Ultrasound-Guided Regional Anesthesia: A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters

The relatively recent incorporation of ultrasound technology for placement of peripheral nerve blocks and perineural nerve catheters has revolutionized the field of regional anesthesia. For those practitioners who have trained using the nerve stimulator technique, incorporating ultrasound into their busy practice may seem like a daunting task. As the title suggests, Ultrasound-guided Regional Anesthesia: A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters targets not only this audience but also current trainees by providing a pragmatic guide for those interested in learning ultrasound-guided regional anesthesia. Well written with a straightforward style, Ultrasoundguided Regional Anesthesia presents a comprehensive yet concise introduction to ultrasound-guided nerve blocks. Visually interesting, the book is filled with ample illustrations along with photographs of mock patients and their corresponding ultrasound images. The text reads easily and it often feels as if the authors are conversing and instructing you in person. Detailed instructions on how to identify the target structures, set up for the procedures, and perform the blocks are methodical and easy to follow. The “Author’s Clinical Practice” section at the end of each procedure references the authors’ individual practices and gives the reader practical insight into how these techniques translate to real life. In addition, each chapter is peppered with a highlighted “Key Points” or “Additional Considerations” section filled with relevant clinical pearls and useful tips designed to maximize success. The text is divided into four major sections. The first section focuses on fundamental concepts, including the pharmacology of local anesthetics, ultrasound physics, and the clinical application of ultrasound in regional anesthesia. The second and third sections are dedicated to upper and lower extremity blocks, respectively. Each of these sections begins with a review of relevant anatomy, contraindications to the procedure, potential complications, and, finally, instructions on how to perform the block. Descriptions of the procedure are further organized into categories, including equipment, scanning techniques, needle insertion, and local anesthetic injection. The final section of the book details peripheral perineural catheter placement and management. The first chapter in this section discusses proper patient selection and both inpatient and outpatient management. Dosing regimens and pump selection are reviewed, and the authors describe catheter insertion techniques for both solo and dual practitioners. The remaining chapters cover catheter placement for the various blocks reviewed in the book’s previous chapters. Writing a book with the primary intent to teach procedural techniques can be a challenge, but Ultrasound-guided Regional Anesthesia: A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters is a well-executed guide. As the title suggests, this book is practical: the text is easy to digest, the instructions are clear, and the graphics and clinical insights are beneficial. This book would make a welcome addition to any library as a fast and useful reference for the busy anesthesia provider wishing to incorporate ultrasoundguided regional anesthesia in his or her practice.

[1]  A. Stubhaug,et al.  Use of Magnetic Resonance Imaging to Define the Anatomical Location Closest to All Three Cords of the Infraclavicular Brachial Plexus , 2006, Anesthesia and analgesia.

[2]  T. Komatsu,et al.  [Ultrasound-guided femoral nerve block]. , 2008, Masui. The Japanese journal of anesthesiology.

[3]  C. Berde,et al.  Prolonged Intercostal Nerve Blockade in Sheep Using Controlled‐release of Bupivacaine and Dexamethasone from Polymer Microspheres , 1998, Anesthesiology.

[4]  S. Orebaugh,et al.  Future Considerations for Pharmacologic Adjuvants in Single-Injection Peripheral Nerve Blocks for Patients With Diabetes Mellitus , 2008, Regional Anesthesia & Pain Medicine.

[5]  R. Weller,et al.  Ultrasound-Guided Interscalene Needle Placement Produces Successful Anesthesia Regardless of Motor Stimulation Above or Below 0.5 mA , 2007, Anesthesia and analgesia.

[6]  S. Bloc,et al.  Spread of Injectate Associated With Radial or Median Nerve-Type Motor Response During Infraclavicular Brachial-Plexus Block: An Ultrasound Evaluation , 2006, Regional Anesthesia & Pain Medicine.

[7]  M. Beach,et al.  Ultrasound Improves the Success Rate of a Tibial Nerve Block at the Ankle , 2008, Regional Anesthesia & Pain Medicine.

[8]  B. Walder,et al.  Dexamethasone for the Prevention of Postoperative Nausea and Vomiting: A Quantitative Systematic Review , 2000, Anesthesia and analgesia.

[9]  P. Greis,et al.  Outpatient Management of Continuous Peripheral Nerve Catheters Placed Using Ultrasound Guidance: An Experience in 620 Patients , 2006, Anesthesia and analgesia.

