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Complications in Regional Anesthesia and Pain Medicine ISBN-13:978-1-4160-2392-0
Copyright © 2007 by Saunders,an imprint ofElsevier Inc. ISBN-10:1-4160-2392-5
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Notice
Knowledge and best practice in this field are constantly changing.As new research and experience broaden
our knowledge,changes in practice,treatment,and drug therapy may become necessary or appropriate.
Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the
manufacturer ofeach product to be administered,to verify the recommended dose offormula,the method
and duration ofadministration,and contraindications.It is the responsibility ofthe practitioner,relying on
their own experience and knowledge ofthe patient,and to make diagnoses,to determine dosages and the best
treatment for each individual patient,and to take all appropriate safety precautions.To the fullest extent of
the law,neither the Publisher nor the authors assume any liability for any injury and/or damage to persons
or property arising out ofor related to any use ofthe material contained in this book.
The Publisher
Library ofCongress Cataloging-in-Publication Data
Complications in regional anesthesia and pain medicine / editors,Joseph Neal,
James P.Rathmell.-- 1st ed
p.cm.
ISBN 1-4160-2392-5
1. Conduction anesthesia--Complications.2. Pain--Treatment.3. Pain medicine.
I.Neal,Joseph M.II.Rathmell,James P.
RD84.C658 2007
617.9′64--dc22 2006044963
Executive Publisher: Natasha Andjelkovic
Developmental Editor: Katie Davenport
Project Manager: Bryan Hayward
Printed in the United States ofAmerica
Last digit is the print number: 9 8 7 6 5 4 3 2 1
We dedicate this book to the well being of our patients,
to the education of our residents and fellows,and to the collegiality
of our colleagues.
Most of all,we offer our heartfelt gratitude to our families.
Without their love and support,nothing would be possible—
Kay,Erin,and Pete Neal
Bobbi,Lauren,James,and Cara Rathmell
Neal, J.M.; Rathmell, J.P. (Eds.) (2007) Complications in Regional Anesthesia and Pain
Medicine – Elsevier Saunders
Preface
This text arose from the close collaboration of two physi- The content is organized into distinct sections.The sec-
cians who have spent the early part oftheir careers fascinated tion on regional anesthesia is somewhat artificially separated
with just how we might improve the safety ofthe techniques from the section on pain medicine; we realize that
we use in the operating room and the pain clinic.We have many complications span both subspecialties.The first,and
both published on topics ranging from how to perform a largest,portion is dedicated toward discussing the complica-
“test dose” during the conduct of regional anesthesia, to tions that have been reported with specific techniques or
detailing the probable mechanism underlying catastrophic agents, complications both common and uncommon. The
neural injuries that have been reported during cervical last part attempts to clarify issues of informed consent and
transforaminal injection. liability.
In recent years, we have worked closely in performing We have been honored by the willingness of highly
the editorial work of the journal Regional Anesthesia and respected friends and colleagues to devote their time
Pain Medicine,and in our roles serving the journal we have and expertise to the creation of detailed chapters that were
fielded many case reports detailing new and unexpected subject to rigorous editing.We believe that any knowledge-
complications.The American Society ofRegional Anesthesia able anesthesiologist is likely to recognize these authors
and Pain Medicine, an organization dedicated to training as leading experts in the specific complications on which
physicians to safely and effectively conduct regional anesthe- they have written. Our editorial goals were to ensure a
sia,has spent much effort on assembling guidelines for the consistent framework for how each chapter was organized,
safe conduct ofthese techniques. Indeed,a number ofthese to require the authors to be as evidence-based as possible,
guidelines have become the standard references for guiding and to provide readers with visually appealing figures
the conduct ofneural blockade in settings where the risk of and boxes that would facilitate their understanding of each
adverse events is elevated, such as in the administration of topic.
anticoagulants to patients,or in the prevention and manage- We could not have produced this book without the
ment of infectious or neurologic complications associated valued expertise ofseveral other key people.The spectacular
with regional anesthesia. original artwork is by Gary Nelson,an indefatigable medical
During one of our frequent discussions, the idea of illustrator from the University of Vermont. Working with
compiling a single text that would detail what was known him is almost pleasurable enough to search for yet another
about the occurrence, recognition, treatment, and preven- book project.The readability ofthis book is largely credited
tion of complications took root and has grown to this to Jeff Baker, Managing Editor of the journal Regional
new text. Anesthesia and Pain Medicine based in Seattle,Washington.
When we set out to create a book focusing on the Without his attention to detail,adherence to deadlines,and
complications associated with regional anesthesia and pain unflappable good humor, this project would have been
medicine practice, we had just two goals: to compile in a much less pleasant. In Burlington, Vermont, it was Kellie
single volume the current best knowledge regarding complica- Dutra who organized and reorganized text and reminded
tions specific to our sub-specialties,and to seek that knowledge and re-reminded contributors to stay on schedule. Finally,
from authors who would be recognized worldwide for their no book would ever come to fruition without a dedicated
expertise on the chosen topic. and supportive publishing team. To this end, we offer our
x Preface
sincere thanks to Natasha Andjelkovic, Katie Davenport, regional anesthesia and pain medicine,and for the patients
Bryan Hayward,Karen O'Keefe-Owens,and Anne Snyder of we serve.
Elsevier, Inc., and to Charles Annis of Graphic World
Publishing Services. Joseph M.Neal,MD
Seattle,Washington,USA
Ifone accepts the Hippocratic dictum “first,do no harm,”
preventing complications or effectively treating them
James P.Rathmell,MD
becomes of paramount importance to practitioners of
Boston,Massachusetts,USA
