Regional Nerve Blocks And Infiltration Therapy: Textbook and Color Atlas, 3rd edition

445 Pages·2004·53.22 MB·English

by  Danilo Jankovic

Danilo Jan kovic
Regional Nerve
Blocks and
I nfiI t rat ion Therapy
Textbook and Color Atlas
3rd Edition, fully revised and expanded
Consultant on English Edition
William Harrop-Griffiths
MA, MB, BS, FRCA
Consultant Anaes thet is t
St Mary’s Hospital, Paddington, London
Blackwel I
Publishing

Danilo Jankovic . Regional Nerve Blocks and Infiltration Therapy
I dedicate this book to my wife, Lydia, and my children Lara and Aleks.
Their love, support, and encouragement have made the book possible.
Danilo Jan kovic
Regional Nerve
Blocks and
I nfiI t rat ion Therapy
Textbook and Color Atlas
3rd Edition, fully revised and expanded
Consultant on English Edition
William Harrop-Griffiths
MA, MB, BS, FRCA
Consultant Anaes thet is t
St Mary’s Hospital, Paddington, London
Blackwel I
Publishing
0 2004 by ABW Wissenschaftsverlag GmbH, Berlin
English language edition published by Blackwell Publishing Ltd
Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02 148-5020, USA
Blackwell Publishing ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
Blackwell Publishing Asia Pty ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia
The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs
and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted, in any form or by
01
any means, electronic, mechanical, photocopying, recording 01 otherwise, except as permitted by the UK Copyright, Designs and
Patents Act 1988, without the prior permission of the publisher
First published in German 1997
Second Edition published in English 2001
Third Edition published in English 2004
Library of Congress Cataloging-in-Publication Data
Jankovic, Danilo
[Regionalblockaden und Infiltratioiistherapie English]
Regional nerve blocks and infiltration therapy textbook and color atlas / Danilo Jankovicc 3rd ed , fully rev and expanded / consultant on
English ed., Williorn Hal rop-GIi ffiths.
p., cm
Rev ed. of. Regional nerve blocks / Danilojonkovic, Christopher Wells. 2nd ed. 2001
Includes bibliographical references and index
ISBN 1-4051 -2263-3 (hordbacki
1 Conduction anesthesia. 2 Conduction anesthesia-Atlases
[DNLM: 1 . Anesthesia, Conductioi?-methods-Atlases 2 Anesthetics, tocal~administration& dosage-Atiases. 3 Nerve Block-methods-Atlases.
4 Pain-drug therapy-Atlases. WO 5 I7 J33r 2004al I. Harrop-Griffiths, William. II Jonkovic, Danilo. Regionalblockaden. English Ill Titie.
RD84 J366 2004
6 17 9'64-dc22
2004011189
ISBN 1-4051 - 2263-3
A catalogue record for this title is available from the British library
Set in Germany by Goldener Schnitt, Sinzheim
Printed and bound in Germany by Bosch Druck, Landshui
Commissioning Editor: Stuart Taylor
Development Editor: Katrina Chandlei
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Foreword
Just over 35 years ago, I became interested in the use ledge of anatomy, physiology and pharmacology fol-
of neural blockade for the relief of pain during and af- lowed by carefully supervised training with the assis-
ter surgery and became convinced that this was a su- tance of clear and concise texts and reviews. Again,
perb treatment option for appropriately selected pa- this textbook by Jankovic provides an excellent basis for
tients. Despite the wonderful advances in general those wishing to become skilled in this field. In parallel
anaesthesia and development of much improved sys- with the execution of such skill and knowledge, the
temic analgesia, I have not changed my view of the im- other key ingredient is an appropriate collaboration
portant role of neural blockade in the treatment of with colleagues who can provide the other dimensions
acute pain. Initiatives in the United States of America to of patient care to ensure the best possible outcome in
make pain a "fifth vital sign" have focussed attention the treatment of cancer pain and chronic non-malig-
on the need for improved pain management, and the nant pain. Such an approach is necessary in order to
availability of as wide as possible a choice of options for avoid at one end of the spectrum almost complete
patients. I have proposed that the relief of acute pain neglect of neural blockade techniques and at the other
should be viewed as a "human right". In this context, end of the spectrum an overuse with neglect of alter-
there are a significant number of patients who will not native methods.
obtain effective pain relief without access to potent The author of this text is a very highly skilled practition-
neural blockade techniques. Such techniques are de- er of regional nerve blocks and, like the author, this text
scribed in a very concise and beautifully illustrated is very practically orientated. The descriptions of anato-
manner in this text. my are highly relevant to the regional blocks described
The management of cancer pain and chronic non-ma- and the illustrations are amongst the best that I have
lignant pain represents a much more major challenge seen. I have no doubt that the readers will find this text
than the treatment of acute pain. However, here again extremely valuable in their clinical practice aimed at the
the judicious use of neural blockade techniques can relief of acute, chronic and cancer pain.
make the world of difference to the effective manage-
ment of a substantial number of patients. It is a great
pity that in some clinics there has been a disconnection
between those providing non-invasive methods of Professor Michael J. Cousins AM
management and those with the knowledge and tech- MB BS MD FANZCA FRCA FFPMANZCA FAChPM (RACP)
nical skill to provide effective and safe neural blockade Professor & Director
techniques. The effective and safe performance of Pain Management Research Institute
