• EtheridgeJohn-Paul BJBBill Nelems Pain and Research Centre, Kelowna, British Columbia, Canada., Roderick J Finlayson, Jan Venter, Frederik De Villiers, Jonathan P Etheridge, Reece Wakefield, and Arraya Watanitanon.
• Bill Nelems Pain and Research Centre, Kelowna, British Columbia, Canada.
• Reg Anesth Pain Med. 2024 Mar 19.

BackgroundWhile fluoroscopic guidance is currently the imaging standard for cervical medial branch blocks (CMBBs), ultrasound guidance (USG) offers several potential safety advantages such as real-time needle visualization and the ability to detect and avoid critical soft tissue vascular or neural structures. However, no large-scale trials have examined the safety of USG for CMBB.MethodsFive hundred patients undergoing 2308 individual block levels were recruited using a prospective cohort design, and blocks were performed in an outpatient office setting using an in-plane USG technique. Primary outcomes included immediate block-related complication, as well as delayed occurrences, in the following 2 weeks. Vascular structures adjacent to the target area, as well as the occurrence of vascular breach, were recorded.ResultsThree minor immediate complications were noted (two subcutaneous hematomas, one vasovagal reaction) comprising 0.13% of blocks (0.03% to 0.38%; 95% two-sided CI), and no delayed events were recorded (0% to 0.16%; 97.5% one-sided CI). Blood vessels were detected and avoided in 8.2% of blocks, and vascular breach was noted in 0.52% of blocks (0.27% to 0.91%; 95% two-sided CI).ConclusionWhen performed using an in-plane technique by experienced operators, USG CMBB was found to be safe, with rare minor immediate complications and no further adverse event reported in the following 2 weeks.Trial Registration NumberNCT04852393.© American Society of Regional Anesthesia & Pain Medicine 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

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