The purpose of this handbook is to provide clinicians with an easy access to the art and science of regional anaesthetic techniques. We believe we have provided the reader with a practical guide, in the familiar format of the Oxford Handbook series, combined with aspects of a larger reference text, in a handy pocket-sized book. We have deliberately included both landmark or peripheral nerve stimulator-guided techniques and ultrasound techniques to provide a complete clinical guide. Anatomy features strongly throughout the chapters as it remains the cornerstone of good clinical regional anaesthesia, whether using an ultrasound or a peripheral nerve stimulator, and indeed the legendary Alon P. Winnie remarked 'Regional anesthesia is simply an exercise in applied anatomy'.A\The first section covers a wide range of topics on the background of regional anaesthesia. There is an amusing and enlightening chapter on the history of regional anaesthesia. There are chapters covering the basic science of physiology of pain, pharmacology of drugs, physics and use of ultrasound, and peripheral nerve stimulators. Whilst maintaining a strong science base, we have tried to make these chapters as clinically relevant as possible and have useful clinical tips on the practice of regional anaesthesia and frequent summanes of published evidence. There are also sections to deal with risks and complications of regional anaesthesia. Included in this section are some more advanced techniques of wound and nerve catheters and paediatric regional anaesthesia.A\The remainder of the book provides detailed descriptions of almost all conceivable regional anaesthetic techniques over the whole of the body. The obvious upper and lower limb blocks are there, with descriptions of all common approaches. Unlike some pocket guides we have included head and neck blocks and ophthalmic regional anaesthesia. We have also covered trunk blocks, those of both the chest, including the increasingly popular paravertebral blocks, and of the abdominal wall; such as TAP and rectus sheath blocks. Each chapter provides a representation of the complexity of the block, the indications, contraindications, and complications. There is an overview of the anatomy with frequent diagrams to illustrate. The step-by-step 'hands on' guides of the blacks are again complemented with diagrams to aid understanding and to help the practice of block performance and of course ultrasound images of the appropriate anatomy. There are frequent helpful clinical tips and hints throughout.A\Although familiar to many, we have included a section describing central neuraxial techniques. Although the basics of the practical techniques are.covered, there is perhaps more of a focus on the use of these techniques in certain situations and there is a chapter to describe and illustrate the emerging skill of spinal ultrasonography in regional anaesthesia.A\There are many contributors to the text of the book; all are clinical anaesthetists with an enthusiasm and passion for regional anaesthesia. Many of them will be familiar names from the 'aristocracy' of regional anaesthesia in this country, teaching and preaching on national and international stages over many years of dedication. Our thanks to them all for their expert contributions and their forbearance on bnnging this book to publication.A\The text and images have been checked, but we apologies in advance for any errors (or differing points of view) and would welcome your feedback, comments, and corrections Whilst we hope that this handbook provides an invaluable guide and reference, it is not a substitute for the proper study, training, practice, and mentorship to attain proficiency In the safe and effective delivery of regional anaesthesia to your patients.Paul Warman;David Conn;Barry Nicholls;David Wilkinson

Contributors xii

Symbols and Abbreviations xv

Part 1 Genera! Considerations

1 A brief history of regional anaesthesia 3

2 The physiology of acute pain 11

3 Local anaesthetics and additives 25

4 Local anaesthetic toxicity 37

5 Peripheral nerve location using nerve stimulators 49

6 Basic physics of ultrasound 61

7 Principles and practice of ultrasound-guided regional anaesthesia 79

8 Risks, benefits, and controversies of regional anaesthesia 97

9 Regional anaesthesia in patients taking anticoagulant drugs 117

10 Preparation and care of the awake patient during surgery 127

11 Wound infiltration and catheter techniques 133

12 Dermatomes and myotomes 139

13 Paediatric regional anaesthetic techniques 149

14 Peripheral nerve catheters 159

15 Training and assessment in regional anaesthesia 177

Part 2 Head and Neck

16 Regional anaesthesia for ophthalmic surgery 195

17 Maxillofacial blocks 209

18 Cervical plexus blocks 235

19 Stellate ganglion (cervical sympathetic trunk) block 245

20 Topical and regional anaesthesia of the upper airways 253

Part 3 Upper Limb

21 Interscalene brachial plexus block 265

22 Suprascapular nerve block 277

23 Supraclavicular brachial plexus block 283

24 Infraclavicular brachial plexus block 293

25 Axillary brachial plexus block 303

26 Mid-humeral block 311

27 Elbow and forearm blocks 317

28 Wrist, hand, and finger blocks 329

29 Intravenous regional anaesthesia (Bier's block) 339

Part 4 Trunk Blocks

30 Intercostal and interpleural blocks 345

31 Paravertebral block 353

32 Transversus abdominis plane block 363

33 Ilioinguinal and iliohypogastric nerve blocks 373

34 Rectus sheath block 381

35 Penile block 389

Part 5 Lower Limb

36 Posterior lumbar plexus (psoas compartment, lumbar plexus) block 395

37 Femoral nerve block 405

38 Fascia iliaca block 413

39 Lateral cutaneous nerve of the thigh block 421

40 Saphenous nerve block 427

41 Obturator nerve block 435

42 Parasacral approach to sacral plexus block 443

43 Proximal sciatic nerve block 449

44 Popliteal fossa sciatic nerve block 469

45 Ankle block 481

46 Foot blocks 493

Part 6 Neuraxial

47 General considerations for central neuraxial blocks 499

48 Epidural anaesthesia and analgesia 509

49 Spinal anaesthesia, combined spinal epidural, and continuous spinal anaesthesia 521

50 Ultrasound for central neuraxial blocks 531

Index 545

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