Welcome to the
NextLevel NYSORA.

New

Pediatric Atlas of Ultrasound- and Nerve Stimulation-Guided Regional Anesthesia

Authors: Ban C.H. Tsui, Santhanam Suresh

The first comprehensive text-atlas intended for pediatric anesthesiologists who wish to incorporate regional blockade into their repertoire.
  • Superb coverage of pediatric anatomy in relation to regional anesthesia by internationally renowned experts.
  • PRACTICAL. Highly illustrated format that provides step-by-step guidance and includes cases, clinical pearls, and troubleshooting tips. 
  • UNDERSTAND. How to use ultrasound technology and nerve stimulation techniques to guide regional blockade in children. 
  • BE INSPIRED. NextLevel NYSORA will motivate you to study with our proprietary visual cognitive aids for a unique journey through the material.

Preview

Review

Pediatric Regional Anesthesia, Review

Introduction – Pediatric Regional Anesthesia Over the past 30 years, pediatric regional anesthesia has come of age. There is now a large and rapidly growing body of information regarding the impact of development on pain responses, local anesthetic pharmacology, and the adaptation of a full range of regional anesthetic techniques for infants and children. There is also a quickly expanding literature on safety and efficacy from registries and clinical trials. Thirty years ago, in most pediatric centers worldwide, regional anesthesia was used for only a small fraction of surgeries. Today, it is an essential part of pediatric anesthetic and analgesic management throughout the world. For children in tertiary centers in highly developed countries, regional anesthesia

Read More »

