USG or clinical judgment or both?
Regional anesthesia has been used by anesthetists for decades. Anesthesiologist perform central neuroaxial block, peripheral nerve block and interventional pain injection as a procedure for anesthesia or acute or chronic pain control.228Traditional regional anesthetic techniques usually is done by help of the anatomical landmarks and clinical judgment() . Anatomic landmarks are usually an anatomic sign on the skin of injection site which identified by palpation on the bony prominence or arterial pulse .It could be near bony prominence or arterial pulse or at a few cm far from them according to anatomic passage of a nerve near to the skin or anatomic position of special structure . But many disadvantages like anatomical differences, small adjacent nerves and blood vessels, lungs, and other vital structures lead to the failure of the injections and side effects and complications and put the success of the landmark technique into question.()
With introduction of ultrasound (US) in medicine as a medical diagnostic tool by Dr. Karl Theo Dussik, an Austrian neurologist (),anesthetists tried to test it for possibility of improvement of the quality of injections . US is the first widely used imaging instrument in regional anesthetia practice()176because it is portable, free of radiation risk, and relatively inexpensive when compared with other imaging modalities, such as magnetic resonance and computed tomography.() And It is noninvasive, safe, easy to use, and can be quickly performed. So USG became a promising alternative to traditional landmark-based techniques.()
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However, the advantages makes ultrasound a very attractive option, and with further research and training, ultrasound may well become a standard of