This is a highly informative and carefully presented book for trainees and postgraduate students of anaesthesiology as well as practicing clinicians. This book aims to help them in selecting and implementing the most suitable regional block in each clinical scenario and successfully use the techniques of ultrasound-guided regional anaesthesia (USRA) in their practice. This book covers basics of ultrasound imaging, anatomical aspects and techniques of all nerve blocks that are commonly used in clinical practice in a lucid and illustrated presentation.
Regional anaesthesia can be a safe alternative to general anaesthesia. When combined with general anaesthesia, it can provide excellent postoperative analgesia too. With the advent of ultrasound, the scope, safety and reliability of regional anaesthesia have expanded manifold. However, there is a lack of formal clinical training in regional anaesthesia in most of the anaesthesia postgraduate curricula and this book intends to bridge this gap.
The book serves as a useful resource to the anaesthetist; trainee or practitioner who wants to master the nerve blocks.
Author(s): Arunangshu Chakraborty
Publisher: Springer Singapore
Year: 2021
Language: English
Pages: 193
City: Singapore
Preface
Acknowledgement
Contents
About the Editor
1: Basics of Ultrasound Guided Regional Anaesthesia
1.1 Basics of Ultrasound: Physics and Physiology
1.2 Mechanism of Action
1.3 Key Concepts [4–6]
1.4 Interactions of Ultrasound with Tissue
1.5 Echogenicity
1.6 Transducers
1.7 Time Gain Compensation
1.8 Practical Aspects
1.9 Compound Imaging
1.10 Manoeuvring the US Probe: PART
1.11 Needling Techniques
1.12 Bioeffect and Safety
1.13 Blockmate Pearls
References
2: Regional Anaesthesia for the Upper Limb
2.1 Introduction
2.2 Block Techniques
2.2.1 The Interscalene Block
2.2.2 The Supraclavicular Perivascular Approach
2.2.3 The Infraclavicular Approach
2.2.4 The Costoclavicular Block
2.2.5 The Axillary Block
2.2.6 Distal and Rescue Blocks of the Upper Limb
2.2.6.1 Intercostobrachial Nerve Block
2.2.6.2 Blocks at the Level of Elbow
Median Nerve Block
Radial Nerve Block
Ulnar Nerve Block
2.2.7 Rescue Blocks at the Level of Wrist
2.2.7.1 Median Nerve Block
2.2.7.2 Radial Nerve Block
2.2.7.3 Ulnar Nerve Block
2.2.8 Regional Anaesthesia for Shoulder Surgery
2.2.9 Superficial Cervical Plexus Block
2.2.10 Stellate Ganglion Block
References
3: Lower Extremity Nerve Blocks
3.1 Introduction
3.2 Anatomy and Innervation of Lower Extremity
3.2.1 Lumbar Plexus
3.2.2 Sacral Plexus
3.2.3 Lumbar Plexus Block or Psoas Compartment Block
3.2.3.1 Clinical Implications
3.2.4 Three-in-One Block or Fascia Iliaca Block
3.2.4.1 Clinical Implications
3.2.5 Femoral Nerve Block
3.2.5.1 Clinical Implications
3.2.6 Saphenous Nerve Block
3.2.6.1 Block Below the Knee
3.2.6.2 Adductor (Hunter’s) Canal Block (ACB)
3.2.7 Sciatic Nerve Block
3.2.7.1 Clinical Implications
3.2.8 Popliteal Sciatic Nerve Block
3.2.8.1 Clinical Implications
3.2.9 Infiltration of Local Anesthetic Between Popliteal Artery and Capsule of the Knee Block (IPACK)
3.2.10 Ankle Block
