Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Sep 11;2015(9):CD006459.
doi: 10.1002/14651858.CD006459.pub3.

Ultrasound guidance for upper and lower limb blocks

Sharon R Lewis  1 , Anastasia Price, Kevin J Walker, Ken McGrattan, Andrew F Smith
Affiliations
Meta-Analysis

Ultrasound guidance for upper and lower limb blocks

Sharon R Lewis et al. Cochrane Database Syst Rev. .

Abstract

Background: Peripheral nerve blocks can be performed using ultrasound guidance. It is not yet clear whether this method of nerve location has benefits over other existing methods. This review was originally published in 2009 and was updated in 2014.

Objectives: The objective of this review was to assess whether the use of ultrasound to guide peripheral nerve blockade has any advantages over other methods of peripheral nerve location. Specifically, we have asked whether the use of ultrasound guidance:1. improves success rates and effectiveness of regional anaesthetic blocks, by increasing the number of blocks that are assessed as adequate2. reduces the complications, such as cardiorespiratory arrest, pneumothorax or vascular puncture, associated with the performance of regional anaesthetic blocks

Search methods: In the 2014 update we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 8); MEDLINE (July 2008 to August 2014); EMBASE (July 2008 to August 2014); ISI Web of Science (2008 to April 2013); CINAHL (July 2014); and LILACS (July 2008 to August 2014). We completed forward and backward citation and clinical trials register searches.The original search was to July 2008. We reran the search in May 2015. We have added 11 potential new studies of interest to the list of 'Studies awaiting classification' and will incorporate them into the formal review findings during future review updates.

Selection criteria: We included randomized controlled trials (RCTs) comparing ultrasound-guided peripheral nerve block of the upper and lower limbs, alone or combined, with at least one other method of nerve location. In the 2014 update, we excluded studies that had given general anaesthetic, spinal, epidural or other nerve blocks to all participants, as well as those measuring the minimum effective dose of anaesthetic drug. This resulted in the exclusion of five studies from the original review.

Data collection and analysis: Two authors independently assessed trial quality and extracted data. We used standard Cochrane methodological procedures, including an assessment of risk of bias and degree of practitioner experience for all studies.

Main results: We included 32 RCTs with 2844 adult participants. Twenty-six assessed upper-limb and six assessed lower-limb blocks. Seventeen compared ultrasound with peripheral nerve stimulation (PNS), and nine compared ultrasound combined with nerve stimulation (US + NS) against PNS alone. Two studies compared ultrasound with anatomical landmark technique, one with a transarterial approach, and three were three-arm designs that included US, US + PNS and PNS.There were variations in the quality of evidence, with a lack of detail in many of the studies to judge whether randomization, allocation concealment and blinding of outcome assessors was sufficient. It was not possible to blind practitioners and there was therefore a high risk of performance bias across all studies, leading us to downgrade the evidence for study limitations using GRADE. There was insufficient detail on the experience and expertise of practitioners and whether experience was equivalent between intervention and control.We performed meta-analysis for our main outcomes. We found that ultrasound guidance produces superior peripheral nerve block success rates, with more blocks being assessed as sufficient for surgery following sensory or motor testing (Mantel-Haenszel (M-H) odds ratio (OR), fixed-effect 2.94 (95% confidence interval (CI) 2.14 to 4.04); 1346 participants), and fewer blocks requiring supplementation or conversion to general anaesthetic (M-H OR, fixed-effect 0.28 (95% CI 0.20 to 0.39); 1807 participants) compared with the use of PNS, anatomical landmark techniques or a transarterial approach. We were not concerned by risks of indirectness, imprecision or inconsistency for these outcomes and used GRADE to assess these outcomes as being of moderate quality. Results were similarly advantageous for studies comparing US + PNS with NS alone for the above outcomes (M-H OR, fixed-effect 3.33 (95% CI 2.13 to 5.20); 719 participants, and M-H OR, fixed-effect 0.34 (95% CI 0.21 to 0.56); 712 participants respectively). There were lower incidences of paraesthesia in both the ultrasound comparison groups (M-H OR, fixed-effect 0.42 (95% CI 0.23 to 0.76); 471 participants, and M-H OR, fixed-effect 0.97 (95% CI 0.30 to 3.12); 178 participants respectively) and lower incidences of vascular puncture in both groups (M-H OR, fixed-effect 0.19 (95% CI 0.07 to 0.57); 387 participants, and M-H OR, fixed-effect 0.22 (95% CI 0.05 to 0.90); 143 participants). There were fewer studies for these outcomes and we therefore downgraded both for imprecision and paraesthesia for potential publication bias. This gave an overall GRADE assessment of very low and low for these two outcomes respectively. Our analysis showed that it took less time to perform nerve blocks in the ultrasound group (mean difference (MD), IV, fixed-effect -1.06 (95% CI -1.41 to -0.72); 690 participants) but more time to perform the block when ultrasound was combined with a PNS technique (MD, IV, fixed-effect 0.76 (95% CI 0.55 to 0.98); 587 participants). With high levels of unexplained statistical heterogeneity, we graded this outcome as very low quality. We did not combine data for other outcomes as study results had been reported using differing scales or with a combination of mean and median data, but our interpretation of individual study data favoured ultrasound for a reduction in other minor complications and reduction in onset time of block and number of attempts to perform block.

