Atlas of Peripheral Regional Anesthesia

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Atlas of Peripheral Regional Anesthesia: Anatomy and Techniques Media Center Information Title Page Copyright Contents Foreword Acknowledgements Contributors List of Videos Abbreviations Part I General Aspects of Ultrasound-Guided Peripheral Regional Anesthesia 1 General Principles of Ultrasound-Guided Peripheral Nerve Blocks 1.1 Technical Requirements 1.1.1 Equipment 1.1.2 Optimizing the Ultrasound Image 1.1.3 Structural Features in Ultrasound 1.2 Ultrasound-Guided Needle Approach 1.2.1 Ultrasound Techniques for Needle Insertion 1.3 Ultrasound for Continuous Block Techniques 1.3.1 Learning Ultrasound-Guided Needle Placement Techniques 1.3.2 How to Approach the Nerve? Intraneurally, Extraneurally? 1.3.3 Ultrasound in Any Event—What is the Available Evidence? References Part II Upper Limb 2 General Overview 2.1 Anatomy 2.2 Important Topographical Anatomical Relations in the Region of the Brachial Plexus 2.3 Motor and Sensory Supply of the Upper Limb 2.4 Historical Overview—Upper Limb References 3 Interscalene Techniques of Brachial Plexus Block 3.1 Anatomy 3.2 Meier Approach 3.2.1 Positioning 3.2.2 Needle Approach 3.2.3 Interscalene Brachial Plexus Block with Ultrasound 3.3 Pippa Approach 3.3.1 Posterior Approach 3.3.2 Interscalene Block of the Brachial Plexus Using Ultrasound (Pippa Approach) 3.4 Sensory and Motor Effects 3.5 Indications and Contraindications 3.5.1 Indications 3.5.2 Contraindications 3.6 Supraclavicular Nerve Block (Cervical Plexus) 3.7 Complications, Side Effects, Method-Specific Problems 3.7.1 Neurological Complications after Shoulder Surgery in Interscalene Plexus Anesthesia 3.7.2 Side Effects Intrinsic to the Method References 4 Supraclavicular and Infraclavicular Techniques of Brachial Plexus Block 4.1 Anatomy 4.2 Supraclavicular Block Techniques 4.2.1 Ultrasound-Guided Supraclavicular Block of the Brachial Plexus 4.3 Vertical Infraclavicular Block According to Kilka, Geiger, and Mehrkens 4.3.1 Positioning 4.3.2 Needle Approach 4.3.3 Local Anesthetics, Dosages 4.3.4 Comparison of the Vertical Infraclavicular Technique with the Axillary Technique 4.4 Raj Technique, Modified by Borgeat 4.4.1 Positioning 4.4.2 Needle Approach 4.4.3 Material 4.4.4 Local Anesthetics, Dosages 4.5 Infraclavicular Brachial Plexus Block Using Ultrasound 4.5.1 Ultrasound Visualization of the Brachial Plexus 4.5.2 Needle Approach 4.5.3 Catheter Placement 4.6 Sensory and Motor Effects 4.7 Indications and Contraindications 4.7.1 Indications 4.7.2 Contraindications 4.8 Complications, Side Effects, Method-Specific Problems 4.8.1 Horner Syndrome 4.8.2 Phrenic Nerve Paresis 4.8.3 Pneumothorax References 5 Suprascapular Nerve Block 5.1 Anatomy 5.2 Meier Approach 5.2.1 Procedure 5.2.2 Suprascapular Nerve Block with Ultrasound 5.3 Sensory and Motor Effects 5.4 Indications and Contraindications 5.4.1 Indications 5.4.2 Contraindications 5.5 Complications, Side Effects, Method-Specific Problems References 6 Axillary Block 6.1 Anatomy 6.2 Perivascular Single-Injection Technique 6.2.1 Method 6.2.2 Perivascular Axillary Block of the Brachial Plexus Using Ultrasound 6.3 Sensory and Motor Effects 6.3.1 Local Anesthetic, Dosages 6.4 