Ultrasound Technique Means Less Pain, Faster Recovery vs. Traditional

It’s been said that the most dangerous aspect of surgery is the anesthesia, so I’m happy to report on any and all developments that make it safer and better. Here’s one that may make it possible to have nerve blocks instead of general anesthesia for a wider range of surgeries in more hospitals.

This new ultrasound-guided nerve block works a lot like the technique used by maternal-fetal specialists giving amniocentesis, who rely on ultrasound to help them guide the needle with greater accuracy. (Amnio used to be done blind, which meant there was a high risk of hitting the fetus with the needle.) In much the same way, the ultrasound-guided nerve block enables the doctor to insert the needle and deliver anesthesia more precisely. “This is a major advance,” said Anthony Robin Brown, MD, director of orthopedic and regional anesthesia at New York-Presbyterian Hospital/Columbia University, with whom I spoke about this new technique.

Better for Doctors…

New, more sophisticated ultrasound machines now make it possible for anesthesiologists to use real-time imaging to guide nerve-block injections, which, in turn, allows for better distribution of the anesthetic. Previous techniques relied on physical landmarks, patient feedback (ouch!) or nerve stimulation to mark correct placement of the needle.

Being able to see the nerve in advance means the doctor is able to identify and adjust positioning for any unusual anatomy and also to avoid puncturing blood vessels, thus reducing the risk for complications. Also the doctor can watch as the needle approaches the nerve and delivers the anesthetic, ensuring that it surrounds all nerves in the area.

…and Better for Patients Too

To date, nerve blocks have most often been used for orthopedic, breast and vascular surgeries and usually just in large hospitals and academic centers. Dr. Brown predicts they’ll become more widely available now — great news, since they are not only safer but, because they don’t reach the brain at all, they also prevent what’s known as the “surgical stress response.” This is a physiological reaction to general anesthesia that compromises the immune system and can lead to other potentially serious complications. With nerve blocks, patients don’t suffer the nausea often associated with general anesthesia, and they deliver better pain control after surgery as well.

If you’re having surgery, talk to your surgeon or anesthesiologist about your options. In some cases — for instance, for certain types of brain surgery — general anesthesia may be a necessity. But for others, most especially including surgeries involving the extremities, nerve blocks can be an excellent choice that helps reduce your risk for complications and also means you are likely to heal faster. If your anesthesiologist is experienced with them, this new, highly accurate, ultrasound-guided nerve block may be worth discussing.