The classic approach uses anatomical landmarks, tactile feedback from fascial “clicks,” elicited paresthesias, and transarterial approaches to guide needle advancement and LA injection. This technique has become less popular as many anesthetists have transitioned practice to either peripheral neurostimulation (PNS) or ultrasound-guided regional anesthesia (UGRA). PNS techniques allow the operator to estimate the distance of the needle tip from the target nerve based on the magnitude of current required to elicit the desired motor response. Although it does not require direct nerve contact, nerve stimulation can cause patient discomfort especially in areas of injury, does not provide information about other structures like vasculature, and may be affected by variations in tissue impedance or peripheral neuropathy. UGRA techniques allow for real-time visualization of the desired anatomy, needle tip position and trajectory, and LA spread and have become widely used in recent years. Studies have shown that the use of ultrasound may reduce block performance time, number of needle passes, and volume of LA required for successful block and may also reduce the incidence of vascular puncture. Nevertheless, complications such as intravascular and intraneural injection have occurred even with the use of ultrasound, and visualization of some structures like the lumbar plexus and smaller and deeper nerves may be limited.