04.Part I: Regional Anesthesia Strategies for Various Surgical Procedures
05.1. Analgesia for Shoulder Surgery
06.2. Analgesia for Surgery of the Elbow
07.3. Analgesia for Surgery of the Clavicle
09.5. Anaesthesia for Arteriovenous Fistula [AVF] Creation
10.6. Analgesia for Breast Surgery
11.7. VATS/Thoracic Surgery
12.8. Cardiac Surgery: Open Heart Surgery Through Median Sternotomy
14.10. Analgesia for Caesarean Section
15.11. Analgesia for Upper Abdominal Surgery with Midline Incision
16.12. Analgesia for Laparoscopic/Open Cholecystectomy
17.13. Analgesia for Lap/Open Nephrectomy
18.14. Anaesthesia for Caesarean Delivery
20.16. Analgesia for Inguinal Hernia Surgery
21.17. Analgesia for Total Hip Arthroplasty
22.18. Analgesia for Total Knee Replacement and Cruciate Ligament Surgery
23.19. Analgesia for Lower Limb Amputation
24.20. Analgesia for Ankle and Foot Surgery
25.21. Analgesia for Perineal Surgery
26.Part II: Complications of Regional Anesthesia
27.22. Management of Nerve Injury
28.23. Complication: Central Nerve Damage After Neuraxial Block
29.24. Local Anaesthetic Systemic Toxicity (LAST)
30.25. Vascular Puncture and Hemorrhage
31.26. Block Failure and Rescue Block
32.27. Neurotoxicity of LA and Adjuvants
33.28. Spinal Anaesthesia Induced Hypotension
35.29. Vertebral Canal Haematoma
36.30. Infection with Regional Anaesthesia
38.32. Post Dural Puncture Headache
40.33. Phrenic Nerve Palsy
41.34. Management of Patients on Anticoagulants
42.35. Tourniquet Pain Under Regional Anaesthesia
43.36. Interscalene Block
45.38. Femoral Nerve Block
46.39. Adductor Canal Block
49.40. Popliteal Sciatic Nerve Block
50.41. Erector Spinae Plane Block
51.42. Rectus Sheath Block
52.43. Spinal Anaesthesia
54.Functional Anatomy to Consider During Spinal Anaesthesia
55.Risks and Benefits of Spinal Anaesthesia
56.Indications and Benefits of Spinal Anaesthesia
64.Continuous Spinal Anaesthesia
65.Troubleshooting Difficulties with the Administration of Spinal Anaesthetic
66.44. Lumbar and Thoracic Epidural
73.Blood Vessels of Clinical Significance
74.Ligaments of Clinical Significance
76.Surface Anatomy (Fig. 44.3)
80.Physiological Effects of Epidural Blockade
81.Indications and Contraindications
83.Midline Versus Paramedian
84.Tactile Sensation During Either Approach
88.45. Combined Spinal Epidural Block
90.Functional Anatomy to Consider During CSE
91.Applications of the CSE
94.Technical Consideration of CSE
95.The Needle-Through-Needle Technique (NTN)
97.Applied Anatomy of Standard Approaches to Epidural Space
98.Midline/Interlaminar Approach
101.Different Drugs Used and Their Duration of Action
102.Complications of the CSE Technique
103.Contraindications in CSE
104.46. Superior Trunk Block
105.47. Combined Axillary and Suprascapular Block
106.48. Infraclavicular Block
107.Anatomy & Surface Anatomy
108.Important Anatomical Structures
112.Nerve Stimulator Technique
113.Continuous Regional Anaesthesia Techniques
114.49. Supraclavicular Block
115.Anatomy & Surface Anatomy
117.Advantages Over Other Techniques
119.Ultrasound Techniques
123.Optimal Needle Tip Position
125.Subclavian Perivascular Block (Nerve Stimulator Technique)
126.Continuous Regional Anaesthesia Techniques
127.50. Lumbar Plexus Block
131.Landmark—Peripheral Nerve Stimulation Technique
132.Ultrasound-Guided Approaches to Lumbar Plexus Block
133.Continuous Catheter Technique
134.Part III: Individual Regional Anaesthesia Techniques
136.Anatomy & Surface Anatomy
143.Landmark Techniques (Ankle and Midtarsal)
144.Ultrasound-Guided Block Technique
145.53. Proximal Sciatic Nerve Blocks
147.Proximal Sciatic Blocks
148.Transgluteal Approach
150.Anterior Proximal Sciatic Approach
151.54. Thoracic Paravertebral Block
152.55. Serratus Plane Block
153.56. Interpectoral and Pecto-Serratus Block (PECs1 and PECs 2)
154.57. Quadratus Lumborum (QL Block)
155.58. Transversus Abdominis Plane Block
159.59. Median Nerve Block
160.Anatomy and Surface Anatomy
163.Ultrasound Techniques
164.Needling Technique, Nerve Stimulator
165.60. Radial Nerve Block
166.Anatomy and Surface Anatomy
169.61. Ulnar Nerve Block
170.Anatomy & Surface Anatomy
173.Advantages Over Other Techniques
174.Ultrasound Techniques
177.Wrist Level (Guyon’s Canal)
180.63. Ilioinguinal/Iliohypogastric Block
182.64. WALANT and Tumescent Anaesthesia
183.WALANT (Wide Awake Local Anaesthesia No Tourniquet)
184.Tumescent Local Anaesthesia
185.Technical Pearls for Tumescent Anaesthesia in Liposuction
186.65. Chronic Postsurgical Pain
188.66. Acute Compartment Syndrome
190.67. Failed Spinal Anaesthesia
192.Part IV: Miscellaneous
193.68. Recognition and Management of Accidental Intrathecal Catheter
195.69. Management of Pain During Caesarean Section
197.70. Rebound Pain After Peripheral Nerve Blocks
199.71. Transient Neurologic Symptoms After Spinal Anaesthesia
569.Fig. 1.1: Innervation of the shoulder joint
570.Fig. 1.2: Nerve innervation and muscle anatomy of the posterior shoulder
