RA POCKET GUIDE
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The RA Pocket Guide is formatted so that any block is easily accessed by laying the book flat.
THE REGIONAL ANAESTHESIA POCKET GUIDE APP
The Regional Anaesthesia Pocket Guide is formatted deliberately so that any block is easily accessed by laying the book flat and opened to the relevant page; text information is on the left and accompanying high quality photographs, illustrations and annotated ultrasound images are on the right.
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Individual Chapter Summaries
Introduction: This chapter introduces readers to equipment necessary for regional anaesthesia. This includes needle types for both single shot and continuous catheter techniques in the periphery and neuraxis. Attention is drawn to appropriate patient preparation and consent for regional anaesthesia, and clinical pearls on troubleshooting when problems are encountered. Local anaesthesia systemic toxicity is discussed, with symptoms and signs commonly observed and the treatment.
An extensive section is devoted to ultrasound guided regional anaesthesia, covering equipment, terminology, needle approaches, first principles approaches to scanning and identifying anatomical structures, pitfalls of ultrasound, ergonomics, needle visibility, and safe conduct of ultrasound guided injections.
The Head: This chapter covers relevant anatomy and approaches for the major nerve blocks of the head. This includes peribulbar and sub-Tenon’s eye blocks, anaesthesia and analgesia for surgery to the face and nose by performing supraorbital, supratrochlear, infraorbital, mental, and anterior ethmoidal blocks. Intraoral surgery particularly for the palate and and maxillary teeth is covered by the maxillary nerve block.
Each block is illustrated by anatomical drawings for the sensory and motor innervations of the nerve, and photographs of the block being performed. Text explanations are provided of the equipment, doses, and techniques of each block.
The Upper Extremities: This chapter covers relevant anatomy and approaches for all the major nerve block approaches to the brachial plexus for upper limb regional anaesthesia. These include the interscalene, supraclavicular, multiple techniques for the infraclavicular, suprascapular, and axillary plexus blocks. Nerve blocks at the forearm and wrist are also discussed, which are useful either as supplementation of incomplete plexus blocks, or as primary blocks for superficial surgery of the wrist and hand.
Each block is explained using annotated photographs of the surface anatomy. Other photographs visually explain the relationship of the correct ultrasound probe position and block needle insertion point. Ultrasound images of that region are provided, and reinforced by illustrations of the underlying anatomical structures.
A major section includes ultrasound scanning techniques for the upper limb, which are extremely useful to obtain best quality sonoanatomical images by ergonomic positioning of the patient and probe manipulation.
The Lower Extremities: This chapter covers relevant anatomy and approaches for all the major regional anaesthesia techniques for the lower limb. Multiple ultrasound and landmark based approaches to the sciatic nerve from the sacral plexus to the popliteal fossa including anterior (ventral), lateral, and prone techniques, are covered. The lumbar plexus (psoas compartment) block is discussed, as well as more peripheral approaches including the discrete femoral, saphenous, obturator, and lateral femoral cutaneous blocks; and the fascia iliaca fascial plane block.
As with all chapters in this book, relevant photographs of the surface anatomy and ultrasound probe orientation on the patient are used to orientate the reader to correct positioning for each block. Ultrasound images are used in conjunction with anatomical drawings to illustrate the important anatomical structures to improve nerve block safety and efficacy.
Ultrasound scanning tips have been included in this chapter to orientate the reader to anterior, lateral, and posterior approaches using both linear and curvilinear probes to image the lumbosacral plexus.
The Spine and Para-Axial region: This chapter describes the major regional anaesthesia blocks around the spine and abdomen. Neuraxial blocks covered include the lumbar epidural and the thoracic paravertebral, which are commonly used as continuous catheter techniques for extended analgesia during labour, and anterior chest and breast surgery. Two approaches to the transversus abdominis plane (TAP) blocks are included, using anatomical drawings to explain the different analgesic outcomes from classic posterior TAP and the subcostal TAP blocks for infraumbilical and supraumbilical surgery, respectively. Other discrete blocks of the abdomen are covered, including the intercostal, rectus sheath, ilioinguinal and iliohypogastric, genitofemoral, and dorsal penile blocks.
As with the previous chapters in this book, each nerve block technique has multiple photographs of the surface anatomy, ultrasound probe position, and needle insertion trajectory to supplement the text description. These are supplemented by high definition annotated ultrasound images and anatomical illustrations.