perivascular, sensory and motor effects, 62, side effects, 64 and subfascial hematoma, 221 axillary plexus, 6 7 axonotmesis, 221, 222

Transcription

1 249 Index A abscess, and continuous peripheral nerve block, 244 Achilles tendon rupture, 173 and saphenous nerve block, 208 and sural nerve block, 209 and tibial nerve block, 203, 204, 210, 211 acromion, in vertical infraclavicular block, 38 adjuvants, to local anesthetics, 238 alkalinization, local anesthetics, 238 amputation, lower limb, 138, 139 distal sciatic nerve block, 172 anatomical snuffbox, 83 anatomy ankle, axillary block with Dupré technique, 65 axillary plexus, elbow, 74, 78 foot, knee, 159 lumbar plexus, 94, 95, obturator nerve, , 184 psoas compartment block, 96, 99 saphenous nerve, , 205 suprascapular nerve block, sural nerve, 205 tibial nerve, toes, 213 upper limb, 4 7 wrist, 81, 83 anesthetic agents, see local anesthetics ankle anatomy, surgery, and distal sciatic nerve block, 173 ankle blocks, contraindications, 212 indications, 212 results, anterior sciatic nerve block contraindications, 129, 136 indications, 129, 136 landmarks, 131 muscle gap, proximal, summary, 140 arcus iliopectineus, 111 arm, see upper limb atraumatic needles, 218 axillary blocks, anatomy, complications, 64 contraindications, 64 Dupré technique, failure rates, 218 indications, 64 vs. infraclavicular plexus block, 40, 41, 42 mid-humeral approach, multistimulation technique, perivascular, sensory and motor effects, 62, side effects, 64 and subfascial hematoma, 221 axillary plexus, 6 7 axonotmesis, 221, 222 B backflow, local anesthetic, 119 beach chair position, 27 Beck technique, anterior sciatic block, 129, 130, 137, 140 Bezold Jarisch reflex, blood pressure, and central neuraxial blocks, 218 bone graft harvesting, 180 bones, leg, innervation, 92 brachial plexus blocks anatomy, 4 6 dorsal technique, infraclavicular techniques, interscalene techniques, neurovascular sheath, 11, 55, 56, 57 topographical anatomy, 7, 8, 9 ultrasound guidance, 228, 229 see also infraclavicular blocks; supraclavicular blocks bronchospasm, 26 bupivacaine, 237, 239 C capnography, 226 capnometry, 28, 218 carbonization, local anesthetics, 238 cardiac arrest, 218 cardiac pacemakers, and peripheral nerve stimulation, 232 cardiotoxicity, long-acting local anesthetics, cardiovascular effects, systemic intoxication, catheter placement, anterior sciatic block, 139, 140, 141 distal sciatic nerve block, 164, 165 femoral nerve block, 120, 122 iliac crest infiltration, 181 obturator nerve block, 189 posterior sciatic nerve block, 151, 153, 154, 155 psoas compartment block, 102, 104 sciatic nerve block, 171 transsartorial saphenous block, 197 catheters care of, on general ward, 241, 243 complications, dislocation, 243 distal sciatic, 197 documentation, 244 and infection, 243 locating with CT, 243 looping, 244 needles for, 233 and nerve injury, for outpatient pain management, 243 Plexolong set, 233 results, 245 stimulating, tear, 244 see also catheter placement; indwelling catheter catheter-through-needle technique, 233, 234 central nervous system symptoms, toxic reactions, central neuraxial blocks, 218 cephalic vein, 38 cerebral symptoms, systemic intoxication, cervical plexus, supraclavicular nerve block, 24, Chayen technique, psoas compartment block, circulation monitoring, 225 and peripheral blocks, 218 clavipectoral trigone, 36 claw hand, 221 clonidine, 238 coagulation disorders, 222 coagulation parameters, borderline, 223 coccygeal nerve, 89 common fibular nerve, 91 anatomy, complications, 218, 222 ankle blocks, 213 central neuraxial blocks, 218 fibular nerve block, 200, 202 infraclavicular techniques, 47 computed tomography (CT), and catheter location, 243 conduction anesthesia, toes, conduction block, lower limb, connective-tissue sheath, see neurovascular sheath consciousness, monitoring, 225 consent, informed, 225 continuous peripheral nerve blocks, parallel, 240 continuous psoas compartment block, Contiplex-D needle, 233 contraindications ankle blocks, 212 anterior sciatic nerve block, 129, 136 fibular nerve block, obturator nerve block, 187 peripheral nerve blocks, proximal dorsal sciatic nerve block, 152 sciatic nerve blocks, 167