571.Fig. 1.3: Schematic showing branches of the brachial plexus
572.Fig. 1.4: Anatomy of the brachial plexus and surrounding structures in the shoulder region
573.Fig. 1.5: Interscalene Nerve Block (Ultrasound Cross-Section of Neck Anatomy Depicting Sternocleidomastoid (Scm), Anterior Scalene Muscle (ASm), Internal Jugular Vein (IJ. V), Carotid Artery (Car. A), Vertebral Vein (Ve. V), Vertebral Artery (Ve. A), Longus Colli Muscle (LCm), Middle Scalene Muscle (MSm), and Cervical Nerve Roots (C5, C6, C7) Red arrow – long thoracic nerve, blue arrow – dorsal scapular nerve, white arrow – phrenic nerve. C7 TP = C7 Transverse process
574.Fig. 1.6: Ultrasound Anatomy for Anterior Suprascapular Nerve Block: Anterior Scalene (ASm), Subclavian Artery (Sa), Omohyoid (OHm), Middle Scalene (MSm), Serratus Anterior (SAm), Suprascapular Nerve (SSn), Intercostal Muscle (ICm), 1st and 2nd Ribs, arrowheads (pleura)
575.Fig. 2.1: Ultrasound image of the supraclavicular region for supraclavicular brachial plexus block.
576.Fig. 2.2: Ultrasound image of the infraclavicular region for the costoclavicular approach to the brachial plexus.
577.Fig. 2.3: Ultrasound Image for Axillary Block: Ceph. (Cephalad), Caud. (Caudad), D.m (Deltoid Muscle), TM (Teres Minor Muscle), Tr.m (Teres Major Muscle), HH (Humeral Head), HS (Humeral Shaft), PCH.v (Posterior Circumflex Humeral Vein), PCH.a (Posterior Circumflex Humeral Artery)
578.Fig. 3.1: Anatomical illustration showing the clavicle, brachial plexus and associated nerves. (Reproduced from Leurcharusmee et al. [1])
579.Fig. 3.2: Ultrasound image of the neck for selective supraclavicular nerve block from anteromedial (Ant. med.) to posterolateral (Post. lat.) view, showing sternocleidomastoid muscle (Scm), anterior scalene muscle (ASm), middle scalene muscle (MSm), lateral scalene muscle (LCm), internal jugular vein (IJ. V), carotid artery (Car. A), vertebral vein (Ve. V), vertebral artery (Ve. A), and C5, C6, C7 cervical nerve roots with C7 transverse process (C7 TP). The white, red and blue arrows indicate the phrenic, long thoracic and dorsal scapular nerves respectively. The target, the supraclavicular nerves, are indicated by the white triangle with the needle trajectory indicated by the dashed white arrow.
580.Fig. 3.3: Ultrasound image demonstrating the anatomy for the costoclavicular block from medial (Med.) to lateral (Lat.) view, showing pectoralis major muscle (PMm), subclavius muscle (SCm), axillary vein (Ax. V), axillary artery (Ax. A), lateral cord (LC), posterior cord (PC), medial cord (MC), serratus anterior muscle (SAm), intercostal muscle (ICm), and the underlying rib
581.Fig. 4.1: Cutaneous nerve distribution of the upper limb: anterior and posterior views
582.Fig. 4.2: Ultrasound image of the forearm showing the median nerve anatomy, including the ulnar nerve (Un), ulnar artery (Ua), flexor digitorum superficialis muscle (FDSm), flexor digitorum profundus muscle (FDPm), flexor carpi radialis muscle (FCRm), radial artery (Ra), with the radius and ulna bones labeled. White arrow indicates median nerve
583.Fig. 4.3: Ultrasound image of the antecubital fossa (ACF) highlighting the radial nerve anatomy from medial (Med.) to lateral (Lat.) view, showing median cubital vein (MC.v), brachial artery (Ba), biceps tendon (B.t), cephalic vein (Ce.v), median nerve (Mn), pronator teres muscle (PTm), brachialis muscle (Br.m), brachioradialis muscle (Bra.m), radial nerve (Rn), and humerus bone
584.Fig. 4.4: Ultrasound image of the distal arm highlighting the radial nerve from posterior (Post.) to anterior (Ant.) view, showing the extensor carpi radialis muscle (ECR.m), brachioradialis muscle (BRa.m), radial nerve (Rn), brachialis muscle (Br.m), triceps muscle (Tr.m), and the humerus bone. Arrow indicates posterior cutaneous nerve of forearm
585.Fig. 4.5: Ultrasound image showing the superficial branch of the radial nerve from medial (Med.) to lateral (Lat.) view, including flexor carpi radialis muscle (FCRm), radial artery (Ra), brachioradialis muscle (BRa.m), pronator teres muscle (PTm), extensor carpi radialis muscle (ECRm), flexor digitorum superficialis muscle (FDSm), flexor digitorum profundus muscle (FDPm), and the radius bone. White arrow indicates the superficial branch of radial nerve and red arrow indicates the anterior interosseous nerve and vessels
586.Fig. 6.1: Nerve supply of breast
587.Fig. 6.2: Ultrasound image showing the pectoserratus and interpectoral plane from superior-medial (Sup. med.) to inferior-lateral (Inf. lat.) view, illustrating pectoralis major muscle (PMm), pectoralis minor muscle (Pmm), serratus anterior muscle (SAm), intercostal muscle (ICm), pleura (arrows) and multiple ribs, highlighting the anatomical layers and interfascial planes
