Reply to Dr Hardman et al

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To the Editor:
We greatly appreciate Dr Hardman and colleagues'1 letter to the editor in response to our recent articles on the emerging role of point-of-care ultrasound (PoCUS) for the regional anesthesiologist.2,3 The goal of this series is to encourage regional anesthesiologist proficient in ultrasound-guided regional anesthesia (UGRA) to add to their clinical toolbox by learning these exceedingly relevant PoCUS skills. We agree with Dr Hardman and his colleagues that when it comes to terminology such as “standard of care” there is the medicolegal definition and that we should use cautiously in medical literature until a legal consensus is met.
With that said, “standard of care” is defined as the “degree of attentiveness, caution, and prudence that a reasonable person in the circumstances would exercise.” Although there are aspects of regional anesthesia that can be practiced safely without ultrasound guidance, such as neuraxial techniques, there are some peripheral nerve blocks that arguably should be performed only under ultrasound guidance because of safety concerns, such as avoiding a pneumothorax with a supraclavicular block.4 In addition, there is also a case to be made that UGRA for peripheral nerve blocks should be strongly encouraged in the high-risk patient, increasing patent safety by decreasing the incidence of local anesthesia systemic toxicity and decreasing the likelihood of intravascular injection.4,5
We do agree that words matter. Because UGRA is a component of PoCUS, our goal with the PoCUS series is to encourage learning and actively promote the use of PoCUS by the regional anesthesiologist as we believe that PoCUS has emerged as the 21st-century stethoscope. Point-of-care ultrasound is being taught in medical schools6 and anesthesiology residency training programs,7 and there is a “call to action” to ensure that all anesthesiology residents get formalized training in perioperative ultrasound.8 Therefore, we envision a future in the medical profession where it will be considered “standard of care” to use ultrasound for bedside assessment of the hemodynamically unstable patients and/or patients in respiratory distress, adding valuable information to the clinical picture and serving as a vital part of the clinical decision making. Point-of-care ultrasound will undoubtedly become an integral part of modern medical practice, and if we do not embrace it as anesthesiologists, then we will be left behind.

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