Specialist Anaesthetist

Coimbra University Hospital, Portugal

Comments a recent paper about the Low Volume Techniques


Low-volume ultrasound-guided nerve block provides inferior postoperative analgesia compared to a higher-volume landmark technique.

Fredrickson MJ, White R, Danesh-Clough TK, Reg Anesth Pain Med. 2011Jul-Aug;36(4):393-8



 In recent years, with the support of ultrasound, several papers have described high success rates of peripheral nerve blocks with volumes well below the classically described in the literature, interscalene blocks with 5 ml, 2 ml for each of the brachial plexus nerves etc. This fact opened a window of hope to reduce the theoretical indices of systemic toxicity of local anesthetics, as well as its direct toxicity to the nerve. However there are few works devoted to evaluated other parameters in addition to success. Important questions were forgotten in the euphoria of decrease... decrease... decrease...Questions like: How long does the anesthetic block last? How long does the analgesic block last? Are nerve lesions actually more frequent with high volumes? Regarding the scientific evidence, the theory of lower systemic toxicity with lower volumes is unproven, same applies to the decrease of nerve lesions by direct action of the local anesthetic. With respect to the phrenic nerve block, a side effect of interscalene brachial plexus, the reduction of volumes allows lower incidence of this collateral effect (high scientific evidence – Ia). So apart from the obsession of getting blocks with amazingly small volumes, in the new literature it seems that this is not the obvious way, because apparently we lose on other points, and the most important one is block duration, duration of analgesia and anestesia. Maybe this interpretation will change, if we think in continuous blocks. Clearly, we still have a long way to follow in the investigation of these issues! Always having in mind that our main gool is to meet the patient's needs and not our whims! The article accompanying this review is clearly a contribution to the clarification of this controversial topic.


Career Path


Joined the Faculty of Medicine, University of Coimbra, in 1990, having completed his degree in 1996.

Holder of Competence in Emergency Medicine. He was a researcher at the Center for Histophysiology, Experimental Pathology and Developmental Biology - University of Coimbra, credited and funded by the Foundation for Science and Technology - Ministry of Science and Technology. Takes place has Hospital Assistant HUC-CHUC (2003), diversifying its activities by the various areas of Anesthesiology. 

Devotes part of his time to the area of ​​locoregional anesthesia, since 2005 occupying the role has Coordinator Internalship Orthopedics Locorregional Anesthesia.

Responsible for the development and implementation of regional blocks guided by ultrasound in the HUC, as well as the use of ultrasound in the context of vascular accesses in Anesthesiology. 

Joins the Chronic Pain team, here also responsible for implementing the ecoguided techniques for control and treatment of pain. 

Devotes part of his time to the sub-specialty of Anesthesia for Obstetrics. 

It works in pre-hospitalar emergency medicine since 1999- VMER (INEM) of CHUC-HUC. Served as a physician in  the Helitransportaion of  Critical Patient –INEM (2002-2011) Was an a element of ARS Center trainers.

Teaches various courses / Workshop (nationally and internationally) in the areas of regional anesthesia and ultrasound-guided regional anesthesia , and  also in the emergency / urgency area.

Responsible for many scientific papers presented at national and international conferences in the field of regional anesthesia. 

Author of a chapter in the book: Fundamentals of Anaesthesia Orthopaedics Element of the current Direction of the Club of Regional Anesthesia (CAR)  




Interview with the expert
Sharing experiences...


1- You are opening a new door: ultrasound guided chronic pain treatment. It is a new field with few people working on it. What do you think about the actual situation of Pain Medicine in your country, Portugal?
We are witnessing a revolution! New drugs, the multidisciplinary approach of the patient, and the new believe in intervention medicine, based on high scientific evidence. Invasive techniques are a valid element when used alone or in combination with other approaches. Portugal also saw the entry of ultrasound as a support to the implementation of these techniques, allowing their timely execution and with less deleterious effects when compared with fluoroscopy.          

2- Which is the greatest gratification you got in Pain Medicine?
The patient satisfaction as a result of our medical decisions.


3- After broadening your field of work out of the operation room and treating patients months/years after surgery... Did you change  your vision of acute pain control?

No doubts! Acute pain when undervalued has catastrophic consequences for the welfare of the patient in the short, medium and long term. Fortunately this is changing very quickly too.