[10]  P. Barash Handbook of Clinical Anesthesia , 1991 .

[11]  Thomas W Wright,et al.  Continuous Interscalene Brachial Plexus Block for Postoperative Pain Control at Home: A Randomized, Double-Blinded, Placebo-Controlled Study , 2003, Anesthesia and analgesia.

[12]  K. Candido,et al.  Buprenorphine Added to the Local Anesthetic for Brachial Plexus Block to Provide Postoperative Analgesia in Outpatients , 2001, Regional Anesthesia & Pain Medicine.

[13]  M. Allegri,et al.  Continuous peripheral nerve blocks: state of the art , 2005, Current opinion in anaesthesiology.

[14]  H. Toyooka,et al.  The Effects of Dexamethasone on Antiemetics in Female Patients Undergoing Gynecologic Surgery , 1997, Anesthesia and analgesia.

[15]  M. Yamakage,et al.  The infusion rate of most disposable, non-electric infusion pumps decreases under hypobaric conditions , 2003, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[16]  Colin J. L. McCartney,et al.  Ultrasound examination and localization of the sciatic nerve , 2005, Anesthesiology.

[17]  Fernando L. Arbona,et al.  "Gapped supine" position for ultrasound guided lateral popliteal fossa block of the sciatic nerve. , 2007, Anesthesia and analgesia.

[18]  S. Ho,et al.  Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-Caesarean section analgesia: comparison of droperidol and saline. , 2000, British journal of anaesthesia.

[19]  D. Feinstein,et al.  Lipid Emulsion Infusion Rescues Dogs From Bupivacaine-Induced Cardiac Toxicity , 2003, Regional Anesthesia & Pain Medicine.

[20]  J. Bennett,et al.  Scalene muscles and the brachial plexus: Anatomical variations and their clinical significance , 1997, Clinical anatomy.

[21]  D. Feinstein,et al.  Lipid Infusion Accelerates Removal of Bupivacaine and Recovery From Bupivacaine Toxicity in the Isolated Rat Heart , 2005, Regional Anesthesia & Pain Medicine.

[22]  K. Ibukuro,et al.  Anatomical variants of the lateral femoral circumflex artery: an angiographic study , 2005, Surgical and Radiologic Anatomy.

[23]  Z. Bigat,et al.  Does Dexamethasone Improve the Quality of Intravenous Regional Anesthesia and Analgesia? A Randomized, Controlled Clinical Study , 2006, Anesthesia and analgesia.

[24]  D. Benhamou,et al.  Ultrasound Guidance ror Difficult Lateral Popliteal Catheter Insertion in a Patient With Peripheral Vascular Disease , 2004, Regional Anesthesia & Pain Medicine.

[25]  Johannes W. Rohen,et al.  Color atlas of anatomy : a photographic study of the human body / Johannes W. Rohen, Chihiro Yokochi ; with the collaboration of Lynn J. Romrell , 1983 .

[26]  Christopher L. Wu,et al.  Does Continuous Peripheral Nerve Block Provide Superior Pain Control to Opioids? A Meta-Analysis , 2006, Anesthesia and analgesia.

[27]  S. Orebaugh The Femoral Nerve and Its Relationship to the Lateral Circumflex Femoral Artery , 2006, Anesthesia and analgesia.

[28]  R. Brull,et al.  Teaching an old block a new trick: ultrasound‐guided posterior tibial nerve block , 2008, Acta anaesthesiologica Scandinavica.

[29]  W. Mauritz,et al.  Ultrasonographic Findings of the Axillary Part of the Brachial Plexus , 2001, Anesthesia and analgesia.

[30]  R. Le Verge,et al.  Effect of dexamethasone on motor brachial plexus block with bupivacaine and with bupivacaine-loaded microspheres in a sheep model , 2003, European journal of anaesthesiology.

[31]  J. Putzke,et al.  A pilot study on continuous femoral perineural catheter for analgesia after total knee arthroplasty: the effect on physical rehabilitation and outcomes. , 2006, The Journal of arthroplasty.

[32]  D. Kopacz,et al.  Quantitative analysis of respiratory, motor, and sensory function after supraclavicular block , 1997, Regional Anesthesia & Pain Medicine.

