Atlas of Regional Anesthesia E-Book
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492 pages

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Atlas of Regional Anesthesia, by Dr. David L. Brown, has been the go-to reference for many years, helping clinicians master a myriad of nerve block techniques in all areas of the body. This meticulously updated new edition brings you state-of-the-art coverage and streaming online videos of ultrasound-guided techniques, as well as new coverage of the latest procedures. Hundreds of high-quality full-color illustrations of anatomy and conventional and ultrasound-guided techniques provide superb visual guidance. You’ll also have easy access to the complete contents online, fully searchable, at

  • Obtain superior visual guidance thanks to hundreds of high-quality illustrations of cross-sectional, gross, and surface anatomy paired with outstanding illustrations of conventional and ultrasound-guided techniques.
  • Master the ultrasound-guided approach through 12 online videos demonstrating correct anatomic needle placement.
  • Access the complete contents online and download all of the illustrations at
  • Learn the latest techniques with a new chapter on transversus abdominis block and updated coverage of nerve stimulation techniques, implantable drug delivery systems, spinal cord stimulation, and more.



Publié par
Date de parution 21 juillet 2010
Nombre de lectures 0
EAN13 9781437737882
Langue English
Poids de l'ouvrage 3 Mo

Informations légales : prix de location à la page 0,0774€. Cette information est donnée uniquement à titre indicatif conformément à la législation en vigueur.


Atlas of Regional Anesthesia
Fourth Edition

David L. Brown, MD
Professor of Anesthesiology, Cleveland Clinic Learner College of Medicine, Chairman of Anesthesiology Institute, The Cleveland Clinic, Cleveland, Ohio
Front Matter

ATLAS OF Regional Anesthesia
Fourth Edition
David L. Brown , MD, Professor of Anesthesiology, Cleveland Clinic Learner College of Medicine, Chairman of Anesthesiology Institute, The Cleveland Clinic, Cleveland, Ohio
I llustrations by
Jo Ann Clifford

1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
Copyright © 2010, 2006, 1999, 1992 by Saunders, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: You may also complete your request on-line via the Elsevier website at .

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on his or her own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book.
Library of Congress Cataloging-in-Publication Data
Brown, David L. (David Lee)
Atlas of regional anesthesia / David L. Brown ; illustrations by Jo Ann Clifford and Joanna Wild King.—4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4160-6397-1
1.  Conduction anesthesia—Atlases. 2.  Local anesthesia—Atlases. I.  Title.
[DNLM: 1.  Anesthesia, Conduction—methods—Atlases. WO 517 B877a 2011]
RD84.B76 2011
Executive Publisher: Natasha Andjelkovic
Developmental Editor: Julie Goolsby
Publishing Services Manager: Tina Rebane
Project Manager: Amy Norwitz
Design Direction: Steven Stave
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedicated to
Kathryn, Sarah, Eric, Noah, and Cody
And you who think to reveal the figure of a man in words, with his limbs arranged in all their different attitudes, banish the idea from you, for the more minute your description the more you will confuse the mind of the reader and the more you will lead him away from the knowledge of the thing described. It is necessary therefore for you to represent and describe.

Leonardo da Vinci
The Notebooks of Leonardo da Vinci, Vol. 1, Ch. III *
Reynal & Hitchcock, New York, 1938

* Translator: Edward MacCurdy

André P. Boezaart, MD, PhD , Professor of Anesthesiology and Orthopaedic Surgery, University of Florida College of Medicine; Chief of Division of Acute Pain Medicine and Regional Anesthesia; Director of Acute Pain Medicine and Regional Anesthesia Fellowship Program, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

Ursula A. Galway, MD , Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Staff Anesthesiologist, Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio

James P. Rathmell, MD , Associate Professor of Anaesthesia, Harvard Medical School; Chief of Division of Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts

Richard W. Rosenquist, MD , Professor of Anesthesia and Director of Pain Medicine Division, Department of Anesthesia, University of Iowa School of Medicine; Medical Director of Center for Pain Medicine and Regional Anesthesia, Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa

Brian D. Sites, MD , Associate Professor of Anesthesiology and Orthopedics, Dartmouth Medical School, Hanover; Director of Regional Anesthesiology and Orthopedics, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Brian C. Spence, MD , Assistant Professor of Anesthesiology, Dartmouth Medical School, Hanover; Director of Same-Day Surgery Program, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Preface to the Fourth Edition
Creating another edition of our Atlas of Regional Anesthesia demanded that we include the advances that are driving much of the change in regional anesthesia and pain practices, and we have wisely chosen experts in our specialty to contribute to this edition. The first two editions of the Atlas were based on my experience in my practice; thankfully, as my academic practice grew, others came alongside me to add their knowledge and practical experience. The goal with this fourth edition remains the same as with the first edition—to teach physicians needing to learn regional anesthesia and pain medicine technical procedures these techniques as they are practiced by physicians who use them daily, incorporating the pearls learned from this daily practice.
I remain indebted to my three outstanding physician contributors to the third edition, Drs. André Boezaart, James Rathmell, and Richard Rosenquist. Each has updated his contributions to this work. Additionally, two physicians helping to lead the revolution in ultrasound imaging in regional anesthesia have joined us, Drs. Brian Sites and Brian Spence. Their insights into the use of ultrasound will keep each of us focused on where our subspecialty is going. Finally, Dr. Ursula Galway has added her expertise in transversus abdominis plane block. Our artist for this edition remains Ms. Joanna Wild King; again she used her vision for simplification of images and concepts to improve on our technical messages.
I want to thank so many colleagues and patients across the country who share a belief that society as a whole benefits from physicians’ becoming more adept at regional anesthesia and pain medicine techniques, as we are able to treat both acute and chronic pain more effectively.

David L. Brown
The necessary, but somewhat artificial, separation of anesthetic care into regional or general anesthetic techniques often gives rise to the concept that these two techniques should not or cannot be mixed. Nothing could be farther from the truth. To provide comprehensive regional anesthesia care, it is absolutely essential that the anesthesiologist be skilled in all aspects of anesthesia. This concept is not original: John Lundy promoted this idea in the 1920s when he outlined his concept of “balanced anesthesia.” Even before Lundy promoted this concept, George Crile had written extensively on the concept of anociassociation.
It is often tempting, and quite human, to trace the evolution of a discipline back through the discipline’s developmental family tree. When such an investigation is carried out for regional anesthesia, Louis Gaston Labat, MD, often receives credit for being central in its development. Nevertheless, Labat’s interest and expertise in regional anesthesia had been nurtured by Dr. Victor Pauchet of Paris, France, to whom Dr. Labat was an assistant. The real trunk of the developmental tree of regional anesthesia consists of the physicians willing to incorporate regional techniques into their early surgical practices. In Labat’s original 1922 text Regional Anesthesia: Its Technique and Clinical Application, Dr. William Mayo in the foreword stated:

The young surgeon should perfect himself in the use of regional anesthesia, which increases in value with the increase in the skill with which it is administered. The well equipped surgeon must be prepared to use the proper anesthesia, or the proper combination of anesthesias, in the individual case. I do not look forward to the day when regional anesthesia will wholly displace general anesthesia; but undoubtedly it will reach and hold a very high position in surgical practice.
Perhaps if the current generation of both surgeons and anesthesiologists keeps Mayo’s concept in mind, our patients will be the beneficiaries.
It appears that these early surgeons were better able to incorporate regional techniques into their practices because they did not see the regional block as the “end all.” Rather, they saw it as part of a comprehensive package that had benefit for their patients. Surgeons and anesthesiologists in that era were able to avoid the flawed logic that often seems to pervade application of regional anesthesia today. These i

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