Head and Neck Blocks

Central Neural Blocks

The spinal column consists of vertebral bodies which together form 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal vertebrae (see Transparency 1). A typical vertebra consists of two basic parts: the ventral vertebral body and the dorsal vertebral arch. Between the vertebral bodies are the intervertebral disks, which give the spinal column its flexibility. Together, the vertebral bodies and the intervertebral disks form a strong column supporting the head and trunk, while the vertebral arch protects the spinal cord. When the spinal column is viewed from the side, four flexures are visible: the thoracic and the sacrococcygeal flexures are concave ventrally, while the cervical and…

Blocks of the Trunk and Perineum

Intercostal nerve block was derived from thoracic paravertebral block. Its origin can thus be traced to the beginning of the century (see Sect. VII. B).

Intravenous Regional Anesthesia

Intravenous regional anesthesia was first described by Bier in 1908. The technique fell into disuse until 1963, when Holmes revived the technique by substituting lidocaine for procaine (see Sect. V. D, “Choice and Dosage of Agents”).

Hemisensory disturbances in patients with complex regional pain syndrome.

Sensory disturbances often spread beyond the site of injury in complex regional pain syndrome (CRPS) but whether this applies equally to CRPS I and II, or changes across the course of the disease, is unknown. Establishing this is important, because different symptom profiles in CRPS I and II, or in acute vs chronic CRPS, might infer different pathophysiology and treatment approaches. To explore these questions, sensory disturbances were assessed in the limbs and forehead of 71 patients with CRPS I and 33 patients with CRPS II. Pain had persisted up to 12 months in 32 patients, for 13 to 36 months in 29 patients, and for longer than this in 43 patients. Patients with CRPS I were more likely …

Complex regional pain syndrome: evidence for warm and cold subtypes in a large prospective clinical sample.

Limited research suggests that there may be Warm complex regional pain syndrome (CRPS) and Cold CRPS subtypes, with inflammatory mechanisms contributing most strongly to the former. This study for the first time used an unbiased statistical pattern recognition technique to evaluate whether distinct Warm vs Cold CRPS subtypes can be discerned in the clinical population. An international, multisite study was conducted using standardized procedures to evaluate signs and symptoms in 152 patients with clinical CRPS at baseline, with 3-month follow-up evaluations in 112 of these patients. Two-step cluster analysis using automated cluster selection identified a 2-cluster solution as optimal. Resul…

Lumbar and thoracic sympathetic radiofrequency lesioning in complex regional pain syndrome.

Autonomic Nerve Blocks

Selective block of the sympathetic trunk was first reported by Sellheim and, shortly thereafter, by Lawen, Kappis, and Finsterer (1905–1910). In 1924, reports were published by Brumm and Mandl and by Swertlow. After 1930, the technique and the indications were established by White in the United States and Leriche and Fontaine in Europe.

Upper-Extremity Blocks

Brachial plexus block was first performed in 1885 by William Steward Halsted, who used cocaine and direct exposure of the roots in the neck to accomplish the block. In 1911, Hirschel and Kulenkampff described the first percutaneous brachial plexus block by the axillary and supraclavicular routes respectively. Since these historic reports, the efficacy of brachial plexus block has been confirmed, and the block is now commonly used to provide upperextremity anesthesia.

Lower-Extremity Blocks

Operations on the lower extremities are commonly performed with either subarachnoid or epidural block. Although conduction anesthesia has a high rate of success and is relatively easy to perform, subarachnoid or epidural procedures may not be indicated for certain groups of patients, including the elderly, debilitated, arthritic, obese, or critically ill. With such patients, lowerextremity regional anesthesia can be accomplished by blocking the lumbosacral plexus or its branches.