Table of contents

  • Differences Between the Pediatric and Adult Populations That Affect Regional Blocks
  • Block Area and Monitoring
  • General Equipment
  • Emergency Drugs and Resuscitating Equipment
  • Resuscitation Equipment
  • Resuscitation Drugs (Intravenous Doses)
  • Monitoring
  • Nerve Block and Catheter Equipment
  • Needles – Needle Tip Design
  • Needle Lengths
  • Needle Gauges
  • Other Needle Designs
  • Peripheral Nerve Catheters
  • Neuraxial Nerve Blocks/Catheters
  • Additional Equipment
  • Suggested Reading
  • Nerve Stimulation Procedure
  • Electrophysiology
  • Characteristics of Electrical Impulses
  • Current Intensity and Duration
  • Rate of Current Change
  • Polarity of Stimulating and Returning Electrodes
  • Distance-Current Relationship
  • Current Density of Electrodes and Injectates
  • Electrodes
  • Injectates
  • Electrical Impedance
  • Electrical Epidural Stimulation
  • Test Equipment and Procedure
  • Mechanisms of the Epidural Stimulation Test
  • Stimulating Epidural Catheter Requirements
  • Effective Conduction of Electrical Current
  • Advancement of the Catheter
  • Considerations for Test Performance and Interpretation
  • Limitations of Epidural Stimulation
  • Useful Equipment Features in Nerve Stimulation
  • Constant Current Output and Display
  • Variable Pulse Width and Frequency
  • Other Features
  • Practical Considerations – Documentation
  • Population Considerations
  • Does Nerve Stimulation Make a Difference?
  • References
  • Basic Ultrasound Physics and Technology
  • Transducers
  • Types of Ultrasound Transducers
  • Sound Wave Properties in Tissue
  • Speed of Sound
  • Reflection
  • Scattering
  • Resolution
  • Refraction
  • Absorption
  • Optimization of Image Quality: Knobology – Frequency
  • Depth
  • Gain
  • Time Gain Compensation
  • Focal Zone
  • Doppler Ultrasound
  • Anisotropy
  • Artifacts
  • Echogenic Appearance of Various Tissues
  • Nerves and tendons
  • Muscle
  • Bone
  • Vascular structure
  • Fat
  • Fascial tissue
  • Pleura and air
  • Equipment Selection
  • Current Advances for Future Developments
  • Compound Imaging
  • Single-Crystal Transducers
  • Capacitive Micromachined Ultrasound Transducers (CMUT)
  • Sonix GPS (Ultrasonix Medical Corp, Richmond, BC, Canada)
  • Power Doppler
  • Robot-Assisted Regional Anesthesia
  • Suggested Reading
  • Image Acquisition
  • Probe Preparation
  • Image Optimization
  • Probe Alignment
  • Practical Approach: Traceback Method
  • Control of Needle Trajectory: Visibility of Needles
  • Hand-Eye Coordination
  • Needling Technique: In-Plane Technique
  • Out-of-Plane Technique: Walkdown Approach
  • References
  • Indications, Contraindications, and Safety of Peripheral Nerve Catheter Placement
  • Equipment Required: Types of Catheters
  • Sterile Transducer Preparation
  • Choice of Injectates: During Catheter Insertion
  • Technique
  • Confirming Catheter Tip Location with Ultrasonography
  • Confirming Catheter Tip Location with Nerve Stimulation
  • Catheter-Over-Needle Assembly Insertion
  • Securing the Catheter
  • Examples of Common Peripheral Nerve Catheterization Procedures Used in Children: Infraclavicular Nerve Block Catheterization
  • Femoral Nerve Block Catheterization
  • Sciatic Nerve Block Catheterization: Subgluteal Approach
  • Sciatic Nerve Block Catheterization: Popliteal Approach
  • Summary
  • References
  • Background
  • Principles of Pain Assessment in Infants and Children
  • Assessing Pain in Neonates and Infants
  • The Premature Infant Pain Profile (PIPP)
  • Neonatal Pain Agitation and Sedation Scale (N-PASS)
  • CRIES
  • Assessing Postoperative Pain in Infants and Young Children
  • FLACC (Faces, Limb, Activity, Cry, and Consolability)
  • Parents’ Postoperative Pain Measure (PPPM)
  • Assessing Pain in Children and Adolescents
  • Faces Pain Scale-Revised
  • Numeric Rating Scales (NRS)
  • Oucher
  • Pieces of Hurt/Poker Chip Scale
  • Wong-Baker FACES Pain Scale
  • Visual Analogue Scale (VAS)
  • Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS)
  • Assessing Postoperative Pain in Critically Ill Children
  • Assessing Postoperative Pain in Children with Cognitive Impairments
  • Summary
  • Developmental, Familial, and Psychological Factors: Age
  • Developmental Delays
  • Psychological Factors
  • Gender
  • Cultural Factors
  • Conclusion
  • References
  • Introduction
  • Structure and Physiochemical Properties
  • Onset of Action, Potency, and Duration
  • Sodium Channel
  • Physiological Considerations
  • Pharmacokinetics
  • Absorption
  • Absorption from Epidural Space
  • Absorption from Other Routes of Administration
  • Distribution
  • Plasma Protein Binding
  • Hepatic Metabolism
  • Toxicity
  • Central Nervous System Toxicity
  • Cardiac Toxicity
  • Treatment of Toxicity
  • Prevention of Toxicity
  • Dosing
  • References
  • General Principles
  • Adverse Events Related to Local Anesthetics – Allergic Reactions
  • Prevention
  • Management
  • Systemic Toxic Reactions
  • Prevention
  • Nervous System Toxicity and Management
  • Cardiovascular Toxicity and Management
  • Summary
  • Complications Related to Regional Anesthesia Equipment
  • Adverse Events Caused by Needles – Needle Trauma to the Peripheral Nerve
  • Needle Trauma to the Spinal Cord
  • Needle Trauma to Pleura
  • Adverse Events Caused by Nerve Stimulators
  • Adverse Events Caused by Ultrasound Probes
  • Summary
  • Block Complications
  • Complications of Peripheral Nerve Blocks – Phrenic Nerve Paralysis and Paresis
  • Hematoma and Subsequent Sequelae
  • Bacterial Infection
  • Complications of Neuraxial Blocks – Hematoma
  • Infection
  • Total Spinal Anesthesia
  • Subdural Injections
  • Post-Dural-Puncture Headache
  • Hypotension
  • Summary
  • References
  • Clinical Anatomy of Trigeminal Nerve
  • Ophthalmic Nerve (V1 Division of the Trigeminal Nerve, Pure Sensory)
  • Maxillary Nerve (V2 Division of the Trigeminal Nerve, Pure Sensory)