2 250 contrast spread, local anesthetic distribution anterior sciatic nerve block, 140 axillary block, 63, 64 distal sciatic nerve block, 173 femoral nerve block, 119 interscalene plexus, 20 Mansour parasacral sciatic nerve block, 158 obturator nerve block, 189 perivascular axillary plexus technique, 60 psoas compartment and sciatic nerve block, 109 psoas compartment block, 103, 104 Raj technique, 46 vertical infraclavicular block, 41 coracoid process, 34, cubital fossa, 74, 76, 77 cuff pressures, ankle blocks, D dancing patella, 117, 121 deep fibular nerve, 91, 206, 207, 210 deep peroneal nerve, 206 diaphragm contraction, in interscalene block, 7 elevated, 27 twitching, see hiccup distal sciatic nerve block, effectiveness, lateral approach, and lower leg amputation, 172 needle positioning, posterior approach, and saphenous nerve block, 173, 174 distribution of local anesthetic, see contrast spread documentation, regional pain catheters, 244 Doppler vascular ultrasound, 226, 227 dorsal technique, brachial plexus block, dorsiflexion of foot and common fibular nerve stimulation, 199 and deep fibular nerve block, 210 and sciatic nerve stimulation, 135 dorso-dorsal technique, sciatic nerve block, dosages, local anesthetics, , long-term, double-click, in femoral nerve block, 112, 117, 124 Dupré technique, axillary blocks, E elastomer pumps, , 241, 242, 243 elbow anatomy, 74, 78 indications for block, 239 selective blocks, electrocardiography, monitoring, 225 epidural anesthesia, and psoas compartment block, F fascial click, 235 femoral artery, 116 and saphenous nerve, 190 femoral fracture, proximal, 239 femoral nerve, 89, 90, 94 course, 118, 122 distance from skin, and lumbar plexus, ultrasound imaging, 230 femoral nerve block, and catheter advancement, 120, 122 complications, 121 contraindications, 121 contrast spread, 119 double-click, 112 indications, 121 landmarks, 114, 115 and obturator nerve, and sciatic nerve block, 124 sensory and motor effects, 121 and sensory innervation of leg, 92 side effects, 121 and subfascial hematoma, 221 Winnie technique, fibula, innervation, 92 fibular division, 164 fibular nerve, 203 anatomy, , 202 neuritis, 202 paresis, 202 see also common fibular nerve; deep fibular nerve; superficial fibular nerve fibular nerve block, complications, 200 contraindications, 200 dorsal technique, 199 indications, 200 lateral technique, 200 field block, below-the-knee, 194 finger point, in vertical infraclavicular block, 36, 38 foot anatomy, ankle block, 212 dorsiflexion, sciatic nerve stimulation, 135 dorsiflexion and pronation, common fibular nerve stimulation, 199 incomplete block, 218 sensory innervation, 207, 208 forearm, indications for block, 239 fourth lumbar nerve (L4), 88, 89, frozen shoulder syndrome, suprascapular nerve block, 54 furcal nerve, 88, 89 G gangrene diabetic, 167 foot, 212 and toe blocks, 214 gastrocnemius and common fibular nerve, 198, 199 and saphenous nerve, 192, 193 genitofemoral nerve, 89, 94 H hand, indications for block, 239 hearing loss, 26 hematoma and, subfascial, 221 hiccup, in interscalene block, 14, 16 hip arthroplasty, 239 hip surgery, and psoas compartment block, hoarseness, 47 Horner syndrome, 7, 26, 27, 47 humerus, and selective radial nerve block, hygiene requirements, 224 I idiopathic neuritis, 221 iliac crest infiltration, and lateral cutaneous nerve of thigh, 176, 177 iliohypogastric nerve, 89, 94 ilioinguinal nerve, 94 iliopectineal arch, see arcus iliopectineus incomplete peripheral nerve blocks, 218 indications ankle blocks, 212 anterior sciatic nerve block, 129, 136 continuous peripheral nerve blocks, fibular nerve block, 200 obturator nerve block, 187 proximal dorsal sciatic nerve block, 152 saphenous nerve block, 196 sciatic nerve blocks, indwelling catheter anterior sciatic nerve block, 137 axillary block, 61, 63, 64 distal sciatic nerve block, 165 Meier technique, 17 perivascular axillary plexus technique, 61 Raj technique, 45, 46 vertical infraclavicular block, 39 see also catheters infection and catheters, 243 and peripheral nerve blocks, 222 informed consent, 225

