Several steps are critical in achieving proficiency with ultrasound
imaging for regional block.24,25 The first step is
scanning skills (the ability to obtain images and recognize nerves).
Scanning practice and review of teaching files are critical. In this process
it is important to develop image quality control presets, so that the number
of adjustments is minimal when actually performing blocks. Learn with the
highest quality imaging available before “graduating” to another machine
(some people start on the low end and experience frustration). Regarding the
art and practice of neural imaging, it is best to begin with nerves that are
easier to visualize (ulnar and median in the forearm, tibial nerve near the
popliteal crease) before working up to the more difficult ones (brachial
plexus in the interscalene groove or infraclavicular region). Of course,
some people are difficult to image, but transducer manipulation skills can
help a great deal in such cases.