The publication of the third edition of this atlas provided us with the opportunity not only to update techniques of the previously included blocks, but also to introduce the reader to the recent progress in neurostimulation including nerve mapping and sequential stimulation and in ultrasound guided techniques. The technological progress in ultrasounds over the past 4 years has been absolutely phenomenal. It is becoming increasingly easier, even for novices, to determine the location of nerves using ultrasound and it is clear that more progress is on the horizon including better resolution and 3D imaging. Although it is still unclear if the use of ultrasound will help reduce the frequency of some of the complications associated with the performance of blocks, even today the use of ultrasound offers the opportunity for the practitioner to see where the needle goes and even the local anesthetic distribution. Recent data support the concept that practitioners can learn ultrasound guided approaches quickly. These approaches can be used with or without neurostimulation, but as before requires a very good knowledge of the anatomy.
As before, the content of the third edition has been developed with the assistance of many experts in regional anesthesia including those from the Department of Anesthesiology of the University of Pittsburgh. In the past six years that I have had the privilege of being a part of the Department of Anesthesiology of the University of Pittsburgh, our efforts in regional anesthesia and acute interventional perioperative pain have led to the establishment of unique regional anesthesia and acute interventional perioperative pain services, performing annually over 15,000 peripheral nerve blocks and growing at an annual rate of at least 30%. Most recently, to facilitate education and standardization across the department, a Division of Regional Anesthesia and Acute Interventional Perioperative Pain was established that presently includes 7 different services operating in 9 different hospitals and/or ambulatory centers and at least 2 more services are expected to be developed in the near future.
On behalf of all the contributors, I can say that “it is our most sincere wish that this atlas serves as a daily source of practical information for residents, fellows, and even attendings of various specialties (anesthesiology, acute and chronic pain, emergency medicine, orthopedics, otolaryngology, maxillofacial surgery, ophthalmology, and emergency medicine, etc.) who are interested in peripheral nerve block techniques. However, it is important to recognize that this atlas is not intended to replace proper supervision of trainees performing peripheral nerve blocks. It has to be seen as a tool among several educational materials to increase theoretical, technical knowledge of regional anesthesia.
Jacques E. Chelly MD, PhD, MBA
Professor of Anesthesiology (with Tenure) and Orthopedic Surgery, Vice Chair of Clinical Research, Director of the Regional and Orthopedic Fellowships, Director of the Division of Acute Interventional Perioperative, Pain and Regional Anesthesia, Department of Anesthesiology, University of Pittsburgh Medical Center, Director of Orthopedic Anesthesia, UPMC Shadyside Hospital, Director of Acute Interventional Perioperative Pain, UPMC Presbyterian-Shadyside Hospitals, Pittsburgh Pennsylvania
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