Tutorial_in_Peripheral_Regional_Anaesthesia.pdf

Tutorial

in the Ulm Rehabilitation Hospital

Prof. H.-H. Mehrkens, M.D., P.M. Geiger, M.D.

Department of Anaesthesiology/Intensive Care Medicine

Preface to the First Edition

Despite increasing use in recent years, peripheral regional anaesthesia techniques continue to occupy a rat-

her secondary position in comparison to spinal procedures. This is particularly the case for peripheral blocka-

de techniques of the lower extremities.

The manifold advantages of complete anaesthesia of a single extremity for operative procedures of the most

diverse sort have prompted us to devote particular attention to these techniques over many years. Urged on

by interested colleagues as well as our own aspirations, the idea emerged of developing a practically orien-

ted, anatomical-clinical training on this subject so as to pass on the exceedingly positive experiences accu-

mulated both by practitioners and patients to a wider circle of colleagues. Previous and current employees

have now produced an accompanying text for this “Peripheral Regional Anaesthesia Tutorial”, which sum-

marises the content of this course in condensed form.

The support of the B. Braun Co. now makes it possible for us to make this text available in the present form

to a wider audience. We hope that this will contribute to the wider dissemination of the regional anaesthe-

sia methods presented herein and thus to the greater well being of our patients. In this connection, the par-

ticular worth of these procedures with the help of the continual catheter technique for long-term pain mana-

gement should not be overlooked.

My thanks to all the employees who have worked so hard to see this brochure through to completion. My

particular appreciation goes to Prof. M. Herrmann, M.D., the previous director of the Institute for Anatomy at

Ulm University, for his unstinting efforts in helping with the organisation of the Tutorial, as well as to our

orthopaedic colleagues, Prof. W. Puhl, M.D., Director of the Orthopaedic Clinic and his employees, without

whom the realisation of the clinical-practical portion of the tutorial could not have been accomplished.

Ulm, September 1997

Prof. H.-H. Mehrkens, M.D.

Preface to the Second Expanded Edition

Three years have passed since the first tutorial was published. The time has now come to revise the accom-

panying script to include all the further developments that have meanwhile taken place.

The extremely positive response and the continued and generous support provided by AstraZeneca and B.

Braun Melsungen have additionally helped us dare take a quantum leap into the era of modern media. We

are eagerly awaiting the results of the new and extensive visual and interactive possibilities offered by CD-

ROM media and the Internet.

This new forum that has been created will ultimately open up possibilities for more direct and quicker feed-

back. We would like to expressly encourage all those colleagues interested to send us their critique and con-

structive suggestions.

Ulm, March 2000

Prof. H.-H. Mehrkens, M.D.

Preface to the Third Expanded Edition

Following the 2004 publication of the compact version of our tutorial on "Peripheral Regional Anesthesia in

the RKU", now, to keep pace with rapid advancements, we release the new, comprehensively revised and

updated edition of the original script. This brochure has been expanded by several, meanwhile established

block techniques. Useful knowledge and experience from clinical routine gathered over the past years have

been included in equal measure with current and newly developed materials. Its publication takes place in

sync with a new DVD version with expanded contents and an updated homepage www.nerveblocks.net . For

mobile use, we recommend the compact version in PDF format that fits on a pocket PC. Once again, all of the

above would not have been possible without the continuingly generous support of B. Braun Melsungen and

the commitment of our own clinical team.

Ulm, September 2005

Prof. H.-H. Mehrkens, M.D.

Contents

1 Fundamentals

1.1 Anatomy

1.2 Electrical nerve stimulation

1.3 Local anaesthesia

2 Blocks of the upper extremity

2.1 Interscalene nerve blocks

2.2 Infraclavicular vertical brachial plexus block

2.3 Axillary nerve block

2.4 Suprascapular nerve block

3 Blocks of the lower extremity

3.1 Psoas block

3.2 Femoral nerve block

3.3 Saphenous nerve block

3.4 Obturator nerve block

3.5 Proximal sciatic nerve blocks

3.6 Distal sciatic nerve blocks

4 Side effects/Contraindications

5 Catheter Technique in Peripheral Regional Anaesthesia

5.1 Indications for Catheter Use

5.2 Possible catheter techniques

5.3 Equipment and Drugs

5.4 Contraindications

5.5 Complications

5.6 Organisation

6 Equipment and drugs (overview)

6.1 Single-shot technique - Upper Extremity

6.2 Single-shot technique - lower extremity

6.3 Catheter technique - upper extremity

6.4 Catheter technique - lower extremity

6.5 Conclusion

7 Possible indications for peripheral regional anaesthesia

7.1 Operations on the upper extremity

7.2 Operations on the lower extremity

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