3 251 infraclavicular blocks anatomy, 6, vs. axillary plexus block, 40, 41, 42 Kilka technique, Raj technique, sensory and motor effects, 46 ultrasound guidance, 228 see also brachial plexus blocks infusion pumps, 241 inguinal paravascular lumbar plexus block, anatomy, injection/puncture site anterior proximal sciatic nerve block, 129, 131, 134 deep fibular nerve block, 210 disinfection, 235 distal sciatic nerve block, 161, 162, 163 femoral nerve block, 116, 118, 122, 124 Labat proximal sciatic nerve block, 149 lateral proximal sciatic nerve block, 146 Meier suprascapular nerve block, 51 Meier technique, 15 Pippa technique, 22 psoas compartment block, 97 Raj infraclavicular technique, 43 vertical infraclavicular block, 35, 36 interadductor approach, obturator nerve block, 190 interscalene approach, brachial plexus, ultrasound guidance, 228 interscalene blocks anatomy, 8 brachial plexus, catheter tip position, 28 complications and side effects, contraindications, 24 contrast spread, 20 general overview, indications, 24 Meier technique, 13, Pippa technique, 14, sensory and motor effects, and ultrasound imaging, 18 Winnie technique, 12, 13 intramedullary nail, 240 intraperitoneal injection, and psoas compartment block, 104, 106, intravascular injection, accidental, ischiocrural muscles, and anterior sciatic nerve block, 136 IVAN ( inside vein, artery, nerve), 113, 114 J jugular notch acromion distance, 34, 36, 37 K kidney, subcapsular hematoma, 104, 107 Kilka technique, infraclavicular block, knee anatomy, 159 blocks at, , 202 common fibular nerve, field block, 194 innervation, 92, 124, 128 periosteum, and obturator nerve, 190 saphenous nerve course, 191, 192 surgery,, 124 total arthroplasty, L Labat technique, 135 femoral nerve block, 114, 121 proximal sciatic nerve block, , , 173 sciatic nerve block in popliteal fossa, 169 latency time, local anesthetics, 238 lateral cutaneous nerve of thigh, 89, 90, 94 anatomy, 175 course, 176, 177, 178 innervation area, 92 lateral cutaneous nerve of thigh block, alternative technique, 178 classical technique, indications, 178 and peripheral nerve stimulation, 178, 179 and psoas compartment block, leg, see lower limb lidocaine, 237 local anesthetics and adjuvants, 238 alkalinization, 238 carbonization, 238 in continuous peripheral nerve blocks, 239 distribution, see contrast spread dosages, , , general principles, latency time, 238 overdosage, overview, 237 toxic reactions, 221 warming, 238 loss-of-resistance (LOR) technique, 196, 198, 233, 235 and psoas compartment block, lower limb, conduction blocks, femoral nerve block, individual nerve blocks, inguinal paravascular lumbar plexus block, overview, periosteal innervation, 128 proximal sciatic nerve block, psoas compartment block, sensory innervation, see also ankle; femoral; fibular; foot; saphenous; thigh; tibial; toes lumbar nerve L4 (nervus furcalis), 88, 89, lumbar nerve L5, and psoas compartment block, lumbar plexus, 89, 90, 94 anatomy, 94, 95 anesthesia, and obturator nerve block, 188 lumbosacral plexus, M Mansour technique, 135 parasacral sciatic nerve block, subsartorial saphenous nerve block, 198 median nerve, 5, 9, median nerve block elbow, 74, 78, 79 needle direction, 65, 66 ultrasound guidance, 229 at wrist, 80, 82 Mehrkens technique, psoas compartment block, Meier technique anterior sciatic block, 129, 131, 137, 140 dorsal transgluteal sciatic nerve block, 151, 152 interscalene block, 13, 14 21, 26 sciatic nerve block, posterior approach, 160 suprascapular nerve block, 49, mepivacaine, 237, 238 meralgia paresthetica, 178 metoprolol, 28 mid-humeral approach, axillary block, Mohrenheim s fossa, 36 monitoring of patient, 218, mortality and morbidity, central neuraxial blocks, 218 motor effects axillary block, 62, motor stimulus response, upper limb nerves, 9 motor supply, upper limb, 9 muscle gap, in anterior sciatic nerve block, musculocutaneous nerve, 5, 9, 69 musculocutaneous nerve block elbow, 73 74, 77, 78 needle direction, 69, 70 myotoxicity, 237 N Naropin, see ropivacaine nausea, postoperative, 218 needle direction anterior sciatic nerve block, 130, 135 femoral nerve block, 115, 117 median nerve block, 65, 66 Meier technique, 15, 19 musculocutaneous nerve block, 69, 70