588.Fig. 6.3: Ultrasound image of the paravertebral sagittal plane from cephalad (Ceph.) to caudal (Caud.) view, showing trapezius muscle (Tz.m), erector spinae muscle (ESm), transverse process (TP), intertransverse ligament (IT), multifidus muscle (MF), ribs, and interfascial space. The white arrows indicate the intertransverse ligament (IT), while the arrowheads mark the interfascial space between the transverse process and ribs
589.Fig. 6.4: Ultrasound image of the paravertebral transverse plane from medial (Med.) to lateral (Lat.) view, showing spinous process (Sp), trapezius muscle (Tz.m), erector spinae muscle (ESm), transverse process (TP), latissimus dorsi muscle (La), and external intercostal muscle (Elm). The white arrows indicate the intercostal membrane, while the arrowheads mark the interfascial plane between the transverse process and external intercostal muscle
590.Fig. 7.1: Anatomy of the intercostal nerve and sympathetic chain
591.Fig. 7.2: Intercostal nerve in the intercostal space
592.Fig. 8.1: Ultrasound image of the serratus plane block from anterocephalad (Ant. ceph.) to posterocaudal (Post. caud.) view, showing serratus anterior muscle (SAm), latissimus dorsi muscle (LDm), intercostal muscle (ICm), and ribs. White arrow heads are the pleural, red arrow is the thoracodorsal nerve, white arrow the superficial serratus plane and the yellow arrow needle path to the deep serratus plane
593.Fig. 8.2: Ultrasound image of the parasternal intercostal plane in a superficial view from cephalad (Ceph.) to caudal (Caud.) orientation, showing pectoralis major muscle (PMm), internal intercostal muscle (IIm), transversus thoracis muscle (TTm), and costal cartilage (CC). The white arrowheads indicate the interfascial plane between the internal intercostal and transversus thoracis muscles
594.Fig. 8.3: Ultrasound image of the deep parasternal intercostal plane from medial (Med.) to lateral (Lat.) view, showing pectoralis major muscle (PMm), internal intercostal muscle (IIm), transversus thoracis muscle (TTm), sternum, internal mammary vein (IMv), internal mammary artery (IMa), and myocardium. The red arrowheads indicate the myocardium layer
595.Fig. 10.1: Ultrasound image showing the anatomy for a transverse abdominis plane (TAP) block from superior-medial (Sup. Med.) to inferior-lateral (Inf. Lat.) view, including rectus abdominis muscle (RAm), external oblique muscle (EOm), internal oblique muscle (IOm), transversus abdominis muscle (TAm), and peritoneum and bowel (P&B). The white arrow heads represent the peritoneum. Dotted arrow is the needle trajectory
596.Fig. 10.2: Ultrasound image showing the anatomy for an anterior quadratus lumborum (QL) block from posterior (Post.) to anterior (Ant.) view, including latissimus dorsi muscle (LDm), external oblique muscle (EOm), internal oblique muscle (IOm), transversus abdominis muscle (TAm), quadratus lumborum muscle (QLm), erector spinae muscle (ESm), psoas major muscle (PMm), transverse process (TP), vertebral body (VB), peritoneum and bowel (P&B), iliac vessels (Iv), and iliac artery (Ia). The red dotted line indicates the needle path and end point for an anterior QL block (between QLm and PMm) and the white dotted line for the posterior QL block (between QLm and ESm). The white arrow in the body of the PMm points to the lumbar plexus
597.Fig. 10.3: Ultrasound image showing the anatomy for a lateral quadratus lumborum (QL) block from posterior (Post.) to anterior (Ant.) view, including latissimus dorsi muscle (LDm), external oblique muscle (EOm), internal oblique muscle (IOm), transversus abdominis muscle (TAm), quadratus lumborum muscle (QLm), perinephric fat (PnF), and peritoneum and bowel (P&B). The dotted white line indicates the needle path
598.Fig. 10.4: Ultrasound image showing the anatomy for the ilioinguinal nerve block from superior-medial (Sup. med.) to inferior-lateral (Inf. lat.) view, illustrating external oblique muscle (EOm), internal oblique muscle (IOm), transversus abdominis muscle (TAm), iliacus muscle (Im), peritoneum and bowel (P&B), and ilium. The white arrow marks the ilioinguinal nerve, while the yellow arrow indicates the neurovascular bundle
599.Fig. 11.1: Muscles of the abdominal wall and Cutaneous innervation of the anterolateral abdominal wall
600.Fig. 11.2: Ultrasound image showing the anatomy for an upper subcostal TAP (Transversus Abdominis Plane) block from medial (Med.) to lateral (Lat.) view, including rectus abdominis muscle (RAm), transversus abdominis muscle (TAm), and peritoneum and bowel (P&B). The dotted white line (LS) indicates the needle path for the TAP block targeting the interfascial plane between the rectus abdominis and transversus abdominis muscles
601.Fig. 11.3: Ultrasound image showing the anatomy for a lower subcostal TAP (Transversus Abdominis Plane) block from superior-medial (Sup. Med.) to inferior-lateral (Inf. Lat.) view, including rectus abdominis muscle (RAm), external oblique muscle (EOm), internal oblique muscle (IOm), transversus abdominis muscle (TAm), and peritoneum and bowel (P&B). Dotted white line is the needle trajectory and infiltration site. Arrow heads are the peritoneum
