Regional Anesthesia for Outpatient Hand Surgery: Ultrasound-Guided Peripheral Nerve Block

o c t t t h t o u f p r u q t i d d r AS THE NUMBER OF AMBULATORY surgeries and scrutiny of health care expenses continue to increase, it is important to use anesthetic techniques that fford specific characteristics; rapid onset, adequate pain ontrol, minimal postoperative nausea and vomiting, and apid resolution of systemic effects (to enhance postaneshesia care efficiency) are desired components of outpaient anesthesia. In addition, our patient demographics ave changed markedly over the past 20 years, trending oward increased age, increased obesity, and a higher prevlence of chronic opioid usage. Because of these patterns, the popularity of regional nesthesia for outpatient hand surgery has increased ramatically in the last decade. In the past, regional nesthetic blocks were performed using palpable anaomical landmarks, and by eliciting paresthesia and/or lectrical nerve stimulation the anesthesiologist was ble to ascertain the proximity of needle to nerve. uccess rates ranging from 60% to 95% were reported, epending on the site and practitioner expertise. These lind techniques brought into question other factors, ncluding onset, quality, safety, and patient comfort. ould the variable results of blind regional anesthetic locks be improved and made more reliable? Since the mid 1990s, the role of ultrasound guidance as generated a renaissance of interest in peripheral erve blockade within the anesthesia community. Ulrasound guidance affords several advantages in comarison to traditional methods. The primary advantage f ultrasound is the direct visualization of neural and djacent anatomical structures. This allows for visualzation of the spread of local anesthetic during injection. n addition, sonographic imaging allows for detection