The third edition of this standard textbook on ultrasound nerve blocks is released during a unique period in human history. The COVID-19 pandemic and the threats that the disease poses to both patients and healthcare workers have substantially changed perioperative practice. During the pandemic, regional anesthesia was established as the preferred method over general anesthesia whenever possible. Nerve blocks preserve respiratory function and avoid aerosolization during intubation and extubation and, hence, viral transmission to other patients and healthcare workers. As an example, the use of nerve blocks as the preferred surgical anesthesia method during the pandemic allowed many limb surgeries to be carried out with decreased exposure to healthcare workers and less burden on post-anesthesia care units (PACUs) and utilization of hospital beds. With regional anesthesia, patients can leave acute postoperative care facilities faster and avoid admission to the limited hospitalization beds. In our center, using regional anesthesia and nerve blocks as the main anesthetic choice allowed elective orthopedic surgery in many patients.
The use of ultrasound-guided local regional anesthesia (LRA) has increased exponentially in the last few years. The traditional techniques have been refined and a number of new approaches have been devised to better suit the evolving clinical practice. Nerve blocks are an essential component of multimodal analgesia in enhanced recovery after surgery (ERAS) protocols. Their use enhances analgesia and reduces or eliminates the use of opioids in the postoperative period. Some traditional nerve block techniques have been substituted by more selective techniques to minimize motor block and facilitate early rehabilitation and recovery. New ultrasound-guided fascial plane techniques, distal nerve blocks, and selective periarticular injections also are increasingly being used to yield a better balance between efficacy, simplicity, safety, and sensory-motor block ratio.
This third edition of NYSORA's textbook is substantially updated and revised to include the many new developments in regional anesthesia and trends in clinical practice. The new edition features entirely new artwork, new clinical images, and new fascial plane and infiltration techniques. All in all, some 500 new algorithms, illustrations, ultrasound images, clinical photographs, and cognitive aids were included to facilitate learning. In addition to anesthesiologists, the highly didactic and organized technique descriptions and functional anatomy principles will be valuable to all anesthesia providers, acute and chronic pain specialists, as well as interventional pain, musculoskeletal medicine, and emergency department physicians.
NYSORA's Reverse Ultrasound Anatomy™ (RUA) images feature functional anatomy or block techniques with clear instructions on the principles and goals of each given technique. These cognitive aids entailed countless hours of work and collaboration between NYSORA's creative and editorial teams to develop highly didactic creatives that facilitate understanding of the anatomy, fascial planes, and principles of nerve blockade. RUA helps students memorize sonoanatomy patterns, which is essential for ultrasound imaging. The knowledge of the sonoanatomy patterns substantially increases ultrasound proficiency and skills retention. Wherever applicable, clinical images of the patient's position, ultrasound transducer placement, and anatomical detail are featured. Recent relevant literature was added to the "Suggested Reading" for readers who like to explore the original sources of the information presented. We chose this approach in an effort to provide the most practical, pragmatic information and relieve the content from massive literature citations.
Readers should be advised that this book is not meant to be an encyclopedic listing of all techniques and their variations. Rather, our textbook should be viewed as a compendium of well-established knowledge, didactically organized for learning, and transferring knowledge to students of anesthesiology. With this approach, the textbook aims to help standardize, and implement well-established techniques, indications, pharmacology, monitoring, and the documentation of nerve blocks. Instead of burdening the reader with experimental block techniques with unproven clinical benefit, we aimed to include the most clinically useful nerve block, fascial, and infiltration techniques with proven efficacy and clinical applicability. Information about perioperative management and local anesthetic toxicity treatment was also added, and/or fully revised. Because patients commonly present with a vague history of allergy to local anesthetics, the new edition also features highly practical algorithms to facilitate decision-making and management of allergy to local anesthetics.
We are confident that this textbook will continue to be one of the primary resources on peripheral nerve blocks in medical practices worldwide.
Drs Hadzic, Lopez, Balocco, and Vandepitte