  • Mandibular Nerve (V3 Division of the Trigeminal Nerve, Sensory and Motor to Muscles of Mastication)
  • Clinical Anatomy of the Cervical Plexus
  • Clinical Anatomy of Occipital Nerves
  • Lesser Occipital Nerve (C2)
  • Greater Occipital Nerve (C2)
  • Clinical Anatomy of the Nerve of Arnold
  • Suggested Reading
  • Brachial Plexus: Overview
  • Branches of the Brachial Plexus
  • Branches from the Roots (Ventral Rami) – Phrenic Nerve
  • Dorsal Scapular Nerve
  • Branches from the Trunks – Long Thoracic Nerve
  • Nerve to the Subclavius
  • Suprascapular Nerve
  • Branches from the Cords – Lateral Pectoral Nerve
  • Medial Pectoral Nerve
  • Upper and Lower Subscapular Nerves
  • Thoracodorsal Nerve
  • Terminal Nerves – Axillary Nerve
  • Musculocutaneous Nerve
  • Lateral Cutaneous Nerve of the Forearm
  • Medial Cutaneous Nerve of the Arm
  • Medial Cutaneous Nerve of the Forearm
  • Median Nerve
  • Ulnar Nerve
  • Radial Nerve
  • Suggested Reading
  • Lumbar Plexus
  • Branches of the Lumbar Plexus
  • Iliohypogastric Nerve
  • Ilioinguinal Nerve
  • Genitofemoral Nerve
  • Lateral Femoral Cutaneous Nerve (Lateral Cutaneous Nerve of Thigh)
  • Femoral Nerve
  • Obturator Nerve
  • Suggested Reading
  • Sacral Plexus
  • Direct Muscular Branches of the Sacral Plexus: Nerve to the Piriformis
  • Nerve to Obturator Internus and Gemellus Superior
  • Nerve to Quadratus Femoris and Gemellus Inferior
  • Major Terminal Nerves of the Sacral Plexus: Superior Gluteal Nerve
  • Inferior Gluteal Nerve
  • Posterior Femoral Cutaneous Nerve
  • Sciatic Nerve
  • Tibial Nerve
  • Common Peroneal (Fibular) Nerve
  • Pudendal Nerve
  • Pelvic Splanchnic Nerves
  • Suggested Reading
  • Spinal Nerves and the Vertebral Column
  • Vertebral Column
  • Development of the Vertebral Column
  • Growth and Curves of the Vertebral Column
  • Developmental Anatomy of the Thoracic and Lumbar Vertebral Column (Spine)
  • Developmental Anatomy of the Sacrum
  • Costovertebral Articulations
  • Paravertebral Space
  • Thoracic Spinal Nerves and Intercostal Nerves
  • Vertebral (Spinal) Canal
  • Vertebral Levels, Spinal Nerve Roots, and Spinal Cord Segments
  • Spinal Nerves Above the Sacrum
  • Termination of the Spinal Cord and Dural Sac
  • CSF Volume
  • References
  • Introduction – Dermatomes
  • Myotomes
  • Osteotomes
  • Innervation of the Upper Extremity – Dermatomes and Cutaneous Distribution of the Peripheral Nerves
  • Myotomes
  • Osteotomes
  • Innervation of the Major Joints of the Upper Extremity
  • Innervation of the Shoulder
  • Innervation of the Elbow
  • Innervation of the Wrist and Hand
  • Innervation of the Lower Extremity – Dermatomes and Cutaneous Distribution of the Peripheral Nerves
  • Myotomes
  • Osteotomes
  • Innervation of the Major Joints
  • Innervation of the Hip
  • Innervation of the Knee
  • Innervation of the Ankle
  • Suggested Reading
  • Indications
  • Block Techniques
  • Superficial Transcutaneous Approach to Trigeminal Nerve Blocks: Supraorbital, Infraorbital, and Mental Nerve Block
  • Patient Positioning
  • Landmarks and Surface Anatomy
  • Considerations and Needle Insertion Technique (Infraorbital Nerve Block)
  • Needle Insertion Techniques: Infraorbital Nerve and Branches
  • V1: Ophthalmic Branches
  • Local Anesthetic Application
  • Intraoral Approach to Trigeminal Nerve Blocks: Infraorbital, Mental, and Greater Palatine Nerves
  • Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion Technique
  • Local Anesthetic Application
  • Deep Trigeminal Nerve Blocks
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Indications for Cervical Plexus Block
  • Classic (Deep) Cervical Plexus Block
  • Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion Technique
  • Nerve Localization and Local Anesthetic Application
  • Current Literature for Deep Cervical Plexus Block
  • Ultrasound-Guided Superficial Cervical Plexus Block
  • Patient Positioning
  • Landmarks and Surface Anatomy
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion Technique
  • Local Anesthetic Application
  • Current Literature for Superficial Cervical Block
  • Great Auricular Nerve Blocks
  • Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion Technique
  • Nerve Localization and Local Anesthetic Application
  • Current Literature for Great Auricular Nerve Block
  • Case Study
  • References
  • Indications
  • Block Techniques
  • Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion Technique
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Indications
  • Block Technique
  • Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion Technique
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Indications
  • Surface Anatomy: Patient Positioning
  • Nerve Stimulation Technique
  • Needle Insertion
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Preparing the Site
  • Scanning Technique
  • Cricoid Cartilage Approach
  • Traceback Approach
  • Sonographic Appearance
  • Needle insertion
  • Local Anesthetic Application
  • Clinical Pearls: Interscalene Block
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Indications
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Needle Insertion
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Clinical Pearls: Supraclavicular Block
  • Case Study
  • References
  • Indications
  • Surface Anatomy
  • Nerve Stimulation Technique – Needle Insertion
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Preparing the Site
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Indications
  • Surface Anatomy
  • Nerve Stimulation Technique – Needle Insertion
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Preparing the Site
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound- Guided Approaches
  • Case Study
  • References
  • Median Nerve Block
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Case Study
  • Radial Nerve Block
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Ultrasound-Guided Technique – Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Case Study