Indications and Contraindications 6.4.1 Indications 6.4.2 Contraindications 6.5 Complications, Side Effects, Method-Specific Problems 6.6 Multistimulation Technique, “Midhumeral Approach” According to Dupré 6.6.1 Positioning, Landmarks 6.6.2 Method 6.6.3 Puncture Needle 6.7 “Classical” Axillary Block of the Brachial Plexus with Ultrasound 6.7.1 Visualization of the Brachial Plexus Using Ultrasound (in the Axilla) 6.7.2 Puncture 6.7.3 Catheter Placement References 7 Selective Blocks of Individual Nerves in the Upper Arm, at the Elbow, and Wrist 7.1 Radial Nerve Block (Middle of Upper Arm) 7.1.1 Anatomy 7.1.2 Method 7.1.3 Radial Nerve Block of the Upper Arm Using Ultrasound 7.2 Blocks at the Elbow 7.2.1 Anatomy 7.2.2 Radial Nerve Block (Elbow) 7.2.3 Musculocutaneous Nerve Block (Elbow) 7.2.4 Median Nerve Block (Elbow) 7.2.5 Ulnar Nerve Block (Elbow) 7.2.6 Individual Nerve Blocks with Ultrasound (Elbow) 7.3 Blocks at the Forearm (“Wrist Block”) 7.3.1 Anatomy 7.3.2 Median Nerve Block (Wrist) 7.3.3 Ulnar Nerve (Wrist) 7.3.4 Radial Nerve (Wrist) 7.3.5 Block of Individual Nerves with Ultrasound References Part III Lower Limb 8 General Overview 8.1 Lumbosacral Plexus 8.1.1 Lumbar Plexus 8.1.2 Sacral Plexus 8.2 Historical Overview—Lower Limb 8.3 Sensory Innervation of the Leg 8.3.1 Innervation of the Bones (Innervation of Periosteum) References 9 Psoas Block 9.1 Anatomical Overview 9.2 Technique of Psoas Block 9.2.1 Classical Technique (according to Chayen) 9.2.2 Psoas Blockade with Ultrasound 9.3 Sensory and Motor Effects 9.4 Indications and Contraindications 9.4.1 Indications 9.4.2 Contraindications 9.5 Complications, Side Effects, Method-Specific Problems 9.6 Remarks on the Technique 9.7 Summary References 10 Inguinal Paravascular Lumbar Plexus Anesthesia (Femoral Nerve Block) 10.1 Anatomical Overview 10.2 Femoral Nerve Block 10.2.1 Needle Approach 10.2.2 Needle Approach with Ultrasound 10.3 Sensory and Motor Effects 10.4 Indications and Contraindications 10.4.1 Indications 10.4.2 Contraindications 10.5 Complications, Side Effects, Method-Specific Problems 10.5.1 Method-Specific Problems 10.6 Remarks on the Technique References 11 Proximal Sciatic Nerve Block 11.1 Anatomical Overview 11.1.1 Sciatic Plexus 11.1.2 Sciatic Nerve (L4–S3) 11.1.3 Posterior Cutaneous Nerve of the Thigh (S1–S3) 11.1.4 Periosteal Innervation 11.2 Anterior Proximal Sciatic Nerve Block (with Patient in Supine Position) 11.2.1 Technique of Anterior Sciatic Nerve Block 11.2.2 Indications and Contraindications (in Combination with Femoral Nerve Block) 11.2.3 Side Effects and Complications 11.2.4 Remarks on the Technique 11.2.5 Anterior Proximal Sciatic Nerve Block Using Ultrasound 11.3 Posterior Proximal Sciatic Nerve Block (in Supine Position) 11.3.1 Technique 11.3.2 Indications and Contraindications 11.3.3 Side Effects and Complications 11.3.4 Remarks on the Technique 11.3.5 Posterior Proximal Sciatic Nerve Block (in Supine Position) with Ultrasound 11.4 Proximal Lateral Sciatic Nerve Block (with Patient in Supine Position) 11.4.1 Technique 11.4.2 Indications, Contraindications, Complications, Side effects 11.4.3 Remarks on the Technique 11.5 Proximal Sciatic Nerve Block (with Patient Lying on Side) 11.5.1 Techniques of Posterior