602.Fig. 11.4: Ultrasound image showing the anatomy for a midaxillary TAP (Transversus Abdominis Plane) block from posterior (Post.) to anterior (Ant.) view, including external oblique muscle (EOm), internal oblique muscle (IOm), transversus abdominis muscle (TAm), and peritoneum and bowel (P&B). The dotted white line indicates the needle path for the TAP block, targeting the interfascial plane between the internal oblique muscle and transversus abdominis muscle
603.Fig. 13.1: Cutaneous innervation of the anterolateral abdominal wall
604.Fig. 19.1: Schema of the sacral plexus showing the posterior and anterior divisions
605.Fig. 19.2: Lumbar plexus
606.Fig. 19.3: Cutaneous innervation of lower limb
607.Fig. 19.4: Lumbar plexus and innervation of the anterior thigh
608.Fig. 19.5: Innervation of the lower leg and foot—peroneal nerve branches and distribution
609.Fig. 19.6: Cross-sectional anatomy of the mid-thigh
610.Fig. 19.7: Cross-sectional anatomy of the distal thigh
611.Fig. 19.8: Innervation of the dorsal foot and lower leg
612.Fig. 19.9: Ultrasound image showing the anatomy for a sacral plexus block from medial (Med.) to lateral (Lat.) view, including gluteus maximus muscle (GMm), piriformis muscle (Pi.m), gluteus medius muscle (Gme.m), posterior border of ilium (PBI), sacrum, sacral plexus (SP), and retroperitoneal space and bowel (Rp&B). The red arrow is the inferior gluteal artery, the dotted white line indicates the needle path targeting the sacral plexus for local anesthetic injection
613.Fig. 19.10: Ultrasound image showing the anatomy for an anterior approach to the sciatic nerve block from posteromedial (Post. med.) to anterolateral (Ant. lat.) view, including adductor longus muscle (ALm), adductor brevis muscle (ABm), adductor magnus muscle (AMm), rectus femoris muscle (RFm), biceps femoris muscle (BFm), semitendinosus muscle (STm), and sciatic nerve (Sn). The dotted white line indicates the needle path, the solid red arrow marks the femoral artery, and the dotted arrow points to the location of the sciatic nerve
614.Fig. 19.11: Ultrasound image showing the anatomy for an infragluteal approach to the sciatic nerve block from medial (Med.) to lateral (Lat.) view, including gluteus maximus muscle (GMm), biceps femoris muscle (BFm), quadratus femoris muscle (QFm), obturator externus muscle (OEm), sciatic nerve (Sn), femur, and ischial tuberosity (IT). The dotted white line indicates the needle path for the block, and the white arrow points to the biceps femoris muscle
615.Fig. 19.12: Ultrasound image showing the anatomy for a sciatic nerve block at the popliteal fossa from medial (Med.) to lateral (Lat.) view, including semimembranosus muscle (SMm), biceps femoris muscle (BFm), tibial nerve (Tn), common peroneal nerve (CPn), popliteal vein (Pv), popliteal artery (Pa), and femur. Dotted line is needle trajectorty
616.Fig. 19.13: Ultrasound image showing the anatomy for an adductor canal block from posteromedial (Post. med.) to anterolateral (Ant. lat.) view, including sartorius muscle (Sm), adductor magnus muscle (AMm), vastus medialis muscle (VMm), femoral artery (Fem. A), and femoral vein (Fem. V). The double asterisk (**) indicates the saphenous nerve location within the adductor canal
617.Fig. 19.14: Ultrasound image showing the anatomy for an infrainguinal fascia iliaca block from medial (Med.) to lateral (Lat.) view, including pectineus muscle (Pm), iliopsoas muscle (IPm), sartorius muscle (Sm), femoral artery (Fem. A), femoral vein (Fem. V), and femoral nerve (Fem. N)
618.Fig. 19.15: Ultrasound image showing the anatomy for a lateral femoral cutaneous nerve block from medial (Med.) to lateral (Lat.) view, including sartorius muscle (Sm), rectus femoris muscle (RFm), tensor fasciae latae muscle (TFL), and the fascial plane. The white arrowheads indicate the fascia iliaca, the dotted outline shows the potential space for the injection, and the small white arrow points to the lateral femoral cutaneous nerve within the interfascial plane
619.Fig. 19.16: Ultrasound image showing the anatomy for the division of the obturator nerve from medial (Med.) to lateral (Lat.) view, including adductor longus muscle (ALm), adductor brevis muscle (ABm), adductor magnus muscle (AMm), and pectineus muscle (Pe.m). The white arrow indicates the anterior division of the obturator nerve, while the red arrow points to the posterior division of the obturator nerve as it courses between the adductor muscles
620.Fig. 19.17: Ultrasound image showing the anatomy of the subpectineal plane for the obturator nerve block from inferomedial (Inf. med.) to superolateral (Sup. lat.) view, including adductor longus muscle (ALm), adductor brevis muscle (ABm), adductor magnus muscle (AMm), obturator externus muscle (OEm), pectineus muscle (Pe.m), and superior pubic ramus (SPR). The white arrowheads indicate the subpectineal plane
