Comparative study of Ultrasound-Guided versus Anatomic Landmark-Guided Techniques for Nerve Block Anesthesia

Abstract

Peripheral nerve blocks are widely used in orthopaedic surgery to provide effective perioperative analgesia and enhance postoperative recovery. Ultrasound-guided (USG) and landmark-guided (LMG) techniques are commonly employed; however, evidence comparing their effectiveness in Libya is limited. To compare the efficacy and safety of ultrasound-guided and landmark-guided peripheral nerve block techniques in patients undergoing elective orthopaedic surgery. A prospective multicentre observational comparative study was conducted between January and December 2025 at Sabratha Teaching Hospital, Mitaga Military Hospital, and Abu Salim Trauma Hospital. One hundred patients undergoing elective orthopaedic surgery were included and allocated equally to either the USG group (n = 50) or the LMG group (n = 50). The primary outcome was the blocking success rate, defined as the absence of pain during surgery without the need for supplemental anaesthesia. Secondary outcomes included block onset time, number of needle passes, complications, and patient satisfaction. Data were analysed using SPSS version 27, with statistical significance set at p < 0.05. Both techniques achieved comparable success rates, with no statistically significant difference between groups. However, the USG technique resulted in significantly shorter sensory and motor block onset times, fewer needle passes, a lower incidence of complications, and higher patient satisfaction scores compared with the LMG technique. While both ultrasound-guided and landmark-guided techniques were effective for peripheral nerve blocks in orthopaedic surgery, ultrasound guidance offered important advantages in terms of faster block onset, improved safety, and greater patient satisfaction. These findings support the wider adoption of ultrasound-guided nerve blocks where resources and expertise are available.