Authors' conclusions: There is evidence that peripheral nerve blocks performed by ultrasound guidance alone, or in combination with PNS, are superior in terms of improved sensory and motor block, reduced need for supplementation and fewer minor complications reported. Using ultrasound alone shortens performance time when compared with nerve stimulation, but when used in combination with PNS it increases performance time.We were unable to determine whether these findings reflect the use of ultrasound in experienced hands and it was beyond the scope of this review to consider the learning curve associated with peripheral nerve blocks by ultrasound technique compared with other methods.

PubMed Disclaimer

Conflict of interest statement

Sharon R Lewis: none known

Anastasia Price: deceased; no declarations of interest available

Kevin J Walker: none known

Ken McGrattan: none known

Andrew F Smith: none known

Figures

1
1
Study flow diagram.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
4
4
Funnel plot of comparison: 1 Ultrasound technique versus other technique, outcome: 1.1 Predicted adequacy of block.
1.1
1.1. Analysis
Comparison 1 Ultrasound technique versus other technique, Outcome 1 Predicted adequacy of block.
1.2
1.2. Analysis
Comparison 1 Ultrasound technique versus other technique, Outcome 2 Supplementation of block.
1.3
1.3. Analysis
Comparison 1 Ultrasound technique versus other technique, Outcome 3 Time to perform block.
1.4
1.4. Analysis
Comparison 1 Ultrasound technique versus other technique, Outcome 4 Paraesthesia.
1.5
1.5. Analysis
Comparison 1 Ultrasound technique versus other technique, Outcome 5 Vascular puncture.
2.1
2.1. Analysis
Comparison 2 Ultrasound with nerve stimulation versus nerve stimulation, Outcome 1 Predicted adequacy of block.
2.2
2.2. Analysis
Comparison 2 Ultrasound with nerve stimulation versus nerve stimulation, Outcome 2 Supplementation of block.
2.3
2.3. Analysis
Comparison 2 Ultrasound with nerve stimulation versus nerve stimulation, Outcome 3 Time to perform block.
2.4
2.4. Analysis
Comparison 2 Ultrasound with nerve stimulation versus nerve stimulation, Outcome 4 Paraesthesia.
2.5
2.5. Analysis
Comparison 2 Ultrasound with nerve stimulation versus nerve stimulation, Outcome 5 Vascular puncture.
3.1
3.1. Analysis
Comparison 3 Time to perform block by subgroups US vs other, Outcome 1 By type of intervention/comparison.
3.2
3.2. Analysis
Comparison 3 Time to perform block by subgroups US vs other, Outcome 2 By type of nerve block/approach.
4.1
4.1. Analysis
Comparison 4 Time to perform block by subgroups US + PNS vs PNS, Outcome 1 By type of nerve block/approach.
4.2
4.2. Analysis
Comparison 4 Time to perform block by subgroups US + PNS vs PNS, Outcome 2 By catheter/no catheter placement.
5.1
5.1. Analysis
Comparison 5 Paraesthesia by subgroups, Outcome 1 By type of intervention/comparison.
5.2
5.2. Analysis
Comparison 5 Paraesthesia by subgroups, Outcome 2 By type of nerve block/approach.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bloc 2010 {published data only}
    1. Bloc S, Mercadal L, Garnier T, Komly B, Leclerc P, Morel B, et al. Comfort of the patient during axillary blocks placement: A randomized comparison of the neurostimulation and the ultrasound guidance techniques. European Journal of Anaesthesiology 2010;27(7):628‐33. [EMBASE: 2010346101] - PubMed
Brull 2009 {published data only}
    1. Brull R, Lupu M, Perlas A, Chan VW, McCartney CJ. Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance. Canadian Journal of Anaesthesia 2009;56(11):812‐8. [CENTRAL: CN‐00727909] - PubMed
Casati 2007a {published data only}
    1. Casati A, Danelli G, Baciarello M, Corradi M, Leone S, Cianni S, et al. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology 2007;106(5):992‐6. [PUBMED: 17457131] - PubMed
Cataldo 2012 {published data only}
    1. Cataldo R, Carassiti M, Costa F, Martuscelli M, Benedetto M, Cancilleri F, et al. Starting with ultrasonography decreases popliteal block performance time in inexperienced hands: A prospective randomized study. BMC Anesthesiology 2012;12:33. [EMBASE: 2013011260] - PMC - PubMed
