Medicine
,
15
(6).
https://doi.org/10.5811/westjem.2014.5.21716
7.
Hebard, S., & Hocking, G. (2011). Echogenic
Technology Can Improve Needle Visibility During
Ultrasound-Guided Regional Anesthesia.
Regional
Anesthesia and Pain Medicine
,
36
(2), 185
–
189.
https://doi.org/10.1097/aap.0b013e31820d4349
8.
Huang, J., Li, J., & Wang, H. (2018). The Principles
and Procedures of Ultrasound-guided Anesthesia
Techniques.
Cureus
https://doi.org/10.7759/cureus.2980
9.
Johnson, A. N., Peiffer, J. S., Halmann, N., Delaney,
L., Owen, C. A., & Hersh, J. (2017). Ultrasound-
Guided Needle Technique Accuracy.
Regional
Anesthesia and Pain Medicine
,
42
(2), 223
–
232.
https://doi.org/10.1097/aap.0000000000000549
10.
Lewis, S. R., Price, A., Walker, K. J., McGrattan, K., &
Smith, A. F. (2015). Ultrasound guidance for upper
and lower limb blocks.
Cochrane Database of
Systematic
Reviews
https://doi.org/10.1002/14651858.cd006459.pub3
11.
Mao, Q., He, H., Lu, Y., Hu, Y., Wang, Z., Gan, M., Yan,
H., & Chen, L. (2021). Ultrasound probe tilt impedes
the needle-beam alignment during the ultrasound-
guided procedures.
Scientific Reports
,
11
(1).
https://doi.org/10.1038/s41598-021-81354-w
12.
NYSORA. (2022, May 13).
Ultrasound Technical
Aspects: How to Improve Needle Visibility
. NYSORA.
13.
Orebaugh, S. L. (2018, September 17).
Introduction
to
Ultrasound-Guided
Regional
Anesthesia
.
https://www.nysora.com/topics/equipment/introd
uction-ultrasound-guided-regional-anesthesia/
14.
Pascarella, G., Strumia, A., Costa, F., Rizzo, S., Del
Buono, R., Remore, L. M., Bruno, F., & Agrò, F. E.
(2021). Triple Monitoring May Avoid Intraneural
Injection during Interscalene Brachial Plexus Block
for Arthroscopic Shoulder Surgery: A Prospective
Preliminary Study.
Journal of Clinical Medicine
,
The American Journal of Medical Sciences and Pharmaceutical Research
43
https://www.theamericanjournals.com/index.php/tajmspr
The American Journal of Medical Sciences and Pharmaceutical Research
10
(4), 781.
https://doi.org/10.3390/jcm10040781
15.
Pescatore, R. (2024, October).
How To Do an
Ultrasound-Guided Peripheral Nerve Block
. Merck
Manual
Professional
Edition.
16.
Rambhia, M., & Gadsden, J. (2019). Pressure
monitoring: The evidence so far.
Best Practice &
Research Clinical Anaesthesiology
,
33
(1), 47
–
56.
https://doi.org/10.1016/j.bpa.2019.03.001
17.
Ruíz, Á., Sala‐Blanch, X., & Martínez
-Ocón, J. (2014).
Incidence of intraneural needle insertion in
ultrasound-guided
femoral
nerve
block:
A
comparison between the out-of-plane versus the in-
plane
approaches.
PubMed
,
61
(2),
73
–
https://doi.org/10.1016/j.redar.2013.09.023
18.
Smith, R. L., West, S. J., & Wilson, J. (2021). Using the
BBraun BSmartTM Pressure Manometer to Prevent
Unsafe Injection Pressures During Simulated
Peripheral Nerve Blockade: A Pilot Study.
The Open
Anesthesiology
Journal
,
15
(1),
49
–
58.
https://doi.org/10.2174/2589645802115010049
19.
Viderman, D., Dossov, M., Seitenov, S., & Lee, M.-H.
(2022). Artificial intelligence in ultrasound-guided
regional anesthesia: A scoping review.
Frontiers in
Medicine
,
9
https://doi.org/10.3389/fmed.2022.994805
