Speakers
Prof. Paul KESSLER
Professor
The Orthopaedic University Clinic
Germany
Paul Kessler is board certified in anaesthesiology, critical care medicine and pain therapy and was awarded professorship in anaesthesia in 1998. From 2003 to January 2020 he was Chair of the Department of Anaesthesiology of the Orthopaedic University Clinic in Frankfurt, Germany. Since February 2020 he is Vice Chairman of the Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy of the University Hospital Frankfurt.
His clinical expertise focuses on regional anaesthesia. Paul Kessler has co-authored over 100 peer-reviewed papers, review articles, case reports, and book chapters. Paul Kessler is a member of many national and international societies of anaesthesia. From 2009 to 2014 he was chairman of the German Task Force of Regional Anaesthesia. From 2009 to 2013 he was Board member of the ESRA, from 2014 to 2018 he was the German Zone Representative in the ESRA Council. He is currently the Chair of the ESRA cadaver workshops.
The efficacy of peripheral nerve blocks is characterized by success rate, block onset and duration and quality of block. Safety issues include vascular injury, local anesthetic systemic toxicity, pneumothorax, phrenic nerve palsy and block-related mechanical nerve injury.
Efficacy
Systematic reviews and meta-analysis demonstrate that the use of ultrasound increases the likelihood that the blocks were successful. Success rate is defined as achieving surgical anesthesia without supplementary pain relief or conversion to general anesthesia. However, the success may depend on the expertise of the provider administering it.
Almost all comparative studies show that onset time is significantly improved with ultrasound of about 30% and block duration of about 25%.
Block quality is characterized by need for rescue anesthetic, supplemental analgesia and complete block of all studied nerves. Most studies found a statistically improved quality of sensory block with ultrasound.
Safety
Systematic reviews and meta-analysis demonstrate that ultrasound-guided PNB is associated with a reduced incidence of vascular injury, dose-related side-effects, local anesthetic requirements for some block types, local anesthetic systemic toxicity, pneumothorax and phrenic nerve block.
In contrast, there has not been consistent evidence that ultrasound guidance is associated with a reduced incidence of nerve injury. Data with nerve stimulation prove that the incidence of severe long-term PNB-related nerve injury is low and estimated to be 2–4 per 10,000 PNBs. Register analyzes show that the incidence of paresthesia, a direct needle nerve contact, is higher under ultrasound than with nerve stimulation. The main reason for this is that the provider does not have good control over the needle tip when advancing the needle. Adequate training and proficiency in ultrasound-guided regional anesthesia are essential for minimizing the risks of block-related mechanical injury to a peripheral nerve.