Chan 2007 {published data only}
    1. Chan V, Perlas A, McCartney C, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Canadian Journal of Anaesthesia 2007;54(3):176‐82. [PUBMED: 17331928] - PubMed
Conceição 2009 {published data only}
    1. Conceição DB, Helayel PE, Oliveira Filho GR. [A comparative study between ultrasound and neurostimulation guided axillary brachial plexus block]. Revista Brasileira de Anestesiologia 2009;59(5):585‐91. [CENTRAL: CN‐00731129] - PubMed
Danelli 2012 {published data only}
    1. Danelli G, Bonarelli S, Togn A, Ghisi D, Fanelli A, Biondini S, et al. Prospective randomized comparison of ultrasound‐guided and neurostimulation techniques for continuous interscalene brachial plexus block in patients undergoing coracoacromial ligament repair. British Journal of Anaesthesia 2012;108(6):1006‐10. [EMBASE: 2012297232] - PubMed
Dhir 2008 {published data only (unpublished sought but not used)}
    1. Dhir S, Ganapathy S. Comparative evaluation of ultrasound‐guided continuous infraclavicular brachial plexus block with stimulating catheter and traditional technique: a prospective randomized trial. Acta Anaesthesiologica Scandinavica 2008;52(8):1158‐66. [PUBMED: 18840118] - PubMed
Domingo‐Triado 2007 {published data only}
    1. Domingo‐Triado V, Selfa S, Martinez F, Sanchez‐Contreras D, Reche M, Tecles J, et al. Ultrasound guidance for lateral midfemoral sciatic nerve block: a prospective comparative randomized study. Anesthesia and Analgesia 2007;104(5):1270‐4. [PUBMED: 17456685] - PubMed
Dufour 2008 {published data only}
    1. Dufour E, Quennesson P, Robais A L, Ledon F, Laloe P A, Liu N, et al. Combined ultrasound and neurostimulation guidance for popliteal sciatic nerve block: a prospective, randomized comparison with neurostimulation alone. Anesthesia and Analgesia 2008;106(5):1553‐8. [PUBMED: 18420875] - PubMed
Geiser 2011 {published data only}
    1. Geiser T, Lang D, Neuburger M, Ott B, Augat P, Buttner J. Perivascular brachial plexus block: Ultrasound versus nerve stimulator. [German]. Der Anaesthesist 2011;60(7):617‐24. [EMBASE: 2011416604] - PubMed
Gurkan 2008 {published data only}
    1. Gurkan Y, Acar S, Solak M, Toker K. Comparison of nerve stimulation vs. ultrasound‐guided lateral sagittal infraclavicular block. Acta Anaesthesiologica Scandinavica 2008;52(6):851‐5. [EMBASE: 2008287554] - PubMed
Kapral 2008 {published data only}
    1. Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Regional Anesthesia and Pain Medicine 2008;33(3):253‐8. [PUBMED: 18433677 ] - PubMed
Liu 2005 {published data only}
    1. Liu F, Liou J, Tsai, Li A, Day Y, Hui Y, et al. Efficacy of ultrasound‐guided axillary brachial plexus block: a comparative study with nerve stimulator‐guided method. Chang Gung Medical Journal 2005;28:396‐402. [MEDLINE: ] - PubMed
Liu 2009a {published data only}
    1. Liu SS, Zayas VM, Gordon MA, Beathe JC, Maalouf DB, Paroli L, et al. A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesthesia and Analgesia 2009;109(1):265‐71. [PUBMED: 19535720] - PubMed
Macaire 2008 {published data only}
    1. Macaire P, Singelyn F, Narchi P, Paqueron X. Ultrasound‐ or nerve stimulation‐ guided wrist blocks for carpal tunnel release: a randomized prospective comparative study. Regional Anesthesia and Pain Medicine 2008;33(4):363‐8. [MEDLINE: ] - PubMed
Meierhofer 2014 {published data only}
    1. Meierhofer JT, Anetseder M, Roewer N, Wunder C, Schwemmer U. Guidance of axillary multiple injection technique for plexus anesthesia. Ultrasound versus nerve stimulation. [German]. Der Anaesthesist 2014;63(7):568‐73. [EMBASE: 2014499331] - PubMed
Morros 2009 {published data only}
    1. Morros C, Perez‐Cuenca MD, Sala‐Blanch X, Cedo F. Contribution of ultrasound guidance to the performance of the axillary brachial plexus block with multiple nerve stimulation. [Spanish]. Revista Espanola de Anestesiologia y Reanimacion 2009;56(2):69‐74. [PUBMED: 19334654] - PubMed
