In this abstract author has critically looked beyond ultrasound, to rediscover nerve
stimulator as not only a nerve locator but detector of and preventer of intraneural injections.
Systemic reviews has shown that ultrasound guided blocks are not inferior to other
techniques, have similar success rate, need less time to perform, have faster onset, longer
duration, reduce volume of local anaesthetics and decreased risk of vascular puncture 1, 2.
Ultrasound guidance however has not been associated with reduce rate of long term peripheral
nerve injury and reported data claim range from 1:2500- 1:5000.for both pre and
ultrasound era 3, 4. Even if perfect technique and training existed there will be obstacles
related to limitations of ultrasound physics as well as individual patient anatomy and targeted
structures. More difficult visualisation of targeted structures has been confirmed in
clinical practice especially in regards of plexus anaesthesia: interscalene block (ISB), supraclavicular
(SCB), infraclavicular (ICB), sacral plexus (SP), fascial plane blocks 5

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