Transgluteal Sciatic Nerve Block 11.5.2 Indications and Contraindications 11.5.3 Complications and Side Effects 11.5.4 Remarks on the Technique 11.5.5 Proximal Sciatic Nerve Block (in Lateral Position) with Ultrasound 11.5.6 Infragluteal Block of the Sciatic Nerve in Lateral Position with Ultrasound 11.6 Parasacral Sciatic Nerve Block (Mansour Technique) 11.6.1 Technique 11.6.2 Indications and Contraindications 11.6.3 Side Effects and Complications 11.6.4 Remarks on the Technique 11.6.5 Parasacral Sciatic Nerve Block with Ultrasound References 12 Blocks at the Knee 12.1 Anatomical Overview 12.2 Classical Popliteal Block, Posterior Approach 12.2.1 Technique 12.2.2 Remarks on the Technique 12.3 Distal Block of the Sciatic Nerve 12.3.1 Technique 12.3.2 Indications and Contraindications 12.3.3 Side Effects and Complications 12.3.4 Remarks on the Technique 12.3.5 Distal Sciatic Nerve Block Using Ultrasound References 13 Peripheral Block (Conduction Block) of Individual Nerves of the Lower Limb 13.1 Lateral Cutaneous Nerve of the Thigh 13.1.1 Anatomy 13.1.2 Techniques 13.1.3 Indications, Contraindications, Side Effects 13.1.4 Remarks on the Technique 13.1.5 Block of the Lateral Cutaneous Nerve of the Thigh Using Ultrasound 13.2 Infiltration of the Iliac Crest 13.2.1 Indication 13.2.2 Procedure 13.3 Transversus Abdominis Plane Block (TAP Block) 13.3.1 Anatomy 13.3.2 Landmarks 13.3.3 Indications and Contraindications 13.3.4 Procedure 13.4 Obturator Nerve Block 13.4.1 Anatomy 13.4.2 Techniques 13.4.3 Indications and Contraindications 13.4.4 Side Effects and Complications 13.4.5 Remarks on the Technique 13.5 Saphenous Nerve Block 13.5.1 Anatomy 13.5.2 Techniques 13.5.3 Indications and Contraindications 13.5.4 Side Effects and Complications 13.5.5 Remarks on the Technique 13.6 Fibular Nerve Block 13.6.1 Anatomy 13.6.2 Techniques 13.6.3 Indications and Contraindication 13.6.4 Side Effects and Complications 13.6.5 Remarks on the Technique References 14 Peripheral Nerve Blocks at the Ankle 14.1 Anatomy 14.2 Saphenous Nerve, Sural Nerve, and Superficial Fibular Nerve Block 14.2.1 Saphenous Nerve Block 14.2.2 Superficial Fibular Nerve Block and Sural Nerve Block 14.3 Deep Fibular Nerve Block 14.3.1 Landmarks 14.3.2 Procedure 14.4 (Posterior) Tibial Nerve Block 14.4.1 Landmarks and Position 14.4.2 Procedure 14.5 Ankle Block 14.6 Indications, Contraindications, Complications, Side Effects 14.6.1 Indications 14.6.2 Contraindications 14.6.3 Side Effects and Complications 14.7 Remarks on the Combination Block (Ankle Block) 14.8 Summary 14.9 Blocks at the Toes 14.9.1 Anatomy 14.9.2 Block Anesthesia of the Toes (Oberst Anesthesia) References Part IV Peripheral Regional Anesthesia in Pediatrics 15 General Overview 15.1 Needle-Transducer Alignment 15.2 Ultrasound Axes References 16 Upper Limb 16.1 Supraclavicular Block of the Brachial Plexus 16.1.1 Anatomy 16.1.2 Sonoanatomy 16.1.3 Technique of Supraclavicular Brachial Plexus Block 16.1.4 Indications and Contraindications 16.1.5 Complications, Side Effects, Method-Specific Problems 16.1.6 Remarks on the Technique 16.2 Axillary Block of the Brachial Plexus 16.2.1 Anatomy 16.2.2 Technique of Axillary Brachial Plexus Block 16.2.3 Indications and Contraindications 16.2.4 Complications, Side