Anestéziológia a intenzívna medicína 1/2014

Should be UGRA considered as the anesthetic technique of choice at the upper extremity nowadays?

Surface impoundment of the brachial plexus is an ideal precondition for the development of ultrasound-guided regional anesthesia- -UGRA, which is an increasingly used acronym for ultrasound-guided regional anesthesia. 20 years after the publication of the work of Prof. Stephan Kapral, we can conclude that the introduction of ultrasound caused a renaissance in regional anesthesia, particularly at the upper extremity. Unlike previous techniques of regional anesthesia, in which the needle was emplaced “blind”, using ultrasonography the anesthetist can directly visualize in real time nerves, blood vessels and other anatomic structures. It can monitor and adjust the direction and penetration of the needle into tissue in real time, and application and spread of local anesthetic. This reduces the risk of intravascular administration, systemic toxicity, pneumothorax and failure block. UGRA provides better postoperative analgesia, increased patient satisfaction and eliminates the risks associated with general anesthesia. Although the current literature so far has not confirmed the complete safety of ultrasound-guided regional anesthesia, particularly in the area of nerve damage, it is clear that the correct use of this technique pushes the limits of safety in regional anesthesia.

Keywords: ultrasound-guided regional anesthesia, UGRA, peripheral nerve blocks, upper limb.