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Lag period with different pulse oximeters leading to variation in reperfusion times

plane technique), the needle is advanced from the medial to the lateral direction or vice versa, and the entire needle shaft can be visualized as it approaches the PTN (Fig. 1A). A 50 mm, insulated needle (Stimuloplex s , B-Braum/McGaw Medical, Bethlehen, PA) attached to a nerve stimulator (Stimuloplex s HNS11, B-Braum/McGaw Medical) can be used in order to positively identify the nerve in cases of difficult anatomy. A motor response corresponding to the PTN (i.e. plantar flexion), evoked at a current of o0.5 mA, suggests correct needle position. In our experience, 2–5 ml of local anesthetic is sufficient for blocking the PTN provided that local anesthetic spreads circumferentially around the nerve (Fig. 1B). Different modalities aiming to improve the success and safety of peripheral nerve blockade are the subject of endless interested and investigation of regional anesthesiologists. Specifically the use of nerve stimulator has recently been shown to improve the success rate and hasten the onset of PTN block (4). Using US guidance, targeted nerve and needle can be visualized in real time to ensure accurate needle placement, and spread of local anesthetic around the nerve while avoiding potentially dangerous of intraneural, and intravascular injections. In our view, US-guided technique has been able to improve block success while limiting the total dose of local anesthetic. US guidance allows us to decrease excessive needle manipulation and improve patient comfort. As a consequence, less intravenous sedation is used during the block procedure, which may facilitate home discharge for ambulatory patients. Further, we believe US-guided PTN block is an ideal technique for teaching relevant anatomy to medical students and residents. Outcome data are eagerly awaited to determine if USguided PTN block improves block success, decreases onset time, reduces the rate of complications, and increases patient satisfaction, as we would expect.