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Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia, second edition, is being published at an exciting time in the development of regional anesthesia. Reflecting on the first edition of the book,* we believe its success was due largely to the tried-and-true nature of the material taught. It would not be an overstatement to say that the first edition of this book influenced professional lives of many colleagues and ultimately benefited patients worldwide. The success helped garner the New York School of Regional Anesthesia (NYSORA) additional esteem that it enjoys today. In line with the philosophy of the first edition, this second edition minimizes presentation of theoretical considerations. Instead, the featured techniques and teachings are gleaned directly from the trenches of the clinical practice of regional anesthesia.

In recent years, the field of regional anesthesia, and in particular peripheral nerve blockade, has entered an unprecedented renaissance. This renaissance is due primarily to the widespread introduction of ultrasound-guided regional anesthesia. The ability to visualize the anatomy of interest, the needle–nerve relationship, and the spread of the local anesthetic has resulted in significant growth of interest in and use of peripheral nerve blocks. Regardless, many aspects of ultrasound-guided regional anesthesia still require clarification and standardization. Examples include dilemmas regarding the ideal placement of the needle for successful and safe blockade, the number of injections required for individual techniques, the volume of local anesthetic for successful blockade, the integration of additional monitoring tools such as nerve stimulation and injection pressure monitoring and many others. For these reasons, we decided to defer publication of the second edition and opted to wait for clarification from clinical trials or collective experience to provide more solid recommendations. As a result, just as with the first edition, the second book features only tried-and-true descriptions of peripheral nerve block techniques with wide clinical applicability rather than a plethora of techniques and modifications that have mere theoretical considerations. Where the collective experience has not reached the necessary level to recommend teaching a certain technique (e.g., neuraxial blocks), we opted to feature anatomic considerations rather than vague or inadequately developed technique recommendations, which may lead to disappointments, or possibly complications, if they are adopted without careful consideration.

The second edition is organized as a collection of practical introductory chapters, followed by detailed and unambiguous descriptions of common regional anesthesia block procedures rather than an exhaustive theoretical compendium of the literature. Although ultrasound guidance eventually may become the most prevalent method of nerve blockade globally, most procedures world-wide are still performed using the methods of peripheral nerve stimulation and/or surface landmarks, particularly in the developing world. Because this book has been one of the main teaching sources internationally, we decided to retain the section on the traditional techniques of nerve blockade in addition to the new section on ultrasound-guided regional anesthesia. Since knowledge of surface anatomy is essential for practice of both traditional and ultrasound regional anesthesia procedures, we decided to also add an Atlas of Surface Anatomy (Section 8).

The book is organized in eight sections that progress from the foundations of peripheral nerve blocks and regional anesthesia to their applications in clinical practice. Ultrasound-guided regional anesthesia is a field in evolution, and many of its aspects still lack standardization and clear guidance. For this reason, we decided to produce this new edition as an international collaborative effort. This collaboration resulted in teaching that is based not only on our experience at NYSORA but also is endorsed by a number of opinion leaders in the field from around the globe. I would like to thank them for the contributions, enthusiasm, and passion that they invested in creating the second edition of Peripheral Nerve Blocks. This book also would not be what it is without the large extended family of educators and trainees, who took part in the numerous NYSORA educational programs, including our educational outreach program in developing countries in Asia. I thank you immensely for your input, which inspired us to deliver this updated edition, and for your multiple contributions through e-mails, suggestions, and discussion on the website.

There are no standards of care related to peripheral nerve blocks, despite their widespread use. With this edition, we have tried to standardize the techniques and the monitoring approach during local anesthetic delivery, for both greater consistency and greater safety of peripheral nerve blocks. Different institutions naturally may have different approaches to techniques that they customize for their own needs. The material we present in this volume however, comes from the trenches of clinical practice, so to speak. Most procedures described are accompanied by carefully developed flowcharts to facilitate decision making in clinical practice that the authors themselves use on an everyday basis.

The successful practice of ultrasound-guided regional anesthesia and pain medicine procedures depends greatly on the ability to obtain accurate ultrasound images and the ability to recognize the relevant structures. For these reasons, we decided to add an atlas of ultrasound anatomy for regional anesthesia and pain medicine (Section 7) procedures to this volume. The anatomy examples consist of a pictorial guide with images of the transducer position needed to obtain the corresponding ultrasound image and the cross-sectional gross anatomy of the area being imaged. Once the practitioner absorbs this material, he or she can extrapolate the knowledge of the practical techniques presented to practice virtually any additional regional anesthesia technique. We have expended painstaking efforts to provide cross-sectional anatomy examples where possible. Perfecting the matching of ultrasound and anatomy sections is not always possible because the sonograms and cross-sectional anatomy views are obtained from volunteers and fresh cadavers, respectively. The reader should keep in mind that the ultrasound images are obtained from videos during dynamic scanning. For this reason, the labeled ultrasound images are accurate to the best of our abilities and within the limitations of the ultrasound equipment even when they do not perfectly match the available paired cross-sectional anatomy.

Due to popular demand, we decided to include a DVD containing videos of the most common ultrasound-guided nerve block procedures. Assuming that videos are the most beneficial method for novices and trainees, we decided to include videos of well-established ultrasound-guided nerve blocks that should cover most indications for peripheral nerve blocks. Once trainees have mastered these techniques, they typically require only knowledge about the specific anatomy of the block(s) to be performed to apply the principles learned in the videos to any other nerve block procedure. This is another example of how the atlas of ultrasound anatomy (Section 7) included in the book will be useful. With the wealth of information presented in a systematic fashion, we believe that the Atlas also will be of value to anyone interested in the ultrasound anatomy of peripheral nerve and musculoskeletal systems, including radiologists, sonographers, neurologists, and others.

With this edition of Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia, we have tried to provide a wealth of practical information about the modern practice of peripheral nerve blocks and the use of ultrasound in regional anesthesia and to present multiple pathways to troubleshoot common clinical problems. We hope this book will continue to serve as one of the standard teaching texts in anesthesiology, and we thank the readership of previous edition their support and encouragement.

Admir Hadzic, MD

*The first edition was titled Peripheral Nerve Blocks: Principles and Practice.

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