Table Of Contenti
Ultrasound Guided Regional Anesthesia
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Ultrasound Guided
Regional Anesthesia
SECOND EDITION
Stuart A. Grant, MB, ChB
Professor of Anesthesiology
Duke University Medical Center
Durham, North Carolina
David B. Auyong, MD
Medical Director, Lindeman Ambulatory Surgery Center
Section Head, Orthopedic Anesthesiology
Virginia Mason Medical Center
Seattle, Washington
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1
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Published in the United States of America by Oxford University Press
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© Oxford University Press 2017
First Edition Published in 2012
Second Edition Published in 2017
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You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging- in- Publication Data
Names: Grant, Stuart A., author. | Auyong, David B., author.
Title: Ultrasound guided regional anesthesia/ Stuart A. Grant, David B. Auyong.
Description: Second edition. | Oxford ; New York : Oxford University Press, [2016] | Includes bibliographical
references and index.
Identifiers: LCCN 2016005613 | ISBN 978–0–19–023180–4 (pbk. : alk. paper)
Subjects: | MESH: Anesthesia, Conduction—methods | Ultrasonography—methods
Classification: LCC RD84 | NLM WO 300 | DDC 617.9/ 64—dc23
LC record available at http:// lccn.loc.gov/ 2016005613
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Preface
The foundations of this book come from the practical experience gained in performing and
teaching regional anesthesia techniques. Riding the initial waves of ultrasound guided regional
anesthesia, we reviewed many texts and other sources and found them to be lacking. Our
hope is to save the reader time and effort by sharing pearls and identifying pitfalls to set them
on a path for success.
This book differs from others of similar subject matter in that we have designed it as a
step- by- step practical companion. We succinctly lay down what we do and teach each day
in an organized fashion. There can be many approaches to any nerve block, and in the right
hands, many approaches can work. What we have conveyed are simple techniques based on
a thorough understanding of anatomy and our many years of clinical knowledge. This book
should provide all the necessary instruction to safely and accurately perform each nerve block
covered without an overwhelming amount of extraneous information.
In this second edition, we have refined the images that made the first edition so successful.
We have kept the format of clean, with unedited images next to colorfully annotated images
so the reader can compare the two side by side. In the few years since the first publication,
multiple additional ultrasound- guided techniques have been described in the medical litera-
ture. As in the first edition, we have distilled these down to the most clinically successful and
practical approaches and added them to this new edition.
These specific nerve blocks are described in Chapter 2— Upper Limb, Chapter 3— Lower
Limb, and Chapter 4— Trunk and Spine. Readers, whether novice or expert, should take time
to read Chapter 1. Chapter 1 is unique in that it covers the essentials of not just the “How
to Do It,” but the “How to Do It Well.” It contains many clinical pearls that can be useful
in performing any ultrasound- guided procedure. A new appendix, “What Block for What
Surgery?,” is found at the end of Chapter 1. This addition will be useful as a practical guide for
clinical decision making.
It is beyond the scope of this book to be a comprehensive anatomy, physics, pharmacology,
and neurophysiology reference, and we refer readers to the ample texts already published
on these subjects. This book should be used as an everyday working practice guide to cover
the most common blocks and surgical procedures. Within the following pages, we repeatedly
convey the fact that there is no substitute for a good understanding of anatomy. As new blocks
are introduced, we head directly for our anatomy textbooks and the cadaver laboratory to
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best understand how to make these new approaches work clinically. Fortunately, nothing has
changed in the anatomy book that you purchased as a student, so it remains your best com-
panion to supplement this textbook.
We are grateful to our families, friends, and colleagues for their patience and help during
the writing of this book and throughout our careers. We thank our contributors for their
enthusiasm and friendship. Lastly, we thank our teachers and mentors in the United States
and in Scotland for their guidance.
Stuart A. Grant
David B. Auyong
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Acknowledgments
We would like to specifically thank Drs. Jim G. Benonis, Dara S. Breslin, and Jeff Gonzales for
their contributions to the first edition of this book. We would also like to thank Dr. Shin- e Lin
for her time in reviewing this second edition for content and clarity.
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Contents
Chapter 1: Basic Principles of Ultrasound Guided
Nerve Block 1
Basic Ultrasound Physics and Ultrasound Machine Settings 3
How to Visualize Nerves and Needles 12
Common Artifacts and Errors 21
Positioning the Patient 26
Equipment and Preparation 28
Keys to Ultrasound Success 30
Principles of Peripheral Nerve Catheter Placement 35
Appendix: What Block for What Surgery? 39
Chapter 2: Upper Limb Ultrasound Guided
Regional Anesthesia 41
Interscalene Nerve Block 43
Suprascapular Nerve Block 61
Cervical Plexus Nerve Block 66
Supraclavicular Nerve Block 69
Infraclavicular Nerve Block 76
Axillary Nerve Block 83
Intercostobrachial Nerve Block 92
Nerve Blocks of the Elbow and Forearm 94
Chapter 3: Lower Limb Ultrasound Guided
Regional Anesthesia 105
Introduction 108
Femoral Nerve Block 111
Fascia Iliaca Block 121
Lateral Femoral Cutaneous Nerve Block 126
Adductor Canal Block (Selective Femoral Nerve Block) 129
Saphenous Nerve Block 137
