13 Sonographic Signs of Successful Injections

It seems simple enough to state that successful drug injections for regional blockade should surround the peripheral nerve. However, studies have reported that the doughnut sign, previously considered the gold standard for success, has a positive predictive value of only 90% for producing surgical anesthesia.¹ It is therefore important to carefully consider multiple factors that constitute sonographic signs for success that can be evaluated after injection.

First, successful drug injections should clarify the nerve border. Most regional blocks are performed with nerves viewed in short axis to evaluate the circumferential distribution. If more than half of the nerve border is contacted by local anesthetic, it is unlikely there is an intervening fascial plane that will serve as a barrier to diffusion. Therefore, it is important that the injection round the corner of the nerve so that there is demonstrated curvature of the injection.

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