[33]  X. Bargalló,et al.  The Influence of Arm Abduction on the Anatomic Relations of Infraclavicular Brachial Plexus: An Ultrasound Study , 2009, Anesthesia and analgesia.

[34]  V. Chan,et al.  Ultrasound-Guided Supraclavicular Block: Outcome of 510 Consecutive Cases , 2008, Regional Anesthesia & Pain Medicine.

[35]  J. Guay,et al.  Ropivacaine plasma concentrations are similar during continuous lumbar plexus blockade using the anterior three-in-one and the posterior psoas compartment techniques , 2004, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[36]  J. Mazoit,et al.  Successful resuscitation after ropivacaine and lidocaine-induced ventricular arrhythmia following posterior lumbar plexus block in a child. , 2008, Anesthesia and analgesia.

[37]  T. Morey,et al.  Continuous Popliteal Sciatic Nerve Block for Postoperative Pain Control at Home: A Randomized, Double-Blinded, Placebo-Controlled Study , 2002, Anesthesiology.

[38]  J. Neal,et al.  Upper Extremity Regional Anesthesia: Essentials of Our Current Understanding, 2008 , 2008, Regional Anesthesia & Pain Medicine.

[39]  R. Myers,et al.  Dexamethasone Decreases Blood Flow in Normal Nerves and Dorsal Root Ganglia , 2002, Spine.

[40]  T. Chew,et al.  Comparison of the Particle Sizes of Different Steroids and the Effect of Dilution: A Review of the Relative Neurotoxicities of the Steroids , 2007, Anesthesiology.

[41]  H. Chong,et al.  Continuous femoral nerve block in total knee arthroplasty: immediate and two-year outcomes. , 2009, The Journal of arthroplasty.

[42]  P. Gloeggler,et al.  Pulmonary Function Changes During Interscalene Brachial Plexus Block: Effects of Decreasing Local Anesthetic Injection Volume , 1992, Regional Anesthesia & Pain Medicine.

[43]  G A Albright,et al.  Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. , 1979, Anesthesiology.

[44]  S. Kapral,et al.  Ultrasonographic Guidance Improves Sensory Block and Onset Time of Three-in-One Blocks , 1997, Anesthesia and analgesia.

[45]  B. R. Shrestha,et al.  Comparative study between tramadol and dexamethasone as an admixture to bupivacaine in supraclavicular brachial plexus block. , 2007, JNMA; journal of the Nepal Medical Association.

[46]  R. S. Meyer,et al.  Ambulatory Continuous Femoral Nerve Blocks Decrease Time to Discharge Readiness after Tricompartment Total Knee Arthroplasty: A Randomized, Triple-masked, Placebo-controlled Study , 2008, Anesthesiology.

[47]  Patrick W. Tank,et al.  Grant's Dissector , 1978 .

[48]  S. Beevi,et al.  Epidural dexamethasone reduces postoperative pain and analgesic requirements , 2006, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[49]  A. Prescher,et al.  The sensory innervation of the hip joint - an anatomical study , 2005, Surgical and Radiologic Anatomy.

[50]  K. Enneking Regional Anesthesia: The Requisites in Anesthesiology , 2005, Regional Anesthesia & Pain Medicine.

[51]  M. Mulroy Systemic Toxicity and Cardiotoxicity From Local Anesthetics: Incidence and Preventive Measures , 2002, Regional Anesthesia & Pain Medicine.

[52]  J. Sañudo,et al.  Patterns of the circumflex femoral arteries revisited , 2007, Clinical anatomy.

[53]  Stefano Bianchi,et al.  Ultrasound of the musculoskeletal system , 2007 .

[54]  C. McCartney,et al.  Needle placement and injection posterior to the axillary artery may predict successful infraclavicular brachial plexus block: a report of three cases , 2005, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[55]  S. García del Valle,et al.  A comparison of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block in the popliteal fossa , 2001, Acta anaesthesiologica Scandinavica.

[56]  T. Morey,et al.  Popliteal Sciatic Perineural Local Anesthetic Infusion: A Comparison of Three Dosing Regimens for Postoperative Analgesia , 2004, Anesthesiology.

