Walking the tightrope after knee surgery: optimizing postoperative analgesia while minimizing quadriceps weakness.

248 February 2013 I ntroduction of ultrasound as a monitor of needle placement and disposition of the local anesthetic has had a significant impact on the clinical practice of peripheral nerve blocks. in particular, the ability to visualize the interaction between needle and anatomy in real time has led to an increase in the use and success of peripheral nerve blocks. not surprisingly, ultrasound guidance has inspired the development of a multitude of new block techniques, previously unreliable because of the inability to position a needle tip consistently in a tissue plane or adjacent to sensory nerves. A few examples include transverse adductor canal, transversus abdominis plane, and pectoralis blocks; all enthusiastically discussed at regional anesthesia gatherings and online discussion forums.‡ However, before widespread adoption, scrutinizing the novel approaches in high-quality, randomized, controlled trials is necessary to document a favorable risk–benefit ratio. For this reason, the study involving femoral nerve blocks published in this issue of AnestHesi-