621.Fig. 19.18: Ultrasound image showing the anatomy for a lumbar plexus block using the Shamrock sign from posterior (Post.) to anterior (Ant.) view, including latissimus dorsi muscle (LDm), external oblique muscle (EOm), internal oblique muscle (IOm), transversus abdominis muscle (TAm), quadratus lumborum muscle (QLm), erector spinae muscle (ESm), psoas major muscle (PMm), transverse process (TP), vertebral body (VB), iliac vein (Iv), iliac artery (Ia), and peritoneum and bowel (P&B). The white arrow points to the psoas major muscle, while the dotted interface represents the Shamrock sign configuration for the lumbar plexus block
622.Fig. 19.19: Ultrasound image showing the anatomy for a lumbar plexus block using the Trident sign from cephalad (Ceph.) to caudal (Caud.) view, including erector spinae muscle (ESm), psoas major muscle (PMm), transverse processes (TP), and peritoneum and bowel (P&B). The white arrowheads indicate the location of the psoas major muscle between the transverse processes, forming the characteristic Trident sign configuration for the lumbar plexus block
623.Fig. 20.1: Three bones of ankle joint
624.Fig. 21.1: Innervation of the perineum: 1: Ilioinguinal, Iliohypogastric and Genitofemoral nerves; 2: Posterior cutaneous nerve of thigh—a: perineal branch, b: inferior clunial nerve; 3: Pudendal nerve and branches—c: dorsal nerve of clitoris (penis in males), d: perineal nerve, e: inferior rectal nerve; A: Area supplied by the pudendal nerve
625.Fig. 21.2: Anatomy of pudendal nerve. (Source: Häggström M. Medical gallery of Mikael Häggström 2014. WikiJ Med. 2014:1(2). https://doi.org/10.15347/wjm/2014.008. ISSN 2002-4436)
626.Fig. 21.3: Pudendal nerve block Ultrasound image: (a) the initial scanning image, (b) Colour Doppler image showing pudendal vessels (PV) and inferior rectal vessels (IRV), (c) Pudendal nerve block: the block needle enters out of the plane, LA is deposited around the pudendal nerve (PN). Note that the ischial tuberosity (Isch tub) lies lateral and anus/perineal body medial. The above image is of a pudendal nerve block on the right side
627.Fig. 27.1: Cellular mechanism of LA toxicity
628.Fig. 28.1: Algorithm for management of spinal-induced hypotension
629.Fig. 31.1: Stop before you block, adapted from RA-UK NHS
630.Fig. 36.1: Brachial plexus
631.Fig. 36.2: Ultrasound of the brachial plexus in the interscalene region showing sternocleidomastoid muscle (Scm), anterior scalene muscle (ASm), middle scalene muscle (MSm), longus colli muscle (LCm), internal jugular vein (IJ. V), carotid artery (Car. A), vertebral artery (Ve. A), vertebral vein (Ve. V), cervical nerve roots (C5, C6, C7), and C7 transverse process (C7 TP), with anterior-medial (Ant.med.) and posterior-lateral (Post.lat.) orientations. Red and blue arrows mark relevant structures for nerve identification
632.Fig. 37.1: Brachial plexus at the level of axilla
633.Fig. 37.2: Ergonomics and needling direction for Axillary brachial plexus block
634.Fig. 37.3: Ultrasound image for axillary brachial plexus block showing the conjoined tendon of Latissimus Dorsi muscle (LDm), teres major muscle (TMm), triceps muscle (Tr.m), humerus, radial nerve (RN), ulnar nerve (UN), median nerve (MN) around the axillary artery (Ax.A). Musculocutaneous nerve (McN) is embedded in the coracobrachialis muscle (CBm). Arrowheads—fascia over conjoined tendon, arrow—intercostobrachial nerve
635.Fig. 38.1: Ultrasound of the femoral region showing the femoral artery (Fem. A), femoral vein (Fem. V), femoral nerve (Fem. N), sartorius muscle (Sm), pectineus muscle (Pm), iliopsoas muscle (IPm), with medial (Med.) and lateral (Lat.) orientations
636.Fig. 39.1: Ultrasound of the adductor canal showing the femoral artery (Fem. A), femoral vein (Fem. V), sartorius muscle (Sm), adductor magnus muscle (AMm), vastus medialis muscle (VMm), with posterior-medial (Post.med.) and anterior-lateral (Ant.lat.) orientations
637.Fig. 40.1: Ultrasound-Guided Anatomy for Sciatic Nerve Block at the Popliteal Fossa. Visualization of the sciatic nerve bifurcating into the tibial (Tn) and common peroneal (CPn) nerves, with adjacent structures including the popliteal vein (Pv), popliteal artery (Pa), and surrounding muscles
638.Fig. 41.1: Anatomy relation of ESP muscle, transverse process, costotransverse groove, dorsal and ventral rami with their branches
639.Fig. 41.2: Probe position parasagittal in-plane technique for Erector Spinae Plane Block
640.Fig. 41.3: Erector spinae continuous catheter in a case of breast surgery with latissimus dorsi flap
641.Fig. 41.4: TLIP anatomy and deposition of LA: Arrows represent needle trajectory, blue coloured area spread of LA, PM: psoas major, QL: quadratus lumborum, IC: iliocostalis, LT: longissimus thoracis, MF: multifidus muscle, L2: second lumbar vertebra, SAP: superior articular process, IAP: inferior articular process, TP: transverse process