[57]  C. McCartney,et al.  Ultrasound guidance improves success rate of axillary brachial plexus block , 2007, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[58]  T. Morey,et al.  Infraclavicular Perineural Local Anesthetic Infusion: A Comparison of Three Dosing Regimens for Postoperative Analgesia , 2004, Anesthesiology.

[59]  D. Babin,et al.  The Pharmacodynamics of Ropivacaine and Bupivacaine in Combined Sciatic and Femoral Nerve Blocks for Total Knee Arthroplasty , 2006, Anesthesia and analgesia.

[60]  W. Urmey,et al.  Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. , 1992, Anesthesia and analgesia.

[61]  G. Weinberg Lipid infusion therapy: translation to clinical practice. , 2008, Anesthesia and analgesia.

[62]  B. Shrestha,et al.  Supraclavicular brachial plexus block with and without dexamethasone - a comparative study. , 2003, Kathmandu University medical journal.

[63]  A. Meysamie,et al.  Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade , 2006, Anesthesia and analgesia.

[64]  T. Morey,et al.  Continuous Infraclavicular Brachial Plexus Block for Postoperative Pain Control at Home: A Randomized, Double-blinded, Placebo-controlled Study , 2002, Anesthesiology.

[65]  S. Ho,et al.  The Use of Dexamethasone for Preventing Postoperative Nausea and Vomiting in Females Undergoing Thyroidectomy: A Dose-Ranging Study , 2000, Anesthesia and analgesia.

[66]  A. Winnie,et al.  The Inguinal Paravascular Technic of Lumbar Plexus Anesthesia: The “3 ‐ in‐1 Block” , 1973, Anesthesia and analgesia.

[67]  V. Dayan,et al.  Surgical anatomy of the saphenous nerve. , 2008, The Annals of thoracic surgery.

[68]  M. Beach,et al.  Use of a nerve stimulator does not improve the efficacy of ultrasound-guided supraclavicular nerve blocks. , 2006, Journal of clinical anesthesia.

[69]  S. Ho,et al.  Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-Cesarean analgesia , 2001, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[70]  G. Strichartz,et al.  Irreversible Conduction Block in Isolated Nerve by High Concentrations of Local Anesthetics , 1994, Anesthesiology.

[71]  G. Weinberg,et al.  Pretreatment or Resuscitation with a Lipid Infusion Shifts the Dose‐Response to Bupivacaine‐induced Asystole in Rats , 1998, Anesthesiology.

[72]  F. Netter Atlas of Human Anatomy , 1967 .

[73]  J. Neal,et al.  Complications in Regional Anesthesia and Pain Medicine , 2006 .

[74]  H. Katsuki,et al.  Lidocaine Disrupts Axonal Membrane of Rat Sciatic Nerve In Vitro , 2000, Anesthesia and analgesia.

[75]  D. Theriaque,et al.  The Effects of Local Anesthetic Concentration and Dose on Continuous Infraclavicular Nerve Blocks: A Multicenter, Randomized, Observer-Masked, Controlled Study , 2009, Anesthesia and analgesia.

[76]  T. Özelsel,et al.  Ultrasound-Guided Transsartorial Perifemoral Artery Approach for Saphenous Nerve Block , 2007, Regional Anesthesia & Pain Medicine.

[77]  X. Capdevila,et al.  Continuous post-operative regional analgesia at home. , 2001, Minerva anestesiologica.

[78]  S. Abram Central hyperalgesic effects of noxious stimulation associated with the use of tourniquets. , 1999, Regional anesthesia and pain medicine.

[79]  T. Torda,et al.  A Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine for Axillary Brachial Plexus Anaesthesia , 1998, Anaesthesia and intensive care.

[80]  P. White,et al.  The Use of a Continuous Popliteal Sciatic Nerve Block After Surgery Involving the Foot and Ankle: Does It Improve the Quality of Recovery? , 2003, Anesthesia and analgesia.

[81]  V. Chan,et al.  Ultrasound Imaging for Popliteal Sciatic Nerve Block , 2003, Regional Anesthesia & Pain Medicine.

[82]  B. Finucane,et al.  The Importance of Ultrasound Landmarks: A “Traceback” Approach Using the Popliteal Blood Vessels for Identification of the Sciatic Nerve , 2006, Regional Anesthesia & Pain Medicine.

[83]  A. Gray,et al.  Reply to Drs. Tsui and Özelsel , 2008, Regional Anesthesia & Pain Medicine.