Essential anatomy for anesthesia7/29/2023 There are few situations in medical practice that are more unforgiving and difficult than the management of polytrauma casualties in austere battlefield conditions. I am pleased to say that regional anesthesia and continuous nerve blocks are now routine practice in American military and civilian medicine. As in André’s experience, these continuous regional techniques provided excellent operating room anesthetic conditions, remarkable perioperative analgesia, and greatly enhanced the wounded soldiers comfort during long evacuation flights without the nausea and respiratory depression associated with the exclusive (and at the time far too common) use of morphine for pain management. Many years later, in 2003, employing far better equipment and the same love of anatomy, I would place the first continuous peripheral nerve block in a United States soldier evacuated from Iraq after sustaining near fatal injuries that included a traumatic amputation of his left leg below the knee. André’s experience likely represents the first utilization of a continuous peripheral nerve block during war. These catheters would remain in place for weeks and were used for frequent dressing changes and debridements common to war wounds. In an effort to improve efficiency and avoid repeated axillary blocks for soldiers with upper extremity wounds that required further surgery or dressing changes, André performed axillary artery cut-downs and then passed central line catheters cephalad next to the artery to where the plexus crosses the first rib to provide continuous access to the brachial plexus for re-block and continuous analgesia of the arm. Clutching a worn copy of Daniel Moore’s 1967 4th edition textbook, “Regional Block,” he quickly applied the lessons therein to many war casualties in long operating room sessions. André served in the South African Defense Force in 1975 during the Angola War as the only anesthesiologist for the Forward Surgical Unit. Boezaart, MD, PhD, asked me to provide a forward to this masterful work, “ The Anatomical Foundations of Regional Anesthesia and Acute Pain Medicine.”Īndré and I have both turned to the potential of regional anesthesia in time of war to provide safe, compassionate, and logistically sound anesthesia and analgesia to soldiers wounded in combat. I was therefore flattered and enthusiastic when my friend and colleague, André P. Winnie, one of the ”Founding Fathers” of the American Society of Regional Anesthesia, that “ regional anesthesia is nothing more than applied anatomy.” This quote and approach to regional anesthesia has been the foundation of much of my career as a military anesthesiologist. I have often used the quote, attributed to my dear friend, the late Alon P. The book is essential for all medical graduates and training anesthesiologists seeking to understand the basics and detailed nuances of nerve anatomy and regional anesthesia. The extensive reference lists adequately complement the knowledge provided in the text. This textbook is written and designed to convey practical working knowledge of the macro-, micro-, sono-, and functional anatomy required for regional anesthesia and acute pain medicine in an accessible manner through the use of detailed illustrations, (anatomical figures, diagrams and tables), with simplified legends and videos that allow readers to understand concepts – such as percutaneuous nerve mapping and nerve blockade access – in a dynamic manner. The textbook also features detailed information on nerve sonoanatomy. The Anatomical Foundations of Regional Anesthesia and Acute Pain Medicine is a textbook which explains the sensory function of each nerve in the human body in detail, including the motor function. With this understanding on an anatomical basis, anesthesiologists can now better appreciate the reasoning behind why pain blocks sometimes fail or where the “sweet spot” of a nerve is and how to find it or why epidural blocks are segmental while subarachnoid blocks are not or why older patients are less prone to postdural puncture headache, and many more issues of regional anesthesia and pain medicine. Copyright and Permission for ReproductionĪlthough the timeless quote of Alon Winnie (ASRA Founding Father), that regional anesthesia is simply an exercise in applied anatomy, rings true and will continue to ring true for many years to come, we now have a better understanding of the micro- and ultrastructure of the nerves and the anatomical features – membranes, fascia, fascial planes, and barriers – that surround them.
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