Perlas 2008 {published data only}
    1. Perlas A, Brull R, Chan V W, McCartney C J, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Regional Anesthesia and Pain Medicine 2008;33(3):259‐65. [PUBMED: 18433678 ] - PubMed
Renes 2009 {published data only}
    1. Renes SH, Spoormans HH, Gielen MJ, Rettig HC, Geffen GJ. Hemidiaphragmatic paresis can be avoided in ultrasound‐guided supraclavicular brachial plexus block. Regional Anesthesia and Pain Medicine 2009;34(6):595‐9. [CENTRAL: CN‐00732118] - PubMed
Salem 2012 {published data only}
    1. Salem MH, Winckelmann J, Geiger P, Mehrkens HH, Salem KH. Electrostimulation with or without ultrasound‐guidance in interscalene brachial plexus block for shoulder surgery. Journal of Anesthesia 2012;26(4):610‐3. [EMBASE: 2012629376] - PubMed
Sauter 2008 {published data only}
    1. Sauter AR, Dodgson MS, Stubhaug A, Halstensen AM, Klaastad O. Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer‐blinded, comparative study. Anesthesia and Analgesia 2008;106(6):1910‐5. [PUBMED: 18499631 ] - PubMed
Seidel 2013 {published data only}
    1. Seidel R, Natge U, Schulz J. [Distal sciatic nerve blocks : Randomized comparison of nerve stimulation and ultrasound guided intraepineural block]. Der Anaesthesist 2013;62(3):183‐92. [PUBMED: 23494021] - PubMed
Shrestha 2011 {published data only}
    1. Shrestha BR. Nerve stimulation under ultrasound guidance expedites onset of axillary brachial plexus block. Journal of Nepal Health Research Council 2011;9(2):145‐9. [PUBMED: 22929843] - PubMed
Sites 2006 {published data only}
    1. Sites B, Beach M, Spence B, Wiley C, Shiffrin J, Hartman G, et al. Ultrasound guidance improves the success rate of a perivascular axillary plexus block. Acta Anaesthesiologica Scandinavica 2006;50(6):678‐84. [PUBMED: 16987361] - PubMed
Soeding 2005 {published data only}
    1. Soeding P, Sha S, Royse C, Marks P, Hoy G, Royse A. A randomized trial of ultrasound‐guided brachial plexus anaesthesia in upper limb surgery. Anaesthesia and Intensive Care 2005;33(6):719‐25. [PUBMED: 16398375] - PubMed
Strub 2011 {published data only}
    1. Strub B, Sonderegger J, Campe A, Grunert J, Osterwalder JJ. What benefits does ultrasound‐guided axillary block for brachial plexus anaesthesia offer over the conventional blind approach in hand surgery?. Journal of Hand Surgery: European Volume 2011;36(9):778‐86. [21750097] - PubMed
Taboada 2009 {published data only}
    1. Taboada M, Rodriguez J, Amor M, Sabate S, Alvarez J, Cortes J, et al. Ultrasound guidance superior to conventional nerve stimulation for coracoid infraclavicular brachial plexus block?. Regional Anesthesia and Pain Medicine 2009;34(4):357‐60. [EMBASE: 2009549811] - PubMed
Trabelsi 2013 {published data only}
    1. Trabelsi W, Amor MB, Lebbi MA, Romdhani C, Dhahri S, Ferjani M. Ultrasound does not shorten the duration of procedure but provides a faster sensory and motor block onset in comparison to nerve stimulator in infraclavicular brachial plexus block. Korean Journal of Anesthesiology 2013;64(4):327‐33. [EMBASE: 2013286698] - PMC - PubMed
Van Geffen 2009 {published data only}
    1. Geffen GJ, Broek E, Braak GJ, Giele JL, Gielen MJ, Scheffer GJ. A prospective randomised controlled trial of ultrasound guided versus nerve stimulation guided distal sciatic nerve block at the popliteal fossa. Anaesthesia and Intensive Care 2009;37(1):32‐7. [EMBASE: 2009069819] - PubMed
Williams 2003 {published data only}
    1. Williams S, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesthesia and Analgesia 2003;97(5):1518‐23. [PUBMED: 14570678] - PubMed
Zaragoza‐Lemus 2012 {published data only}
    1. Zaragoza‐Lemus G, Leal‐Gudino L, Chavez‐Heres T, Pena‐Riveron A, Torres‐Maldonado AS. Interscalene cervical block or extremidad superior subsequent surgery: comparative study of ultrasound vs. neurostimulation. Revista Mexicana de Anestesiologia 2012;35(2):107‐14. [EMBASE: 2012497884]

