Comparative Evaluation of Ultrasound-Guided Peripheral Nerve Blocks in Elective Orthopedic Procedures

Ultrasound guidance has, over the last two decades, displaced peripheral nerve stimulation and landmark-based technique as the dominant method for placing peripheral nerve blocks in elective orthopedic surgery, on the strength of direct visualization of the target nerve, the spread of local anesthetic, and adjacent vascular structures. This review synthesizes the comparative evidence for ultrasound-guided peripheral nerve blockade across the elective orthopedic procedures in which it is now most established: upper-limb interscalene and supraclavicular blocks for shoulder arthroscopy and arthroplasty, femoral and adductor canal blocks for total knee arthroplasty, and popliteal sciatic blocks for foot and ankle surgery. Randomized and meta-analytic data indicate that ultrasound guidance reduces block failure and vascular puncture relative to nerve-stimulator technique, while adductor canal block preserves quadriceps strength and reduces fall risk relative to femoral nerve block after total knee arthroplasty without sacrificing analgesic efficacy. Continuous perineural catheter techniques extend these benefits into the ambulatory and early postoperative period, and current practice increasingly treats peripheral nerve stimulation as an adjunct confirmatory tool rather than a primary localization method once ultrasound is available. We conclude that site-specific selection among ultrasound-guided techniques, rather than a single default approach, is what the comparative literature actually supports for elective orthopedic practice, and we identify where the evidence base for newer fascial-plane alternatives remains comparatively thin.