4 252 needle direction Pippa technique, 22, 23 posterior sciatic nerve block, 150, 151 psoas compartment block, 97, 98, radial nerve block, 67, 68 Raj technique, ulnar nerve block, 66, 67 Winnie technique, 13 needles, 218, neostigmine, 238 nerve injury by catheters, classification, nerves, see peripheral nerve blocks nerve stimulation, see peripheral nerve stimulation nervus furcalis, 88, 89 neurapraxia, 221, 222 neuritis, idiopathic, 221 neurological deficits, and peripheral nerve blocks, 223 neuropathy, and peripheral nerve blocks, neurotmesis, 221 neurovascular sheath axillary region, 55, 56, 57 brachial plexus, 7, 11, 55, 56, 57 O Oberst conduction anesthesia, obese patients anterior sciatic block, 138 distal sciatic nerve block, 163 obturator nerve, 89, 90, 94, 111 accessory, 188 course, , 184 and knee joint periosteum, 190 obturator nerve block, alternative technique, anatomy, classical technique, contraindications, 187 and femoral nerve block, indications, 187 interadductor approach, 190 and lumbar plexus anesthesia, 188 modified technique, 187 patient position, 183, 184 obturator reflex, and neuraxial anesthesia, 188 opioids, 238 outpatient pain management, peripheral nerve catheters, 243 overdosage, local anesthetic, oxygen administration, and toxic reactions, oxygenation, monitoring, 225 P patella, dancing, 117, 121 patient position, 225 anterior block of sciatic nerve, 128 distal sciatic nerve block, 164 dorso-dorsal sciatic nerve block, 142 femoral nerve block, 115 Labat proximal sciatic nerve block, Mansour parasacral sciatic nerve block, 156 and neuropathy, 221 obturator nerve block, 183, 184 popliteal block, dorsal approach, 159 proximal lateral sciatic nerve block, 145 psoas compartment block, 96, 97 patients informed consent, 225 monitoring, 218, safety, see also obese patients; patient position periosteal innervation, lower limb, 128 periosteum, leg, innervation, 92 peripheral nerve blocks advantages, 218 ankle, continuous, contraindications, general principles, and infection, 222 lower limb, partial, 218 problems, special features, toxic reactions, 221 upper limb, 4 84 peripheral nerve stimulation (PNS), 222, and fibular nerve block, 201 and lateral cutaneous nerve of thigh block, 178, 179 and psoas compartment block, and tibial nerve block, 211 peritoneal injection, and psoas compartment block, 104, 106, perivascular axillary block, and radial nerve, 61 peroneal nerve, see fibular nerve phantom pain, 138, 139 phrenic nerve, 7 paresis, 27, 28, 47 Pippa technique injection/puncture site, 22 interscalene block, 14, plantar flexion, 205 sciatic nerve stimulation, 135 tibial nerve block, 211, 212 pleural dome, 7 Plexolong catheter set, 233 pneumothorax, 47 popliteal block, dorsal approach, popliteal fossa, 198 fibular nerve blocking techniques, 202 ultrasound guidance, 229 posterior cutaneous nerve of thigh, 91, 128 postoperative nausea and vomiting (PONV), 218 post-tourniquet syndrome, 213 proximal sciatic nerve block, , 147 dorsal, 152 lateral, psoas abscess, 104, 107 psoas compartment block, and abscess, 104, 107 anatomy, 94 95, 96, 99 bilateral spread, catheter positioning, 102, 104 classical technique (Chayen), combined with sciatic nerve block,, 109 complications, 104, continuous, contraindications, 104 and epidural anesthesia, indications, 104 Mehrkens technique, and peritoneal injection, 104, 106 sensory and motor effects, 104 side effects, 104 skin femoral nerve distance, and subcapsular hematoma in kidney, 104, 107 summary, 110 technique, and total spinal anesthesia, and transverse process of L5, and ultrasound-guided puncture, 107 psoas major, 94 pubic tubercle, and obturator nerve block, 183 pulse duration, peripheral nerve stimulation, 231 pulse oximetry, 218, 225 pulse width, 232 pump systems, continuous peripheral nerve blocks, 241, 242 elastomer, 241, 242 infusion, 241 syringe, 241 puncture site, see injection/puncture site Q quadriceps muscle, and psoas compartment block, 99, 101, 102 R radial nerve, 5, 9, 66 and perivascular axillary block, 61 at wrist, 80, 81 radial nerve block elbow, 73, 76 needle direction, 67, 68 selective, middle of upper arm, at wrist, 83, 84 Raj technique infraclavicular, sciatic nerve block, recurrent nerve, 7 paresis, 28 regional anesthesia general principles, 235