References to studies excluded from this review

Aveline 2010 {published data only}
    1. Aveline C, Roux A, Hetet H, Vautier P, Cognet F, Bonnet F. Postoperative efficacies of femoral nerve catheters sited using ultrasound combined with neurostimulation compared with neurostimulation alone for total knee arthroplasty. European Journal of Anaesthesiology 2010;27(11):978‐84. [EMBASE: 2010624841] - PubMed
Casati 2007b {published data only}
    1. Casati A, Baciarello M, Cianni S, Danelli G, Marco G, Leone S, et al. Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve. British Journal of Anaesthesia 2007;98(6):823‐7. [MEDLINE: ] - PubMed
Danelli 2009a {published data only}
    1. Danelli G, Fanelli A, Ghisi D, Moschini E, Rossi M, Ortu A, et al. Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve block. Anaesthesia 2009;64(6):638‐42. [MEDLINE: ] - PubMed
Danelli 2009b {published data only}
    1. Danelli G, Ghisi D, Fanelli A, Ortu A, Moschini E, Berti M, et al. The effects of ultrasound guidance and neurostimulation on the minimum effective anesthetic volume of mepivacaine 1.5% required to block the sciatic nerve using the subgluteal approach. Anesthesia and Analgesia 2009;109(5):1674‐8. [PUBMED: 19843807] - PubMed
Demirci 2013 {published data only}
    1. Demirci A, Efe EM, Türker G, Gurbet A, Kaya FN, Anil A, et al. Iliohypogastric/ilioinguinal nerve block in the inguinal hernia repair for postoperative pain management: Comparison of the anatomical landmark and ultrasound guided techniques. Regional Anesthesia and Pain Medicine 2013;38(Suppl 1):E150. [71366546] - PubMed
Dolan 2008 {published data only}
    1. Dolan J, Williams A, Murney E, Smith M, Kenny G. Ultrasound guided fascia iliaca block: a comparison with the loss of resistance technique. Regional Anaesthesia and Pain Medicine 2008;33(6):526‐31. [EMBASE: 2008499403] - PubMed
Ko 2013 {published data only}
    1. Ko SH, Kang BS, Hwang CH. Ultrasonography‐ or electrophysiology‐guided suprascapular nerve block in arthroscopic acromioplasty: a prospective, double‐blind, parallel‐group, randomized controlled study of efficacy. Arthroscopy ‐ Journal of Arthroscopic and Related Surgery 2013;29(5):794‐801. [EMBASE: 2013275908] - PubMed
Li 2011 {published data only}
    1. Li M, Xu T, Han WY, Wang XD, Jia DL, Guo XY. Use of ultrasound to facilitate femoral nerve block with stimulating catheter. Chinese Medical Journal 2011;124(4):519‐24. [EMBASE: 2011104114] - PubMed
Maalouf 2012 {published data only}
    1. Maalouf D, Liu SS, Movahedi R, Goytizolo E, Memstoudis SG, Yadeau JT, et al. Nerve stimulator versus ultrasound guidance for placement of popliteal catheters for foot and ankle surgery. Journal of Clinical Anesthesia 2012;24(1):44‐50. [EMBASE: 2012061455] - PubMed
Maldini 2010 {published data only}
    1. Maldini B, Zdravcevic KS, Adam VN, Goranovic T, Zdencar D, Baranovic S. A comparative study between ultrasound versus neurostimulation guided sciatic nerve block in the popliteal fossa. Regional Anesthesia and Pain Medicine 2010;35(5):E128. [70287489]
Marhofer 1997 {published and unpublished data}
    1. Marhofer P, Schrögendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N. Ultrasonographic guidance improves sensory block and onset time of three‐in‐one blocks. Anesthesia and Analgesia 1997;85(4):854‐7. [MEDLINE: ] - PubMed
Marhofer 1998 {published and unpublished data}
    1. Marhofer P, Schrögendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonic guidance reduces the amount of local anesthetic for 3‐in‐1 blocks. Regional Anesthesia and Pain Medicine 1998;23(6):584‐8. [MEDLINE: ] - PubMed
Mariano 2009a {published data only}
    1. Mariano ER, Cheng GS, Choy LP, Loland VJ, Bellars RH, Sandhu NS, et al. Electrical stimulation versus ultrasound guidance for popliteal‐sciatic perineural catheter insertion a randomized controlled trial. Regional Anesthesia and Pain Medicine 2009;34(5):480‐5. [EMBASE: 2010049165] - PubMed
Mariano 2009b {published data only}
    1. Mariano ER, Loland VJ, Bellars RH, Sandhu NS, Bishop ML, Abrams RA, et al. Ultrasound guidance versus electrical stimulation for infraclavicular brachial plexus perineural catheter insertion. Journal of Ultrasound in Medicine 2009;28(9):1211‐8. [EMBASE: 2009503137] - PubMed
Mariano 2009c {published data only}
    1. Mariano ER, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Afra R, et al. Ultrasound guidance versus electrical stimulation for femoral perineural catheter insertion. Journal of Ultrasound in Medicine 2009;28(11):1453‐60. [PUBMED: 19854959] - PubMed
Mariano 2010a {published data only}
    1. Mariano ER, Loland VJ, Sandhu NS, Bishop ML, Lee DK, Schwartz AK, et al. Comparative efficacy of ultrasound‐guided and stimulating popliteal‐sciatic perineural catheters for postoperative analgesia. Canadian Journal of Anesthesia 2010;57(10):919‐26. [2010544877] - PMC - PubMed
Mariano 2010b {published data only}
    1. Mariano ER, Loland VJ, Sandhu NS, Bishop ML, Meunier MJ, Afra R, et al. A trainee‐based randomized comparison of stimulating interscalene perineural catheters with a new technique using ultrasound guidance alone. Journal of Ultrasound in Medicine 2010;29(3):329‐36. [20194929] - PubMed
