Ultrasound-Guided versus Landmark-Based Peripheral Nerve Block: A Comparative Study of Block Success, Procedure Time, and Complications

Open Access

Abstract

Background: Ultrasound guidance has revolutionized peripheral nerve blockade, offering potential advantages over traditional landmark-based techniques. However, comparative data on block success, procedure time, and complications in the local context remain limited. Objective: To compare ultrasound-guided versus landmark-based peripheral nerve block in terms of block success rate, procedure time, and complication profile. Methods & Materials: This prospective comparative study was conducted at the Department of Anaesthesiology & ICU at the National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, from February to December 2025. Sixty adult patients undergoing surgery under peripheral nerve block were equally allocated to ultrasound-guided (n=30) and landmark-based (n=30) groups. Block success rate, procedure time, onset of sensory and motor block, and complication rates were recorded. Data were analyzed using SPSS version 23.0. Results: The block success rate was significantly higher in the ultrasound-guided group (96.7% vs. 80.0%, p=0.044). Procedure time was longer in the ultrasound group (8.4 ± 2.6 minutes vs. 5.2 ± 1.8 minutes, p<0.001). However, the onset of sensory block was faster in the ultrasound group (8.2 ± 3.1 minutes vs. 12.6 ± 4.2 minutes, p<0.001). Complication rates were lower in the ultrasound-guided group (6.7% vs. 20.0%, p=0.017). Conclusion: Ultrasound-guided peripheral nerve block achieves higher success rates, faster block onset, and fewer complications compared to landmark-based techniques, despite requiring longer procedure time. These findings support the preferential use of ultrasound guidance where available.