By Andre P. Boezaart MD PhD
Grasp all the blocks required for orthopaedic anesthesia, together with either single-injection and non-stop nerve blocks! this article and its spouse DVD completely evaluation the anatomy issues you want to recognize to successfully execute those suggestions, and show all sixteen crucial nerve blocks as played by way of experts in orthopaedic anesthesiology. considerable full-color photos of the series of every block - mixed with full-color drawings and images of cadaver sections of the utilized anatomy - aid to make sure right needle placement for every procedure.
- Presents anatomy and strategies from various views via anatomical drawings, gross anatomy photos, and pictures of floor anatomy - making sure right needle placement for every nerve block.
- Uses a realistic, "how-to” method that makes the most recent strategies effortless to learn.
- Covers difficulties and pitfalls that will help you stay away from power complications.
- Shows you the way to accomplish either single-injection and non-stop nerve blocks, and demonstrates the anatomical responses received from percutaneous stimulation of the nerves, through movies at the spouse DVD.
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Extra info for Atlas of Peripheral Nerve Blocks and Anatomy for Orthopaedic Anesthesia
46 REGIONAL BLOCKS AND ANATOMY FOR ORTHOPEDIC ANESTHESIA C FIGURE 3-5 (continued) C, The palpating ﬁngers are moved until the groove can be palpated at the level of C6. D, A solid line is drawn from the dorsal spine of C6 to the suprasternal notch. 6, Dorsal spine of C6; 7, dorsal spine of C7; LS, levator scapular muscle; T, trapezius muscle. The dot in the apex of the “V” between these two muscles indicates the point of needle entry. D FIGURE 3-6 The levator scapulae and trapezius muscles are separated by the index and middle ﬁngers of the nonoperative hand, and the skin and subcutaneous tissue are injected with a local anesthetic agent using a 25-gauge needle.
The point at which the lateral border of the sternocleidomastoid muscle meets the clavicle is marked as shown in Figure 4-4 (medial arrow). 5 cm lateral to the insertion of the sternocleidomastoid muscle to the clavicle or the width of the clavicular head of the patient’s sternocleidomastoid muscle (see Fig. 4-4, lateral arrow), and approximately 1 cm above the clavicle (see Fig. 4-4, dot). A 50-mm, short-bevel, 22-gauge insulated needle is used. After a small skin wheal is raised, the stimulating needle is inserted perpendicular to the skin (Fig.
The catheter is advanced retrograde through the needle and the needle is removed, leaving a loop of catheter at the original catheter exit site. The catheter is situated deep to the external jugular vein and exits in the area of the suprasternal notch. The skin bridge makes removal of the catheter easier. If a skin bridge is not used, the catheter is “buried” under the skin. Place the Luer lock connecting device on the proximal end of the catheter and attach the nerve stimulator and the syringe with the local anesthetic agent to the connecting device (Fig.