Martinez Navas 2011 {published data only}
    1. Martinez Navas A, Ortiz de la Tabla Gonzalez R, Rodriguez de la Torre R, Davila Arias M, Medina Madrid E, Almeida Gonzalez C, et al. Has ultrasonography contribute with more efficacy and security than nerve stimulation in posterior sciatic nerve block?. Regional Anesthesia and Pain Medicine 2011;36(Suppl 2):E161‐2. [70735638]
McCartney 2008 {published data only}
    1. McCartney CJ, Chan VW, Brull R, Perlas A. A randomized, double‐blind study comparing dual endpoint nerve stimulation with ultrasound‐guided infraclavicular block for hand surgery. British Journal of Anaesthesia 2008;100(4):575P.
McCartney 2009 {published data only}
    1. McCartney CJL, Shastri U, McNaught AF, Carmichael NM, Holtby RM. Does ultrasound reduce the minimum effective anaesthetic volume required for Interscalene brachial plexus block (ISBPB)?. British Journal of Anaesthesia 2009;103(2):323P. [70009412] - PubMed
McNaught 2011 {published data only}
    1. McNaught A, Shastri U, Carmichael N, Awad IT, Columb M, Cheung J, et al. Ultrasound reduces the minimum effective local anaesthetic volume compared with peripheral nerve stimulation for interscalene block. British Journal of Anaesthesia 2011;106(1):124‐30. [PUBMED: 21059701] - PubMed
Nassar 2010 {published data only}
    1. Nassar T, Seet M, Subeh Z, Elqestawy B, Elgendy H. Comparison of ultrasound guided technique with nerve stimulator guided technique for multiple injection axillary block: a prospective randomized trial. Regional Anesthesia and Pain Medicine 2010;35(5):E52. [70287216]
Ponrouch 2010 {published data only}
    1. Ponrouch M, Bouic N, Bringuier S, Biboulet P, Choquet O, Kassim M, et al. Estimation and pharmacodynamic consequences of the minimum effective anesthetic volumes for median and ulnar nerve blocks: a randomized, double‐blind, controlled comparison between ultrasound and nerve stimulation guidance. Anesthesia and Analgesia 2010;111(4):1059‐64. [PUBMED: 20705778] - PubMed
Redborg 2009 {published data only}
    1. Redborg KE, Sites BD, Chinn CD, Gallagher JD, Ball PA, Antonakakis JG, et al. Ultrasound improves the success rate of a sural nerve block at the ankle. Regional Anesthesia and Pain Medicine 2009;34(1):24‐8. [PUBMED: 19258984] - PubMed
Sala‐Blanch 2012 {published data only}
    1. Sala‐Blanch X, Riva N, Carrera A, Lopez AM, Prats A, Hadzic A. Ultrasound‐guided popliteal sciatic block with a single injection at the sciatic division results in faster block onset than the classical nerve stimulator technique. Anesthesia and Analgesia 2012;114(5):1121‐7. [EMBASE: 2012239380] - PubMed
Thomas 2011a {published data only}
    1. Thomas LC, Graham SK, Osteen KD, Porter HS, Nossaman BD. Comparison of ultrasound and nerve stimulation techniques for interscalene brachial plexus block for shoulder surgery in a residency training environment: a randomized, controlled, observer‐blinded trial.[Erratum appears in Ochsner J. 2012 Spring;12(1):86]. Ochsner Journal 2011;11(3):246‐52. [PUBMED: 21960758] - PMC - PubMed
Thomas 2011b {published data only}
    1. Thomas L, Forth NE, Nossaman B. Randomized study of ultrasound guidance vs. nerve stimulation for popliteal fossa block of the sciatic nerve. Regional Anesthesia and Pain Medicine 2011; Vol. 36, issue 5:Conference abstract.. [CENTRAL: CN‐01033609; DOI: 10.1097/AAP.0b013e318228df0c; EMBASE: 70728202] - DOI
Tognu 2010 {published data only}
    1. Tognu A, Gullotta S, Danelli G, Borghi B, Niebel T, Bonarelli S, et al. Nerve guidance with versus without prepuncture ultrasound visualization for psoas compartment block and perineural catheter insertion: A randomized, prospective, blinded study. European Journal of Pain Supplements 2010; Vol. 4, issue 4:313‐7. [EMBASE: 2010613988]
Tran 2010 {published data only}
    1. Tran DQ, Dugani S, Finlayson RJ. A randomized comparison between ultrasound‐guided and landmark‐based superficial cervical plexus block. Regional Anesthesia and Pain Medicine 2010; Vol. 35, issue 6:539‐43. [EMBASE: 2010608955] - PubMed
Villeneuve 2009 {published data only}
    1. Villeneuve A, Levesque S, Nadeau MJ, Dion NN, Cote D, Nicole PC, et al. Continuous femoral block: nerve stimulation vs US‐guidance. Canadian Journal of Anesthesia 2009;56:S74. [70078748]
Wildy 2009 {published data only}
    1. Wildy J, Cooper P, Gambala G, Osborne L, Spence D, Pellegrini J. Comparison of ultrasound‐guided and peripheral nerve stimulation techniques for axillary brachial plexus anesthesia on success, duration, and complications. AANA Journal 2009;77(5):403. [EMBASE: 2010449890.]
Yi 2012 {published data only}
    1. Yi J, Lin HH, Li SZ. Ultrasound guided sciatic nerve block, in comparison of the neurostimulation during the popliteal sciatic nerve block: a randomized clinical trail. European Journal of Anaesthesiology 2012;29:120. [EMBASE: 71084382]
Zencirci 2011 {published data only}
    1. Zencirci B. Comparision of nerve stimulator and ultrasonography as the techniques applied for brachial plexus anesthesia. International Archives of Medicine 2011;4(1):4. [EMBASE: 2011084628] - PMC - PubMed

