Ultrasound-guided central neuraxial blocks: breaking barriers to greater adoption

Central neuraxial blocks (CNB) remain a cornerstone of modern anaesthesia, yet traditional landmark-based techniques carry inherent limitations in accuracy and safety. Ultrasound-guided CNB has emerged as a transformative technique, offering improved first-pass success, shorter procedure times, fewer needle passes, and decreased incidence of complications such as inadvertent dural puncture and paraesthesia. Despite compelling evidence supporting these advantages, global adoption of ultrasound-guided CNB remains limited. Surveys across North America, Europe, and Asia consistently reveal underutilisation, suggesting significant barriers to implementation. This editorial explores the multifactorial impediments to wider ultrasound-guided CNB adoption, including logistical issues such as cost and equipment access, workflow disruptions in high-volume settings, the complexity of spinal sonoanatomy, and a steep learning curve requiring structured training. Cultural resistance to change and inadequate institutional support further hinder progress. Drawing from change management models, we propose strategies to overcome individual and systemic inertia. The proliferation of portable ultrasound devices and training dissemination by younger, ultrasound-proficient practitioners are expected to drive change. Ultimately, formal certification pathways and sustained advocacy will be essential to achieving mainstream adoption of ultrasound-guided CNB.