neural blockade methods requires the requisite know- University of Sydney
The extremely gratifying response to the first and sec- tions into the most important trigger points are
ond editions of this book has encouraged me to meet now presented in detail in this new edition, accord-
the strong demand for further training in the technique ing to the regions of the body concerned (jaw,
of regional blocks by providing a substantially expand- shoulder region, arm, gluteal region, etc.). The clin-
ed, thoroughly checked and augmented edition. ical signs and treatment of myofascial pain syn-
Thanks to the translations of the second edition into dromes are also presented in precise detail. For ex-
English, Italian and Spanish, I have received comments ample, intra-articular injections have been added,
and suggestions on the book from all over the world, and the most important techniques involved are de-
and I have taken these into account in the present edi- scribed.
tion. Just under four years since the publication of the I would like to express my thanks to colleagues and
second edition, I am therefore presenting this hand- friends who have contributed to this edition: Prof.
book in an expanded and revised form, including a James Heavner, Prof. Gabor Racz, Prof. Andre van Zun-
much larger number of topics. As always, the focus has dert, and Prof. Battista Borghi. Thanks also go to my
been on educational aspects. colleagues and friends, Prof. E. Freye and Prof. N. Kor-
The following groups of topics have been added: ber, for advice, information, and ideas that have con-
Regional block techniques have been expanded and tributed to the success of this book.
supplemented in accordance with the most recent I am grateful to Mr. H. Kreuzner, Dip. Eng., for his
findings in the field of regional anesthesia, particu- tremendous patience and expertise during our inten-
larly in the area of the brachial plexus and the lum- sive collaboration and for the outstanding photograph-
bosacral plexus. The same applies to the section on ic work that resulted. Thanks also go of course to my
neuraxial anesthesia. son Aleks in this connection, who worked tirelessly and
The chapter on regional anesthesia in ophthalmolo- with tremendous commitment in producing and ar-
gy is completely new. Chapters on percutaneous ranging the photographs. Last but not least, my thanks
epidural neuroplasty and intravenous regional anes- therefore also go to the members of my family, who
thesia have also been newly added, as well as one have again supported me with all their strength and
on the ganglion impar. considerateness.
As the important field of infiltration therapy tech- I would like to express my gratitude for the help with
niques has been seriously and unjustly neglected in the English edition to my colleague and friend Profes-
clinical practice, I have given it particular attention. sor William Harrop-Griffiths.
After all, anesthetists and orthopedists, as well as I am grateful to the staff at the publishers, particularly
physicians working in other specialties, all depend Matthias Franzke and Milena Schaeffer-Kurepkat, for
on this type of precise injection in everyday practice. their constant support and expert assistance.
The treatment of myofascial trigger points is also
extremely important and requires specialized know-
ledge that is presented here. Quite specific injec- Danilo Jankovic Cologne, August 2004
VI
This book presents a practical summary of the most im- cological properties of the most frequently used local
portant block techniques used in diagnostic and ther- a nest heti cs .
apeutic and local anesthesia in the upper body. This The underlying concept for this book was the idea of
work is based on my many years’ experience in clinical presenting, in a clear and practical fashion, ways of car-
practice. rying out ablock with optimal efficacy while at the
The book is aimed at the many specialist disciplines whose same time ensuring the patient’s complete safety.
work involves pain therapy. This includes anesthetists, Special thanks go to my teacher, Prof. Hans Ulrich Ger-
orthopedic surgeons, general surgeons, neurosurgeons, bershagen. I would also like to thank the numerous col-
ENT surgeons, radiologists and fascia maxillary surgeons. leagues and friends who have provided advice, infor-
The techniques presented here in the illustrations and mation and ideas particularly Dr. Gunter Datz for his
-
text are an essential component of the modern multi- tremendous assistance, as weil as my colleagues in my
disciplinary approach to pain therapy. Each individual immediate area of work, particularly Ms. Gabriele Haar-
block is discussed step by step and the way in which it mann and Mr. Peter Kaufmann. Thanks also go to my
is carried out is rendered easier to grasp through the family for their understanding, patience and support.
use of specially developed record forms and checklists. Last, but not least, I should like to express my gratitude
At the same time. the physician concerned is informed to the publishers, Blackwell Science, for their helpful col-
about the relevant regulations that need to be observed. laboration and for the excellent design and presentation
The focus is on the description and discussion of PO- of the book.
tential complications - how to recognize them quickly. I shall welcome and gratefully take account of any sug-
how to prevent them and how to treat them in a timely gestions, tips and constructive criticism from readers of
fashion. I recommend those unfamiliar with this branch this book.
of pain therapy start by familiarizing themselves thor-
oughly with the anatomy of the region and the pharma- Danilo Jankovic Cologne, December 1996
VI I