642.Fig. 42.1: Transverse sections through the anterior abdominal wall. (a) above the costal margin. (b) from the costal margin to the one-third between the umbilicus and SP, (c) below the arcuate line
643.Fig. 42.2: Rectus sheath block. The structures visible in the USG-guided rectus sheath block. (a) Note the needle is inserted in-plane from lateral to medial direction, US transducer being held in a transverse orientation (b, c)
644.Fig. 43.1: Functional anatomy during spinal anaesthesia
645.Fig. 43.2: Surface Anatomy and dermatomal landmarks
646.Fig. 43.3: Sonoanatomy of the lumbar spine. (Blockmate: A practical guide for Ultrasound Guided Regional Anaesthesia. 133–136. Springer Nature)
647.Fig. 43.4: Types of spinal needles
648.Fig. 43.5: Patient positioning (sitting and lateral decubitus); with assistant helping to provide maximal flexion
649.Fig. 43.6: Paramedian approach for spinal anaesthesia
650.Fig. 44.1: Cross section of vertebra and spinal cord
651.Fig. 44.2: Cross section of spinal cord with its blood supply. (Image obtained with permission from Parmar and Ashokka [1])
652.Fig. 44.3: Picture of a skeleton denoting important surface landmarks of the spine
653.Fig. 44.4: Transverse Scan of the lumbar vertebra using the low-frequency ultrasound probe at the spinous process level. The image obtained shows the spinous process (yellow arrow), lamina (red arrow), erector spinae muscle (ESP), and acoustic shadow (AS). (Image obtained with permission from Parmar and Ashokka [1])
654.Fig. 44.5: Sagittal scan of the lumbar vertebra at the lamina using the low-frequency ultrasound probe. The image obtained shows the erector spinae muscle (ESP), lamina (yellow arrow), ligamentum flavum (orange arrow), and posterior dura (red arrow). (Image obtained with permission from Parmar and Ashokka [1])
655.Fig. 44.6: Equipment necessary for the performance of epidural anaesthesia with catheter insertion. Labels A—cleansing solution, B—Gauze, C—5-ml syringe with 25G hypodermic needle with 1% Lidocaine, D—Touhy needle, E—Loss of Resistance syringe, F—Catheter-securing clip, G—Filter, H—Epidural catheter, J—water-resistant and transparent dressing. (Equipment appearance may differ between different institutions and packaging)
656.Fig. 44.7: Structured approach for troubleshooting needle placement in epidural anaesthesia. (Produced with permission from Parmar and Ashokka [1])
657.Fig. 45.1: Positioning for combined spinal epidural (a: With full back flexion; b: Without back flexion)
658.Fig. 45.2: Needle through needle technique
659.Fig. 45.3: Dual-lumen technique
660.Fig. 46.1: Superior trunk sandwiched between anterior and middle scalene muscles
661.Fig. 46.2: Suprascapular nerve branching off from the superior trunk under the omohyoid muscle
662.Fig. 46.3: Transverse in-plane, lateral to medial needling for STB
663.Fig. 47.1: Anatomy for axillary nerve block
664.Fig. 47.2: Ultrasound-guided anatomy of the suprascapular nerve (posterior approach). This ultrasound image demonstrates the posterior approach to the suprascapular nerve (SSn) at the suprascapular notch, visualizing key structures such as the trapezius muscle (Tr.m), supraspinatus muscle (SSm), scapula, and adjacent fascial planes. The suprascapular nerve is identified as it courses near the scapular notch
665.Fig. 47.3: Needle insertion for anterior suprascapular block
666.Fig. 48.1: USG image of an Costoclavicular approach to Infraclavicular brachial plexus block. Pectoralis major muscle (PMm), Subclavius muscle (SCm), Axillary artery (Ax.A), Axillary Vein (Ax.V), Lateral cord (LC), Posterior cord (PC), Medial cord (MC), Serratus anterior muscle (SAm), External intercostal muscle (EIm), Internal intercostal muscle (ICm). Arrowheads- Pleura
667.Fig. 48.2: USG image of the Subcoracoid Infraclavicular brachial plexus block. The Axillary artery (AA) is visualised with surrounding brachial plexus cords- lateral (LC), medial (MC), posterior (PC), deep to the pectoralis major (PMm) and pectoralis minor muscle (Pmm). Axillary vein (Ax.V), Subscapularis muscle (SSm)
668.Fig. 48.3: Ergonomics, probe position and needling direction for (a) Costoclavicular approach (b) Subcoracoid infraclavicular approach
669.Fig. 49.1: Ultrasound Anatomy for Supraclavicular Brachial Plexus Block. This ultrasound image highlights the anatomy relevant to a supraclavicular brachial plexus block. Key structures include the brachial plexus trunks/divisions (BP), anterior scalene (ASm), Subclavian artery (Sa), Sternocleidomastoid muscle (SMm), Omohyoid muscle (Ohm), Subclavian vein (Sv), Serratus Anterior muscle (SAm), Posterior scalene muscle (PSm), Intercostal muscle (ICm), first rib is an important landmark. Arrow- Supraclavicular nerve branched off from the upper trunk and lies under omohyoid, arrowheads- Pleura
670.Fig. 49.2: Patient position for Supraclavicular Brachial Plexus Block
671.Fig. 50.1: Lumbar plexus
