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There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought through a modified Delphi process. A long-list of anatomical structures was refined through serial review by key opinion leaders in UGRA. All rounds were conducted remotely and anonymously to facilitate equal contribution of each participant. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for the “block view” (which visualizes the block site and is maintained for needle insertion/injection). Strong recommendations for inclusion were made if ≥75% of participants rated a structure as “definitely include” in any round. Weak recommendations were made if >50% of participants rated a structure as “definitely include” or “probably include” for all rounds (but the criterion for “strong recommendation” was never met). Thirty-six participants (94.7%) completed all rounds. 128 structures were reviewed; a “strong recommendation” is made for 35 structures on orientation scanning and 28 for the block view. A “weak recommendation” is made for 36 and 20 structures, respectively. This study provides recommendations on the core (minimum) set of anatomical structures to identify during ultrasound scanning for seven basic blocks in UGRA. They are intended to support consistent practice, empower non-experts using basic UGRA techniques, and standardize teaching and research.

Currently, the most commonly used techniques to perform peripheral nerve blockade are ultrasound-guided regional anesthesia (UGRA) and nerve stimulation (NS). Since its introduction in the 1990s, the use of ultrasound has gained popularity. In the beginning, it was used together with NS to confirm identification of nerve structures, once the learning curve has reached its end, there is a trend to use UGRA alone. In this article, we discuss the pros and cons of performing RA procedures with NS, UGRA, or a combination of both, which we call stimulated and ultrasound-guided regional anesthesia (SUGRA). Even though the use of SUGRA does not seem to improve the success rate of the nerve blocks, does not shorten the time to perform them, and does not shorten the onset time, it does help to avoid intraneural injection without increasing patient's discomfort. The use of SUGRA with low-intensity current and without a generation of motor response, would allow positioning of the needle tip close to the nerve avoiding intraneural injection and nerve damage.