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Speaker Interview: Ultrasound-guided Regional Anaesthesia – Part 3

Wed, 10/05/2023


Course Speaker Ulrich Oberndorfer


Head of department of anaesthesia and intensive care medicine
Privatklinik Döbling, Vienna, Austria

With part 1 and part 2 of our speaker interview giving you an overview of the history and advancements in regional anaesthesia, we are now talking with Ulrich Oberndorfer about his experiences in the field!

123sonography: Can you share a significant experience from your career, specifically one where the use of ultrasound had a notable impact?

Dr. Ulrich Oberndorfer, MBA: When studying anesthesiology, there was this myth in all the textbooks that said that the spinal cord in newborns extends to L4 and gradually moves up as it grows. I don't know where it came from, but all the books said not to do epidural blocks in newborns because of the risk of damage to the spinal cord. But when we were scanning newborns, you can scan the whole spine in newborns because it's not ossified yet - we did not see the spinal cord at the L4 level, but rather around Th 12/L1. Our findings contradicted what was written in regional anaesthesia books. This myth was repeated in several textbooks, causing many people to accept it as fact without any real evidence and people believe in these books!

From Textbook Myths to Real-time Visualization

When doing nerve blocks for inguinal hernia surgery in children with the land-mark based approach, we typically insert the needle in the so-called petit triangle and use the double-pop technique to find the correct layer. After the needle is inserted through the skin, a first "pop" and a second "pop" is felt. That's the only clue that the needle tip is in the right layer. But with ultrasound, we've seen that there aren't always two pops. So the chances of targeting the right abdominal wall layer or the parietal peritoneum were 50/50.

In many cases, we could see that when doing the second pop, the local anaesthetic would get into the peritoneum. That was striking. It's only sometimes two pops, but it can be three or one. The anatomical variability of the human body is so wide that a tool that can visualize it in real-time makes a difference!

What is your favorite nerve block, if you have one?

I don’t have a favorite nerve block, but the more tricky it gets, the more I like a technique. Let’s say – I like the challenge!

Do you have any tips for a young colleague who wants to start performing regional anaesthesia?

With more than two decades of experience performing and teaching regional anaesthesia techniques, I know the common pitfalls. In this course, I will teach you the basics of regional anaesthesia and share some insider tips and tricks I've discovered over the years.

Any last comment?

An african proverb says “Smooth seas do not make skillful sailors.” Don‘t be discouraged, if challenging anatomy or other difficulties appear. You‘ll learn from it and it‘ll make you better. 


Are you ready to face the challenges of regional anaesthesia? Let Dr. Ulrich Oberndorfer be your guide with our upcoming course on Ultrasound-Guided Regional Anaesthesia! Pre-register and be the first to know about our course launch in September!