  • Ulnar Nerve Block
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Ultrasound-Guided Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Case Study
  • Current Literature in Ultrasound-Guided Approaches
  • Reference
  • Indications
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Needle Insertion
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Femoral Nerve Block: Indications
  • Surface Anatomy
  • Nerve Stimulation Technique: Needle Insertion
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • Lateral Femoral Cutaneous Nerve Block: Indications
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Needle Insertion
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • Obturator Nerve Block: Indications
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Needle Insertion
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • Saphenous Nerve Block
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Indications
  • Posterior Gluteal (Labat) Sciatic Nerve Block
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Needle Insertion
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Infragluteal/Subgluteal Sciatic Nerve Block Approach
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Case Study
  • Anterior Sciatic Nerve Block Approach
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Popliteal or Mid-Thigh Sciatic Nerve Block
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Needle Insertion
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Case Study
  • Current Literature in Ultrasound-Guided Approaches
  • References
  • Indications
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Needle Insertion
  • Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Indications
  • Clinical Anatomy
  • Block Techniques
  • Landmark-Based Technique: Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion
  • Local Anesthetic Application
  • Nerve Stimulation Technique: Current Application and Appropriate Responses
  • Modifications to Inappropriate Responses
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Alternate Scanning Technique: Transverse Approach
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Clinical Anatomy: Intercostal Nerves
  • Costovertebral Articulations
  • Landmark-Based Technique – Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion
  • Local Anesthetic Application
  • Nerve Stimulation Technique
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Rectus Sheath Block – Clinical Anatomy
  • Landmark-Based Technique – Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion
  • Local Anesthetic Application
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Ultrasonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Umbilical Nerve Block
  • Outcome Evaluation for Blocks at the Anterior Trunk
  • Case Study
  • Transversus Abdominis Plane (TAP) Block – Clinical Anatomy
  • Landmark-Based Technique – Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion
  • Local Anesthetic Application
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Ultrasonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Catheter Placement Under Direct Visualization
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Clinical Anatomy
  • Landmark-Based Technique (Fascial “Click” Method) – Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion
  • Local Anesthetic Application
  • Nerve Stimulation Technique
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Ultrasonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Clinical Anatomy
  • Landmark-Based Technique (Subpubic Approach) – Patient Positioning
  • Landmarks and Surface Anatomy
  • Needle Insertion
  • Local Anesthetic Application
  • Ultrasound-Guided Technique – Scanning Technique
  • Ultrasonographic Appearance
  • Needle Insertion
  • Local Anesthetic Application
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References
  • Epidural Anesthesia – Introduction
  • Patient Positioning
  • Surface Anatomy
  • Approaches – Direct Lumbar Approach
  • Direct Thoracic Approach
  • General Approaches
  • Median Approaches
  • Paramedian Approach
  • Nerve Stimulation Technique
  • Needle Confirmation
  • Catheter Confirmation
  • Mechanism of the Test
  • Considerations for Test Performance and Interpretation
  • Detecting Intrathecal and Intravascular Catheter and Needle Placement
  • Electrocardiograph (ECG) Monitoring Technique
  • Ultrasound-Guided Technique
  • Preparing the Needle Insertion Site
  • Scanning Technique
  • Sonographic Appearance
  • Needle Insertion Technique
  • Catheter Insertion and Confirmation
  • Case Study: Lumbar Epidural
  • Caudal Anesthesia – Introduction
  • Patient Positioning
  • Surface Anatomy
  • Nerve Stimulation Technique
  • Ultrasound-Guided Block – Preparing the Needle Insertion Site
  • Scanning Technique
  • Sonographic Appearance
  • Caudal vs. Intrathecal Injection
  • Needle Insertion and Local Anesthetic Application
  • Case Study: Caudal Epidural
  • Advancing a Catheter to the Lumbar or Thoracic Area from a Caudal Insertion Site
  • Epidural Stimulation Guidance Technique
  • Local Anesthetic Application (“Test”) to Confirm Avoidance of Intravascular Placement
  • Ultrasound-Guided Technique
  • Scanning Technique
  • Sonographic Appearance
  • Catheter Insertion and Local Anesthetic Application
  • Case Study: Thoracic Epidural
  • Current Literature in Ultrasound-Guided Approaches
  • References
  • Introduction
  • Indications
  • Clinical Use and Special Concerns
  • Contraindications
  • Technique – Preparation
  • Patient Positioning
  • Surface Anatomy
  • Sonographic Assessment
  • Nerve Stimulation Technique
  • Equipment and Spinal Needle
  • Needles
  • Local Anesthetics
  • Adjuvants
  • Assessment of the Block Level
  • Complications
  • Current Literature in Ultrasound-Guided Approaches
  • Case Study
  • References

New!

The first comprehensive text-atlas intended for pediatric anesthesiologists who wish to incorporate regional blockade into their repertoire.