Regional Nerve Blocks and Infiltration Therapy: Textbook and Color Atlas, 3rd Edition, Fully Revised and Expanded

433 Pages·2004·60.72 MB·English

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, 01 transmitted, in any form or by
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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The publisher's policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been rnanu-
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paper and cover board used have met acceptable environmental accreditation standards.
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

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V
Preface to the third edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VI
Preface to the first edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VII
1 Regional nerve blocks and infiltration therapy in clinical practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Head and neck region
2 Regional anesthesia in ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Andre van Zundert, Danilo Jankovic
. .
3 Occipitalnerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
4 Trigeminalnerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
5 Infiltration of trigger points in the muscles of mastication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
6 Cervicothoracic ganglion (stellate ganglion) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
7 Superior cervical ganglion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
8 Deep (and superficial) cervical plexus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
9 Brachialplexus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
lnterscaleneblock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Supraclavicular perivascular (subclavian perivascular) block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Vertical infraclavicular block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Axillaryblock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Shoulder region
10 Suprascapularnerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
11 Subscapular nerve blocks
Infiltration of subscapular muscle trigger points ("frozen shoulder") . . . . . . . . . . . . . . . . . . . . . . . . . . 128
12 Rotator cuff muscles
Injection techniques in the myofascial trigger points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
13 Shoulder region: intra-articular injections
Intra-articular injection into the shoulder joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Intra-articular injection into the acromioclavicular joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Elbow and hand region
14 Peripheral nerve blocks in the elbow region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
15 Peripheral nerve blocks in the wrist region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
16 Elbow and wrist
Infiltration of myofascial trigger points and intra-articular injections . . . . . . . . . . . . . . . . . . . . . . . . . . 149
17 Intravenous regional anesthesia (IVRA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
18 Intravenous sympathetic block with guanethidine (Ismelin@) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Thorax. abdomen. lumbar and sacral spinal region
Thorax
19 Thoracic spinal nerve blocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
IX
Contents
Lumbar spinal region
20 Lumbar paravertebral somatic nerve block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
2 1 Lumbar sympathetic block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Abdomen
22 Celiac plexus block . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Lumbosacral region
23 lliolumbosacral ligaments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
24 Ganglion impar (Walther ganglion) block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
25 Infiltration of the piriform trigger points (“piriform syndrome“) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Lower extremity
Anatomy of the lumbar plexus. sacral plexus and coccygeal plexus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Lumbar plexus blocks: introduction
26 Inguinal femoral paravascular block (“three-in-one“ block) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
27 Psoas compartment block (Cheyen access) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
28 Sciaticnerveblock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Blocking individual nerves in the lumbar plexus
29 Femoral nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
30 Lateral femoral cutaneous nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
31 Obturatornerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
32 llioinguinal and iliohypogastric nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
33 Blocking peripheral nerves in the knee joint region ........................................ 248
34 Blocking peripheral nerves in the ankle joint region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Neuraxial anesthesia
35 Neuraxialanatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Spinal anesthesia
36 Spinalanesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
37 Complications of spinal anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
38 Continuous spinal anesthesia (CSA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
39 Continuous spinal anesthesia (CSA) in obstetrics .......................................... 299
40 Chemical intraspinal neurolysis with phenol in glycerol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Epidural anesthesia
41 Lumbar epidural anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
42 Thoracic epidural anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
43 Epidural anesthesia in obstetrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
44 Lumbar epidural anesthesia in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
45 Epidural steroid injection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
46 Combined spinal and epidural anesthesia (CSE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Caudal epidural anesthesia
47 Caudal anesthesia in adult patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
48 Caudal anesthesia in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
49 Percutaneous epidural neuroplasty .................................................... 381
james E . Heavner, Gabor B. Racz, Miles Day, Rinoo Shah
50 Adjuncts to local anesthesia in neuraxial blocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
. .
Subject index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
X
Chapter 2 Chapter 49
Prof. Andre van Zundert Prof. James Heavner, DVM, PhD
Catharina Hospital Professor of Anesthesiology and Physiology
Dept. of Anesthesiology, ICU & Pain Clinic Director, Anesthesia Research
Michelangelolaan 2 Texas Tech University Health Sciences Center
5623 EJ Eindhoven Lubbock, TX 79430
Netherlands USA
Prof. Gabor Racz, MD
Chapter 28 Professor and Chair Emeritus, Dept. of Anesthesiology
Director of Pain Services
For the subgluteal access route Texas Tech University Health Sciences Center
Lubbock, TX 79430
Prof. Battista Borghi USA
Coordinator, International Orthopedic Anesthesia Club
Chief of Anesthesia Research Unit
lstituti Orthopedici Rizzoli
401 36 Bologna
Italy
XI