With the recent proliferation of ultrasound (US)-guided techniques for performing regional anaesthetic procedures such as peripheral nerve blocks, there has been much debate on the relative merits of US technology in comparison with the earlier methods of nerve localization. The use of a peripheral nerve stimulator (PNS) has been the ‘gold standard’ for performing peripheral nerve blocks for the last two decades, and has been shown to be a highly effective technique for determining adequate needle placement to produce regional anaesthesia/analgesia.1–3 Whether or not the use of US can improve practitioners’ ability to successfully perform peripheral nerve blocks remains controversial. Several randomized controlled trials (RCTs) have been conducted to compare these two modalities,4–16 but the number of patients in each study has been too small to conclusively demonstrate superiority of one technique over another. We sought to clarify this issue by performing a meta-analysis of all RCTs that have compared these two techniques. We hypothesized that the success rate of peripheral nerve blocks would be different when comparing placement with US or PNS guidance. We defined the block success rate as the percentage of blocks which allowed patients to undergo a surgical procedure without supplementation or conversion to general anaesthesia (GA) or spinal anaesthesia (SA). Other outcomes we examined included: time to perform the block, onset time, duration of block, and complications such as vascular puncture or persistent neurological symptoms.
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