Effects, Method-Specific Problems 16.2.5 Remarks on the Technique References 17 Lower Limb 17.1 Femoral Nerve Block 17.1.1 Anatomy 17.1.2 Sonoanatomy 17.1.3 Technique of Femoral Nerve Block 17.1.4 Indications and Contraindications 17.1.5 Complications, Side Effects, Method-Specific Problems 17.1.6 Remarks on the Technique 17.2 Distal Sciatic Nerve Block 17.2.1 Anatomy 17.2.2 Technique of Distal Sciatic Nerve Block 17.2.3 Indications and Contraindications 17.2.4 Complications, Side Effects, Method-Specific Problems 17.2.5 Remarks on the Technique References 18 Abdominal Wall 18.1 Penile Root Block 18.1.1 Anatomy 18.1.2 Technique of Penile Root Block 18.1.3 Indications and Contraindications 18.1.4 Complications, Side Effects, Method-Specific Problems 18.1.5 Remarks on the Technique 18.2 Ilioinguinal Nerve Block 18.2.1 Anatomy 18.2.2 Sonoanatomy 18.2.3 Technique of Ilioinguinal Nerve Block 18.2.4 Indications and Contraindications 18.2.5 Complications, Side Effects, Method-Specific Problems 18.2.6 Remarks on the Technique 18.3 Transversus Abdominis Plane Block 18.3.1 Anatomy 18.3.2 Sonoanatomy 18.3.3 Technique of Transversus Abdominis Plane Block 18.3.4 Indications and Contraindications 18.3.5 Complications, Side Effects, Method-Specific Problems 18.3.6 Remarks on the Technique References Part V General Aspects of Peripheral Nerve Blocks of the Extremities 19 Special Features of Peripheral Nerve Blocks 19.1 Advantages of Peripheral Nerve Blocks 19.2 Problems of Peripheral Nerve Blocks 19.2.1 Incomplete Block 19.2.2 Dosages of Local Anesthetic References 20 Complications and General Contraindications of Peripheral Blocks 20.1 Complications of Peripheral Nerve Blocks 20.1.1 Toxic Reactions Caused by the Local Anesthetic 20.1.2 Neurological Injuries (Neuropathy) 20.2 General Contraindications to Peripheral Nerve Blocks 20.2.1 Infections 20.2.2 Coagulation Disorders 20.2.3 Pre-existing Neurological Deficits References 21 General Principles for Performing Peripheral Blocks 21.1 Essential Components Necessary for Proper Aseptic Technique 21.2 General Principles of Informed Consent, Positioning and Monitoring 21.2.1 Patient Informed Consent before Peripheral Nerve Blocks 21.2.2 Position 21.2.3 Monitoring 21.3 Technical Aids for Performing Peripheral Nerve Blocks 21.3.1 Vascular Doppler Sonography 21.3.2 Ultrasonography 21.3.3 Surface Thermometer 21.3.4 Peripheral Nerve Stimulation 21.3.5 Needles and Catheters 21.4 General Principles for Performing Regional Anesthesia 21.4.1 With Nerve Stimulator 21.4.2 With Ultrasound 21.5 Analgosedation 21.5.1 For Peripheral Nerve Blocks 21.5.2 Concomitant Medication during Surgery under Regional Anesthesia 21.6 General Principles for Administration of Local Anesthetics in Peripheral Nerve Block 21.6.1 Local Anesthetics 21.6.2 Dosage 21.6.3 Measures to Shorten the Latency Time 21.6.4 Adjuvants References 22 Continuous Peripheral Nerve Blocks 22.1 Advantages 22.2 Indications 22.2.1 Differential Indications 22.3 Local Anesthetics: Administration, Dosage 22.3.1 Care of Peripheral Pain Catheters in a General Ward 22.3.2 Peripheral Nerve Catheters for Outpatient Regional Pain Management 22.3.3 Complications of Peripheral Nerve Catheters for Pain Management References Index