Ultrasound imaging techniques have gained great popularity in anesthesia during the last decade. They have been shown to allow better quality of regional blocks, improving the outcome of patients and reducing the costs at the same time, for two major reasons. First, ultrasound imaging provides information of the individual anatomic structure and abnormalities before puncture. Second, the ultrasound-guided puncture is displayed in real time, and this enables the physician to correct the direction of the needle, both to improve the spread of local anesthetics and to avoid tissue damage. Ultrasound imaging allows control, even in difficult cases and in situations with variations of normal anatomy. Even positioning dependent variations of nerve roots can be managed most effectively. In addition, the time can be reduced considerably to perform regional blocks; the onset time is shorter, and the quality of blocks is better. So, ultrasound imaging techniques are routinely applied in the University Clinics Bergmannsheil, Bochum, Germany.