672.Fig. 50.2: Ultrasound anatomy for lumbar plexus block: trident sign. This ultrasound image demonstrates the “trident sign,” a key landmark for performing a lumbar plexus block. The transverse processes (TP) and psoas major muscles (PMm) are visualized, resembling the three-pronged trident configuration, with adjacent posterior structures such as the paravertebral space (P&B) and erector spinae muscle (ESm)
673.Fig. 50.3: Ultrasound anatomy of the lumbar plexus (Shamrock sign). This ultrasound image depicts the “shamrock sign,” a key landmark for identifying the lumbar plexus. Key structures include the quadratus lumborum (QLm), psoas major (PMm), transverse process (TP), and surrounding muscles and fascial planes used in regional anesthesia
674.Fig. 51.1: Cross-sectional anatomy
675.Fig. 51.2: USG image demonstrating iPACK (infiltration between popliteal artery and capsule of the knee) block. The popliteal artery (PA) and popliteal vein (PV) are visualised posterior to the femur with the injection target area between the femur and these vessels; the tibial nerve (TN) and common peroneal nerve (CPN) lie more posteriorly and are to be avoided
676.Fig. 52.1: US/S showing tibial nerve. FDL flexor digitorum longus, FHL flexor hallucis longus, TP tibialis posterior, PT posterior tibial, a artery, v vein, nerve
677.Fig. 52.2: Deep peroneal nerve on USG scanning. EDL extensor digitorum longus, EHL extensor hallucis longus, DP.a deep peroneal artery
678.Fig. 52.3: USG scan showing superficial peroneal nerve. PL peroneus longus, PB peroneus brevis, EDL extensor digitorum longus, TA tibial artery
679.Fig. 52.4: USG scan showing sural nerve. AT Achilles tendon, PL peroneus longus, PB peroneus brevis, SS.v saphenous vein
680.Fig. 52.5: USG scan showing saphenous nerve. FDL flexor digitorum longus, FHL flexor hallucis longus, TP tibialis posterior, PT posterior tibial, a artery, v vein, n nerve, GS.v great saphenous vein
681.Fig. 53.1: (a–d) Figure showing sonoanatomy of the location of the sacral plexus
682.Fig. 53.2: (a–d) Ultrasound-guided anatomical approach for sciatic nerve localization in the gluteal region
683.Fig. 53.3: Ultrasound image of greater trochanter (GT) and ischial tuberosity (IT) with fascia separating and position of probe
684.Fig. 53.4: Ultrasound image of sciatic nerve via the subgluteal approach
685.Fig. 53.5: Ultrasound image of sciatic nerve via the anterior approach
686.Fig. 54.1: Anatomy of thoracic paravertebral space: SCTL superior costotransverse ligament
687.Fig. 54.2: Sagittal section through the paravertebral space
688.Fig. 54.3: Sonographic appearance of the parasagittal approach to the paravertebral space
689.Fig. 54.4: (a) Parasagittal in plane TPVB. (b) Parasagittal out of plane TPVB
690.Fig. 54.5: Transverse midline scanning- spinous process view
691.Fig. 54.6: Transverse scanning- transverse process and rib shadows
692.Fig. 54.7: Transverse scanning of TPVS
693.Fig. 54.8: Needling approaches (a) Sitting position, transverse in-plane technique, (b) Sitting position, transverse, out-of-plane technique, (c) Lateral position, transverse, in-plane technique
694.Fig. 55.1: Anatomy of serratus anterior block
695.Fig. 55.2: Scanning and needling technique in coronal plane
696.Fig. 55.3 and 55.4: Probe positioning and needling technique in lateral position with the probe placed transversely
697.Fig. 55.5: Sonoanatomy of SAP block showing thoracodorsal artery as landmark between serratus anterior and latissimus dorsi
698.Fig. 55.6: Deep serratus anterior block
700.Fig. 57.1: QL1 Block: Note the linear UST, needle approach in plane and injection endpoints. PM Psoas major, QL QL, IOM Internal oblique muscle, EOM External oblique muscle, LD Latissimus dorsi muscle
701.Fig. 57.2: QL2 Block: Note the linear UST, needle approach in plane and injection endpoints. PM Psoas major, LIFT Lumbar interfascial triangle
702.Fig. 57.3: (a) QL3 Block: Note the curvilinear UST, needle approach in plane and injection endpoint between the QL and the PM. LIFT Lumbar interfascial triangle. (b) Position for QL3
703.Fig. 58.1: Lateral TAP: Note that the needle (dotted line) enters from a medial to lateral direction, LA deposited in the plane between IOM and TAM. Asterisks denote the TAP plane. EOM = External oblique muscle, IOM = Internal oblique muscle, TAM = Transversus abdominis muscle
704.Fig. 58.2: Posterior TAP: asterisks denote the TAP plane; the red arrow indicates the ideal injection point and the dotted line represents the block needle
705.Fig. 58.3: Oblique subcostal TAP: asterisks define the subcostal TAP plane, the red arrow denotes the ideal injection point, and the dotted line is the block needle. (EOM = External oblique muscle, IOM = Internal oblique muscle, TAM: Transversus abdominis muscle, RAM: Rectus abdominis muscle, LS: Linea semilunaris)