3.2.11 Saphenous Nerve Block
3.2.12 Superficial Peroneal Nerve Block
3.2.13 Deep Peroneal Nerve Block
3.2.14 Sural Nerve Block
3.2.14.1 Clinical Implications
References
4: Truncal Blocks
4.1 Introduction
4.2 Blocks in the Anterior Abdominal Wall
4.2.1 Transversus Abdominis Plane (TAP) Block
4.2.2 Rectus Sheath Block
4.2.3 Quadratus Lumborum Block
4.2.4 Ilioinguinal and Iliohypogastric (Hernia Block)
4.2.5 Spermatic Cord Block or Genitofemoral Nerve Block
4.3 Blocks in the Chest Wall
4.3.1 The Pecs Block
4.3.2 Serratus Anterior Plane Block (SAP)
4.3.3 Intercostal Nerves Block
4.3.4 Interpleural Block
4.4 Blocks in the Back
4.4.1 Erector Spinae Plain (ESP) Block
4.4.2 Thoracolumbar Interfascial Plane (TLIP) Block
4.4.3 Thoracic Paravertebral Block (TPVB)
References
5: Central Neuraxial Blockade
5.1 Anatomy
5.1.1 Intervertebral Discs and Ligaments
5.1.2 Spinal Cord
5.2 Physiology of Central Neuraxial Block and Effects on Various System
5.2.1 Pharmacology: LA + Adjuvants
5.2.2 Factors Affecting LA Spread
5.2.3 Conduct of Central Neuraxial Blockade: EQUIPMENTS
5.2.4 Position and Approach
5.2.5 Complications of CNB
5.2.6 Advantages of Central Neuraxial Nerve Blockade
5.2.7 Sonoanatomical Guidance
5.3 Ultrasonography of Central Neuraxial Space
5.3.1 USG Probe Placement
5.4 Blockmate Pearls
5.4.1 Caudal Anaesthesia
5.4.1.1 Applied Anatomy
5.4.2 Needling Technique
5.5 Blockmate Pearls
5.5.1 What Will You Do? (Table 5.6) [9]
References
6: Paediatric Regional Anaesthesia
6.1 Introduction
6.1.1 How Is USGRA Different in Children and What Are Its Benefits?
6.1.2 Ultrasound Probe Characteristics and Imaging
6.1.3 Clinical Pearls While Doing a USGRA
6.1.4 Prerequisites for Practicing USGRA
6.1.5 Principles of Dosing
6.1.6 Complications in Paediatric Regional Anaesthesia
6.2 Head and Neck Blocks
6.2.1 Maxillary Nerve Block
6.2.2 Greater Occipital Nerve Block
6.3 Upper Limb Blocks
6.4 Truncal Blocks
6.4.1 Thoracic Fascial Plane Blocks (for Details See Chap. 4)
6.4.2 Abdominal Fascial Plane Blocks
6.4.3 Erector Spinae Block (ESP)
6.4.4 Paravertebral Blocks
6.5 Central Neuraxial Blocks
6.5.1 Sub-arachnoid Block (SAB)
6.5.2 Epidural Anaesthesia
6.5.3 Caudal Anaesthesia
6.5.4 Complications of Caudal
6.5.5 Trans-sacral Approach to Caudal Space
6.6 Perineal Blocks
6.6.1 Pudendal Nerve Block
6.6.1.1 Blockmate Pearls
6.6.2 Dorsal Penile Nerve Block
6.6.2.1 Blockmate Pearls
References
7: Recent Advances in Regional Anaesthesia
7.1 Introduction
7.2 Expanding Roles
7.3 Technological Advances
7.4 Injection Pressure Monitoring
7.5 Novel Approaches to Regional Anaesthesia
7.6 Closed-Loop Systems
7.7 Pharmacological Agents
7.8 Novel Formulations
7.9 Adjuncts
7.10 Advances in Catheter Design
7.11 Machine Learning and Image Recognition
References
8: Safety and Ergonomics of Ultrasound-Guided Regional Anaesthesia
8.1 Introduction
8.2 Local Anaesthesia Systemic Toxicity (LAST)
8.3 Clinical Presentation of LAST
8.4 ASRA Guidelines for Management of LAST
8.5 Ergonomics of Ultrasound-Guided Regional Anaesthesia
8.5.1 Location: Place of Conduct
8.5.2 Role of Simulation
References