References to studies awaiting assessment

Aytac 2015 {published data only}
    1. Aytac S, Atalan G, Gulen G, Yilmaz H. Comparison of femoral nerve block by neurostimulator accompanied with ultrasound and without ultrasound in knee artroplasty. Journal of Clinical and Analytical Medicine 2015;6:208‐11.
Dhir 2013 {published data only}
    1. Dhir S, Ganapathy S. Success rate of perineural infra‐clavicular brachial plexus catheters: Randomized controlled single blind trial comparing peripheral nerve stimulation with ultrasound guided catheter placement. Regional Anesthesia and Pain Medicine 2013;38(4):Conference Abstract. [CENTRAL: CN‐01061661; EMBASE: 71378197]
Eren 2014 {published data only}
    1. Eren G, Altun E, Pektas Y, Polat Y, Cetingok H, Demir G, et al. To what extent can local anesthetics be reduced for infraclavicular block with ultrasound guidance?. Der Anaesthesist 2014;63(10):760‐5. [PUBMED: 25098777] - PubMed
González 1993 {published data only}
    1. González González F, Salas Colín S, Parra Ortíz A, Castañeda Gaxiola R, Mancer Reyes V, Interiano Portillo F, et al. Bloqueo del nervio ciático poplíteo interno mediante su localización con ultrasonido doppler. Revista de Sanidad Militar 1993;47(5):165‐8.
Kumar 2014 {published data only}
    1. Kumar A, Sharma D, Sibi ME, Datta B, Gogoi B. Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique. Indian Journal of Anaesthesia 2014;58(6):700‐4. [PUBMED: 25624532] - PMC - PubMed
Lam 2014 {published data only}
    1. Lam NC, Petersen TR, Gerstein NS, Yen T, Starr B, Mariano ER. A randomized clinical trial comparing the effectiveness of ultrasound guidance versus nerve stimulation for lateral popliteal‐sciatic nerve blocks in obese patients. Journal of Ultrasound in Medicine 2014;33(6):1057‐63. [PUBMED: 24866613] - PubMed
Li 2013 {published data only}
    1. Li T, Ye XH, Nan Y, Shi T, Ye QG, Ma JF, et al. Comparison of ultrasound and nerve stimulation techniques for brachial plexus block for regional hemodynamic changes of upper extremity. [Chinese]. National Medical Journal of China 2013;93(3):187‐90. [EMBASE: 2013127999] - PubMed
Martinez Navas 2014 {published data only}
    1. Martinez Navas A, Echevarria Moreno M, Rodriguez de la Torre R, Davila Arias ML, Cuellar Obispo E. Sciatic nerve block: Is ultrasonography better than nerve stimulation?. 33rd Annual European Society of Regional Anaesthesia and Pain Therapy, ESRA Congress 2014 Seville Spain. Conference Start: 20140903 Conference End: 20140906. 2014; Vol. 39:e241.
Smith 2014 {published data only}
    1. Smith A, Kumara P, Ismail K, Elland E. A comparison of the duration of brachial plexus block between ultrasound guided and nerve stimulator techniques in elective shoulder surgery. 33rd Annual European Society of Regional Anaesthesia and Pain Therapy, ESRA Congress 2014 Seville Spain. Conference Start: 20140903 Conference End: 20140906. 2014; Vol. 39:e259.
Stavrati 2014 {published data only}
    1. Stavrati M, Vogiatzaki T, Chloropoulou P, Terleme E, Christofis C, Iatrou C. Comparing onset times and vascular punctures in axillary blocks with nerve stimulation or ultrasound: a randomised controlled trial. European Anaesthesiology Congress, EUROANAESTHESIA 2014 Stockholm Sweden. Conference Start: 20140531 Conference End: 20140603. 2014; Vol. 31:131.

