APPENDIX: Color Plates

Atlas of Regional Anesthesia

Plate 1 Blockage of the terminal sensory branches of the trigeminal nerve. A vertical line connects the supraorbital notch, infraorbital foramen, and mental foramen.

Plate 2 Dermatomes of the head, neck, and face.

Plate 3 Supraclavicular block. The three trunks are compactly arranged at the level of the first rib. The needle is systematically walked anteriorly and posteriorly along the rib until the plexus is located.

Plate 4 Anatomic landmarks and method of needle placement for deep cervical plexus blocks at C2, C3, and C4.

Plate 5 Axillary block. The arm is abducted 90 degrees. Distal pressure is maintained during needle placement and injection of the local anesthetic.

Plate 6 Cross-sectional lumbar vertebral centroneuraxis anatomy at the L3–4 level.

Plate 7 Techniques of epidural needle insertion most often used in locating the epidural space. A, In the loss-of-resistance technique, the needle is inserted into the ligamentum flavum, and a syringe containing an air bubble is attached to the hub. After compression of the air bubble is obtained by applying pressure to the syringe plunger, the needle is carefully advanced until its entry into the epidural space is confirmed by the characteristic loss of resistance to syringe plunger pressure, and the fluid enters the space easily. B, In the hanging-drop technique, the needle is inserted into the ligamentum flavum, and a drop of saline (or local anesthetic) is placed in the hub. The needle is then carefully advanced until its entry into the epidural space is detected by the drop of solution being "sucked" into the epidural space.

Plate 8 Posterior lumbar vertebral centroneuraxis anatomy.

Plate 9 Lateral lumbar vertebral centroneuraxis anatomy from L1 through the coccyx.

Plate 10 Paravertebral nerve block. A, Patient position and surface landmarks. B, The needle is advanced perpendicularly until it contacts the transverse process. It is redirected to walk off the caudad edge of the transverse process and advanced 1 to 2 cm.

Plate 11 The lumbar plexus lies in the psoas compartment between the psoas major and quadratus lumborum muscles.

Plate 12 Anatomic landmarks for lateral femoral cutaneous, femoral, and obturator nerve blocks. In an obturator nerve block, the needle is walked off the inferior public ramus in a medial and cephalad direction until it passes into the obturator canal.

Plate 13 A, Patient positioning. B, Anatomic landmarks for the posterior approach to sciatic nerve block.

Plate 14 Popliteal fossa block. A, Anatomic landmarks for the posterior approach to the sciatic nerve in the popliteal fossa. B, Anatomic landmarks for the lateral approach to the sciatic nerve in the popliteal fossa.

Plate 15 A, Anatomic landmarks for block of the posterior tibial and sural nerves at the ankle. B, Posterior tibial nerve and method of needle placement for block at the ankle. C, Sural nerve and method of needle placement for block at the ankle.

Plate 16 Anatomic landmarks for block of the deep peroneal, superficial peroneal, and saphenous nerves at the ankle.

Plate 17 Intervertebral epidural anesthesia. A, Recommended position of the patient. B, Influence of spinous processes on needle orientation. C, Anatomy of the epidural space.

Plate 18 Caudal anesthesia. A, Anatomic landmarks. B, Position of the patient and surface landmarks. C, Puncture technique: skin penetration using a 60- to 90-degree angle to the skin (1), redirection of the needle (2), and slight penetration (1 to 2 mm) within the spinal canal (3).

Plate 19 Supraclavicular brachial plexus block. A, Relationship of the brachial plexus trunks to the clavicle and lower insertions of the anterior and middle scalene muscles. B, Insertion routes of the most common supraclavicular approaches to the brachial plexus.

Plate 20 Proximal lower extremity blocks. A, Fascia iliaca compartment block. B, Classic femoral nerve block. C, Relationship of the femoral nerve in the groin. D, Insertion routes of the most common proximal blocks of the lower extremity (cross section of the thigh).

Plate 21 Iliohypogastric and ilioinguinal nerve blocks. A, Relationship of the ilioinguinal and iliohypogastric nerves. B, Puncture technique, showing two sites of injection.

Plate 22 Intercostal nerve blocks. A, Recommended position of the patient. B, Intercostal space and puncture technique: insertion of the needle until it contacts the lower border of the upper rib (1) and caudad redirection of the needle to pass it immediately below the rib while continuous pressure is exerted on the barrel of the syringe (2). C, Intercostal nerves and branches.

Plate 23 Penile block. A, Relationship of dorsal nerves and orientation of the needle (sagittal section at the level of the pubic symphysis). B, Position of the patient and needle orientation (almost perpendicular to the skin, with a slight slope medially and caudally).