• Sudipta Sen, Michelle Ge, Amit Prabhakar, Vanessa Moll, Rachel J Kaye, Elyse M Cornett, O Morgan Hall, Ira W Padnos, Richard D Urman, and Alan David Kaye.
• Department of Anesthesiology, McGovern Medical School, University of Texas Health Sciences Centre at Houston, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, USA. Electronic address: Sudipta.Sen@uth.tmc.edu.
• Best Pract Res Clin Anaesthesiol. 2019 Dec 1; 33 (4): 499-505.

AbstractJust two decades ago, regional anesthesia was performed blindly with dubious outcomes and little support from surgeons and patients. Technological advances in regional anesthesia have revolutionized techniques and largely improved outcomes. Ultrasound (US) technology continues to advance and has become more affordable. Improvements have come in the form of picture quality, resolution, portability, and smaller equipment. The US technology can identify otherwise unrecognized pathology and can help to optimize patient flow by allowing for more accurate triage and effective treatments and providing timelier interventions. In recent years, several different strategies to help improve and ease US-guided needle identification and placement have been developed, including magnetically guided needle US technology. Three-dimensional (3D) and four-dimensional (4D) US use is another potential way to help improve first-pass success and limit patient harm for regional anesthetics. The advent of echogenic needles and the resulting improvement in needle visualization under US has had a positive impact on physician comfort in performing regional anesthesia and on visualization time of the needle during US-guided procedures. To reduce variability and to reduce the anesthesiologist's workload, the use of robots in regional anesthesia has been assessed in recent years. Peripheral nerve stimulation (PNS) has also demonstrated efficacy in acute and chronic pain settings. Additional research and randomized controlled trials are necessary to evaluate novel technologies.Published by Elsevier Ltd.

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