References to ongoing studies

NCT 00213954 {published data only}
    1. Ultrasound guidance in nerve block anaesthesia. Ongoing study May 2005.
NCT 009956683 {published data only}
    1. Dual endpoint nerve stimulation versus ultrasound in infraclavicular block for hand surgery. Ongoing study July 2009.
NCT 01010412 {published data only}
    1. Ultrasound visualization versus electrical nerve stimulation. Ongoing study February 2009.
NCT02020096 {published data only}
    1. Ultrasound plus nerve stimulator versus nerve stimulator guided lumbar plexus block. Ongoing study 28 November 2013.

Additional references

Auroy 1997
    1. Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 1997;87(3):479‐86. [MEDLINE: ] - PubMed
Auroy 2002
    1. Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier F, et al. Major complications of regional anesthesia in France: the SOS Regional Anesthesia Hotline Service. Anesthesiology 2002;97(5):1274‐80. [MEDLINE: ] - PubMed
Chan 2003
    1. Chan VW, Perlas A, Rawson R, Odukoya O. Ultrasound‐guided supraclavicular brachial plexus block. Anesthesia and Analgesia 2003;97(5):1514‐7. [MEDLINE: ] - PubMed
Chan 2006
    1. Chan VS, Nova H, Abbas S, McCartney CL, Perlas A, Xu D. Ultrasound examination and localization of the sciatic nerve: a volunteer study. Anesthesiology 2006;104(2):309‐14. [MEDLINE: ] - PubMed
Denny 2005
    1. Denny NM, Harrop‐Griffiths W. Location, location, location! Ultrasound imaging in regional anaesthesia. British Journal of Anaesthesia 2005;94(1):1‐3. [MEDLINE: ] - PubMed
Freitas 2007
    1. Freitas NM, Semedo E, Marques A, Orfao R, Nunes JM. Patients preferences concerning ultrasound guided regional anesthesia. Regional Anesthesia and Pain Medicine 2007;32:99.
Gelfand 2010
    1. Gelfand H, Lesley M, Ko P, Eng C, Wu C. An updated meta‐analysis of ultrasound‐guided nerve blocks. Regional Anesthesia and Pain Medicine. 35th Annual Regional Anesthesia Meeting and Workshops, ASRA 2010 Toronto, ON Canada. Conference Start: 20100422 Conference End: 20100425. 2010; Vol. 35 (5):var. pagings. [70736136]
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org. The Cochrane Collaboration, 2011..
Kapral 1994
    1. Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound‐guided supraclavicular approachfor regional anesthesia of the brachial plexus. Anesthesia and Analgesia 1994;78(3):507‐13. [MEDLINE: ] - PubMed
Kirchmair 2001
    1. Kirchmair L, Entner T, Kapral S, Mitterschiffthaler G. Ultrasound guidance for the psoas compartment block: an imaging study. Anesthesia and Analgesia 2002;94(3):706‐10. [MEDLINE: ] - PubMed
Liu 2009b
    1. Liu XZ, Zhou L, Zhang YJ, Liu B. Efficacy and safety of nerve‐stimulator‐guide needle placement in peripheral nerve block: a systematic review. [Chinese]. Chinese Journal of Evidence‐Based Medicine 2009; Vol. 9, issue 5:542‐51. [2009448109]
Marhofer 2004
    1. Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia 2004;59(7):642‐6. [MEDLINE: ] - PubMed
Marhofer 2005
    1. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. British Journal of Anaesthesia 2005;94(1):7‐17. [MEDLINE: ] - PubMed
RevMan 5.3 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Sandhu 2002
    1. Sandhu NS, Capan LM. Ultrasound‐guided infraclavicular brachial plexus block. British Journal of Anaesthesia 2002;89(2):254‐9. [MEDLINE: ] - PubMed
Schwemmer 2006
    1. Schwemmer U, Anetseder M, Meierhofer J, Obach S, Roewer N. Axillary plexus block: faster onset by ultrasound guidance compared to stimulation of “fascia click". Anesthesiology 2006;105:A1140.

References to other published versions of this review

Walker 2007
    1. Walker KJ, McGrattan K, Aas‐Eng K, Smith AF. Ultrasound guidance for peripheral nerve blockade. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD006459] - DOI - PubMed
Walker 2009
    1. Walker KJ, McGrattan K, Aas‐Eng K, Smith AF. Ultrasound guidance for peripheral nerve blockade. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD006459.pub2] - DOI - PubMed

Publication types