5 253 remifentanil, 236 ropivacaine, 237, 239, 243 S sacral plexus, 89, 91 saphenous nerve, 203 anatomy, , 205 course, 194 external, 205 saphenous nerve block, classical technique, 193, 194 and distal sciatic nerve block, 173, 174 foot, indications, 196 subsartorial, 198 transsartorial technique, , 198 saphenous vein, 192 sartorius muscle and and saphenous nerve block, 191, 192, 194, 195 scapula, 49 sciatic nerve, 90, 91, course, 148, 161 lateral view, 147 ultrasound imaging, 230 sciatic nerve blocks anterior, see anterior sciatic nerve block and body temperature, 173 combined with psoas compartment block,, 109 distal, see distal sciatic nerve block dorsal transgluteal, 151 dorso-dorsal, and femoral nerve block, 124 indications, 166 lateral approach, parasacral (Mansour technique), proximal, see proximal sciatic nerve block subgluteal, sciatic plexus, 89, sedation, 236 seizures, and peripheral nerve blocks, 219 sensory effects axillary block, 62, sensory innervation foot, 207, 208 upper limb, 9 shoulder frozen shoulder syndrome, 54 indications for block, 239 side effects infraclavicular techniques, 47 single-shot techniques dosages, 237 and hygiene requirements, 224 skin incision, 235 sniffing position, 12 snuffbox, anatomical, 83 spread, anesthetic, see contrast spread stimulation needles, subclavian artery, 38 sufentanil, 236 superficial fibular nerve, 91, 206, 207 superficial fibular nerve block, supraclavicular blocks, 24, ultrasound guidance, 228 see also brachial plexus blocks suprascapular nerve, 9, 10 suprascapular nerve blocks, anatomy, complications, 54 indications, 53 sensory and motor effects, 53 side effects, 54 supraspinous fossa, 50, 51, 53 sural nerve, 203, 205 sural nerve block, alternative method, 210 surface thermometer, 155, 173, 230, 231 syringe pumps, 241 systemic intoxication, local anesthetics, T tarsal bones, innervation, 92 temperature, 230 monitoring, 226 and sciatic nerve block, 156, 173 test dose, 222 thermometer, surface, 155, 173, 230, 231 thigh amputation, 138 flexors, and anterior sciatic nerve block, 136 sensory innervation, 92 surgery, 124 tourniquet, 154 see also lateral cutaneous nerve of thigh three-in-one technique, , , 124, 129, 139, 140, 156 and obturator nerve block, 188 tibia, innervation, 92 tibial division, 164 tibial nerve, 91 anatomy, tibial nerve block, and peripheral nerve stimulation, 211 tibial plateau, 240 toes anatomy, 213 blocks, gangrene, 214 total knee arthroplasty, total spinal anesthesia, and psoas compartment block, tourniquet and ankle blocks, lower leg, 167 thigh, 154, 173 and toe blocks, 214 see also post-tourniquet syndrome toxic reactions local anesthetics,, 237 peripheral nerve blocks, 221 transverse costal process, as landmark, 107, transverse process of L5, and psoas compartment block, two-finger grasp, in anterior sciatic nerve block, 129, 132, 134, 137 two-in-one block, 124 U ulnar nerve, 5, 9, 66 injury, 221 and ulnar sulcus, 79, 80 at wrist, 80 ulnar nerve block elbow, 75, 79, 80 needle direction, 66, 67 at wrist, 82, 83 ultrasound and peripheral nerve blocks, and psoas compartment block, 107 see also Doppler unipolar needle, 233 upper limb, 4 84 anatomy, 4 7 axillary block, forearm, indications for block, 239 motor and sensory supply, 9 overview, 4 9 selective block of individual nerves, suprascapular block, see also brachial plexus; humerus; radial; ulnar; wrist V vastoadductor septum, 194 vastus medialis, and saphenous nerve block, 194, 195 ventilation, monitoring, 28, 225, 226 verbal monitoring, vertebral artery, 7 vertical infraclavicular block, 33 40, vs. axillary block, 40, 41, 42 contrast spread, 41 vomiting, postoperative, 218 W warming, local anesthetics, 238 Wassef technique, obturator nerve block, 190 Winnie technique femoral nerve block, , 122 interscalene block, 12, 13 wrist anatomy, 81, 83 blocks, 80 83, 81 84