Orthopedic surgeries are often associated with intense postoperative pain, necessitating effective perioperative analgesia strategies. Regional anesthesia techniques, such as brachial plexus blocks and femoral/sciatic nerve blocks, are commonly employed for this purpose. Traditionally, these blocks have been performed using anatomical landmarks and nerve stimulators. However, these techniques are limited by anatomical variability and a higher incidence of block failure or complications. Ultrasound guidance allows for real-time visualization of nerve structures, adjacent vessels, and spread of local anesthetic, improving block accuracy and safety. Various studies have highlighted the benefits of UGRA in surgical settings, particularly in orthopedic cases requiring limb blocks. This study was designed to quantitatively evaluate the clinical effectiveness of UGRA versus landmark-guided regional anesthesia in patients undergoing elective orthopedic surgery.

Study Design and Participants This was a prospective, randomized, comparative study conducted in the Department of Anesthesiology and Orthopedics over a period of 12 months. After obtaining institutional ethics committee approval, 120 patients aged 18–70 years, scheduled for elective upper or lower limb orthopedic surgery, were enrolled. Inclusion Criteria: • ASA I–III status • Elective orthopedic surgery requiring peripheral nerve block • Willingness to provide informed consent Exclusion Criteria: • Known allergy to local anesthetics • Coagulopathy • Infection at the block site • Inability to comprehend pain scoring systems Randomization and Intervention Patients were randomly allocated into two groups: • UGRA Group (n = 60): Received ultrasound-guided nerve block • LGRA Group (n = 60): Received landmark-based nerve block Blocks performed included brachial plexus (supraclavicular or axillary), femoral, and sciatic nerve blocks, depending on the surgery type. Outcomes Measured Primary and secondary outcomes were: • Block onset time (time from injection to complete motor/sensory block) • Duration of postoperative analgesia (time until first request for rescue analgesia) • Intraoperative and 24-hour postoperative opioid requirement • Patient satisfaction (Likert scale 1–5) • Complications (vascular puncture, hematoma, block failure) Statistical Analysis Data were analyzed using SPSS v26. Continuous variables were presented as mean ± SD and compared using Student’s t-test. Categorical variables were compared using Chi-square or Fisher's exact test. A p-value < 0.05 was considered statistically significant.

The tabulated results collectively demonstrate that ultrasound-guided regional anesthesia (UGRA) significantly outperforms landmark-guided techniques (LGRA) in multiple clinical parameters. Patients in the UGRA group had a notably faster block onset time and significantly prolonged postoperative analgesia duration, as seen in Table 2. Opioid consumption, both intraoperatively and postoperatively (Table 3), was substantially reduced in the UGRA group, indicating better pain control and reduced reliance on systemic analgesics. Table 4 highlights that patient satisfaction was markedly higher with UGRA, with 70% reporting a “highly satisfied” experience compared to only 42% in the LGRA group. Additionally, Table 5 shows a lower incidence of complications such as block failure and vascular puncture in the UGRA group, reinforcing its superior safety profile. Overall, these findings strongly support the clinical effectiveness and patient-centered advantages of UGRA in orthopedic surgery. Table 1: Patient Demographics (No significant difference between groups in age, weight, ASA status) Parameter UGRA (n=60) LGRA (n=60) p-value Age (years) 45.3 ± 11.7 46.9 ± 10.4 0.48 Weight (kg) 71.2 ± 9.3 72.5 ± 8.7 0.42 ASA I/II/III 28/25/7 26/27/7 0.85 Table 2: Block Characteristics Outcome UGRA (Mean ± SD) LGRA (Mean ± SD) p-value Block onset time (min) 6.2 ± 1.1 11.7 ± 2.5 <0.001 Duration of analgesia (hrs) 10.3 ± 1.9 6.4 ± 1.8 <0.001 Table 3: Opioid Consumption Parameter UGRA Group LGRA Group p-value Intraoperative opioid (mg) 15.2 ± 4.5 21.4 ± 5.1 <0.01 Postoperative opioid (mg) 12.1 ± 3.8 19.6 ± 4.7 <0.01 Table 4: Patient Satisfaction Satisfaction Level UGRA (n=60) LGRA (n=60) p-value Highly satisfied 42 (70%) 25 (42%) <0.01 Neutral 12 (20%) 20 (33%) Dissatisfied 6 (10%) 15 (25%) Table 5: Complications Complication UGRA LGRA p-value Vascular puncture 1 5 0.09 Block failure 0 4 0.04 Hematoma 0 1 0.31

Our findings demonstrate that ultrasound-guided regional anesthesia (UGRA) significantly improves block onset time, prolongs postoperative analgesia, reduces opioid use, and enhances patient satisfaction compared to landmark-based techniques. These findings are in agreement with previous studies by Marhofer et al. [1] and Sites et al. [2], who established UGRA’s clinical and safety benefits. Shorter onset times observed in our study can be attributed to the real-time visualization of nerve structures and precise local anesthetic deposition, consistent with Neal et al. [3] and Chan et al. [4]. The extended analgesic duration with UGRA supports earlier results by Casati and Fanelli [6], who emphasized improved outpatient pain control with regional techniques. Reduced opioid consumption noted in the UGRA group aligns with Fredrickson et al. [8], who demonstrated that accurate nerve localization leads to superior analgesia and reduced systemic drug reliance. Patient satisfaction outcomes in our study further corroborate data from Hadzic et al. [7], highlighting the positive patient experience with nerve blocks. Importantly, the lower complication rate—especially block failure and vascular puncture—in the UGRA group mirrors the safety profiles reported by Perlas et al. [9] and Abrahams et al. [5], confirming the reproducibility and safety of ultrasound techniques. Furthermore, Neal et al. [10] have underscored UGRA as essential in modern upper extremity anesthesia practice due to its efficacy and consistency. Overall, our study adds robust evidence to the growing body of literature supporting UGRA as the preferred technique in orthopedicanesthesia for its superior clinical outcomes, safety, and patient-centric benefits.

Ultrasound-guided regional anesthesia offers superior outcomes compared to landmark-based techniques in orthopedic surgery. It provides faster block onset, longer postoperative pain relief, and higher patient satisfaction, with fewer complications. UGRA should be considered a standard of care in modern orthopedicanesthetic practice.

1. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94(1):7–17. 2. Sites BD, Brull R, Chan VW, et al. Artifacts and pitfalls of ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2007;32(5):412–423. 3. Neal JM, Brull R, Chan VW, et al. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2010;35(2 Suppl):S1–S9. 4. Chan VW, Perlas A, McCartney CJ, et al. Ultrasound guidance improves success rate of axillary brachial plexus block. Anesthesiology. 2007;106(5):1005–1012. 5. Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth. 2009;102(3):408–417. 6. Casati A, Fanelli G. Regional anaesthesia for outpatient surgery. Curr OpinAnaesthesiol. 2005;18(6):623–628. 7. Hadzic A, Vloka JD, Kuroda MM, et al. The practice of peripheral nerve blocks in the United States: a national survey. Reg Anesth Pain Med. 1998;23(3):241–246. 8. Fredrickson MJ, Ball CM, Dalgleish AJ. Analgesic effectiveness of ropivacaine 0.2% for continuous interscalene analgesia after shoulder surgery. Br J Anaesth. 2003;91(3):373–376. 9. Perlas A, Brull R, Chan VW. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med. 2008;33(3):259–265. 10. Neal JM, Gerancher JC, Hebl JR, et al. Upper extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med. 2009;34(2):134–170.