706.Fig. 58.4: Probe position, needle trajectory, and sensory distribution of anterior abdominal wall blocks: the grey box represents the probe position and the arrow the block needle. 1: lateral TAP, 2: anterior TAP, 3: OSTAP and 4: RSB. The shaded areas represent the extent of the sensory effect of the blocks as mentioned
707.Fig. 59.1: Median nerve block
708.Fig. 60.1: Radial Nerve ACF
709.Fig. 60.2: Radial nerve
710.Fig. 61.1: Anatomical relation of the Ulnar nerve
711.Fig. 61.2: Probe position for scanning ulnar nerve (a). Distal arm (b). Mid forearm (c). Wrist
712.Fig. 61.3: USG image of the ulnar nerve at the mid-arm level. Brachial artery (Ba) along with the median nerve (Mn), Basillic vein (Ba.v), Ulnar nerve (Un) along with the ulnar collateral artery
713.Fig. 61.4: USG image of the ulnar nerve at the mid-forearm level. Ulnar nerve (Un) along with the ulnar artery (Ua) lies under the flexor carpi ulnaris muscle (FCUm). Flexor digitorum superficialis muscle (FDSm), flexor digitorun profundus muscle (FDPm), median nerve (Mn)
714.Fig. 61.5: USG image of the ulnar nerve at the wrist level. Ulnar artery (Ua), ulnar nerve (Un)
715.Fig. 62.1: Two-channel tourniquet system. Digital versions are available
716.Fig. 62.2: Two-arm tourniquets- reusable and standard in hospitals performing orthopaedic surgery
717.Fig. 62.3: Example of protective cotton underlayer
718.Fig. 62.4: Protective underlayer cotton applied to the proximal upper limb
719.Fig. 62.5: Two single-arm tourniquets are used and connected to each system channel. A coloured dot represents each channel
720.Fig. 62.6: Elevating the arm for passive exsanguination
721.Fig. 62.7: The Esmarch bandage is wrapped in a spiral manner
722.Fig. 62.8: Slow injection of dilute local anaesthetic into the cannula in the exsanguinated arm with an inflated tourniquet
723.Fig. 63.1: The formation and branches of the lumbar plexus
724.Fig. 63.2: Ultrasound image of the ilioinguinal region, with three layers of abdominal wall visible and the nerves seen in the TAP plane
725.Fig. 63.3: Probe position much inferior, where the external oblique muscle is present as aponeurosis and only two muscle layers are visible
726.Fig. 64.1: WALANT injection techniques for different hand surgeries
727.Fig. 64.2: Suctioning is then done using a power-assisted suction device such as a Microaire device, which provides a variety of suction cannulas of varying lengths and port types
728.Table 1.1: Innervation of the Shoulder Joint
729.Table 5.1: Regional anaesthesia techniques for AV fistula creation
730.Table 8.1: Comparison of the peripheral blocks
731.Table 10.1: Key features of TAP and QL blocks for Caesarean delivery
732.Table 13.1: Guidelines for the management of low molecular weight heparin
733.Table 18.1: The sensory innervation of Knee
734.Table 18.2: Plexuses supplying knee joint
735.Table 18.3: Regional anesthesia options for total knee replacement
736.Table 18.4: Regional anesthesia options for cruciate ligament surgery
737.Table 18.5: Comparison of spinal anaesthesia and general anaesthesia for outpatient total joint arthroplasty
738.Table 20.1: Sensory innervation of foot and ankle
739.Table 20.2: Various regional blocks for foot and ankle surgery
740.Table 26.1: Sensory territory, motor testing and landmarks for distal upper limb peripheral nerve blocks
741.Table 28.1: Management of spinal-induced hypotension
742.Table 30.1: Recommendations for the aseptic preparation of a patient for the procedure
743.Table 31.1: Risk factors for wrong site block
744.Table 31.2: Strategies to prevent errors for wrong site blocks
745.Table 32.1: Causes of nonprocedural puncture headache following dural puncture
746.Table 34.1: Nerve blocks classification
747.Table 39.1: The nerves likely to get blocked depending on the location of the block
748.Table 43.1: Contraindications of spinal anaesthesia
749.Table 43.2: Complications of spinal anaesthesia
750.Table 43.3: Risk factors for hypotension following a spinal anaesthetic
751.Table 43.4: Possible Factors that may affect the spread of spinal local anaesthetic
752.Table 43.5: Estimates of the 95% effective dose of local anaesthetic for caesarean delivery
753.Table 44.1: Indications for lumbar epidural anaesthesia/analgesia
754.Table 44.2: Indications for thoracic epidural anaesthesia/analgesia
755.Table 44.3: Complications of epidural block
756.Table 45.1: Distance from skin to ligamentum flavum and thickness of ligament at various levels
757.Table 45.2: Common drugs used and their median effective local anaesthetic intrathecal doses for motor blockade in parturients
758.Table 45.3: Standard intrathecal opioid doses for labour analgesia
759.Table 50.1: Response to nerve stimulation during lumbar plexus block
760.Table 62.1: Choice of local anaesthetic (including volumes)
761.Table 62.2: Symptoms based on methemoglobin concentration
762.Table 64.1: Contraindications of WALANT block
763.Table 68.1: Intrathecal doses for labor analgesia
764.Table 68.2: Intrathecal dose regimens for surgical anesthesia
