Speaker Interview: Ultrasound-Guided Regional Anaesthesia – Part 1
DR. ULRICH OBERNDORFER, MBA
Privatklinik Döbling, Vienna, Austria
Navigating the Nerves with Confidence: The Power of Ultrasound in Regional Anesthesia
Soon we will shoot 123sonography’s Ultrasound-guided Regional Anaesthesia course with our speaker, Ulrich Oberndorfer. Get to know Ulrich, who pioneered ultrasound-guided regional anaesthesia and find out how the field has evolved.
123sonography: Let’s first talk a little about the history of regional anaesthesia. From your point of view, what were the big milestones in the history of local anaesthetics and regional anaesthesia?
Dr. Ulrich Oberndorfer, MBA: Well, the biggest milestone was certainly the discovery of cocaine and its local anaesthetic effect. The chemical properties have already been described in the mid-19th century, but it was in the late 19th century that its local anaesthetic effects were demonstrated. This opened the way for its use in surgical anaesthesia, and then, of course, people started researching local and regional nerve-blocking techniques.
“All local anaesthetics are based on cocaine!”
The structural and pharmacological properties of local anaesthetics are all based on cocaine, so they are relatives. This relationship becomes evident when observing the side effects of local anaesthetics or cases of overdose [...] The discovery of cocaine is an essential root of regional anaesthesia, as it paved the way for developing modern local anaesthetics and regional and peripheral nerve block techniques.
What are the benefits of ultrasound-guided regional anaesthesia for the patient compared to interventions using nerve stimulation techniques?
I would say there's one very, very big difference between the usage of ultrasound as a method for nerve localization in comparison to electrical nerve stimulation, which was performed over centuries; Nerve stimulation tells you how close the needle tip is to the nerve, right? It detects the distance between the needle tip and the nerve. But it doesn’t give you any information about the distribution of the local anaesthetic during the actual injection. However, the spread of the local anaesthetic around the nerve is essential for the effectiveness of a nerve block!
Early studies on regional and peripheral nerve blocks with ultrasound show that the prediction of the efficiency of the nerve block is better and the quality of the nerve blocks is better with ultrasound guidance. Regarding safety, it's still hard to say because it's harder to measure, and major complications were rare even with electrical stimulation [...]. Still, I am sure that even in experienced hands, the ultrasound-guided technique is clearly the safest.
So, before nerve stimulation became a thing, how did doctors predict the success of a nerve block?
In the mid-20th century, when none of these techniques were available, the only way to determine the correct position of the needle (apart from the landmark-only method) was to elicit paraesthesias along with pain [... ]. The anaesthesiologist often tried to produce maximum pain during the block so he could be sure his needle hit the nerve because it was believed that the more painful the procedure, the better the block afterward [...] But as you can imagine, this was often followed by nerve damage! So for the sake of our patients, it's good that this technique is no longer used.
Stay tuned to find out more about the role and advancements in ultrasound-guided regional anaesthesia, as well as experiences of Dr. Ulrich Oberndorfer, MBA!
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