A femoral nerve block is nerve block technique that carries a low risk of complications and is widely used for femur and knee surgery. This article describes  ultrasound-guided approaches to the femoral nerve block including the potential advantages of using ultrasound, tips on technique to achieve a successful block and pitfalls to avoid.   Download the [...]Ultrasound Guided Femoral Nerve Block (284) - April 15, 2013

This tutorial reviews the latest ideas on opioid pharmacology including mechanism of action and receptor subtypes.Update in Opioid Pharmacology (277) - December 3, 2012

Traditionally anaesthetists learn to block 3 nerves at the wrist. In this article we decribe 6 terminal nerves that supply the wrist and hand and how to block them to provide effective analgesia or anaesthesia for wrist or hand surgeryWrist Block – Landmark Technique (275) - November 19, 2012

The lumbar plexus block is very useful for management of pain following unilateral lower limb surgery (principally knee, femur or hip). It is not widely used due to concerns of its potential complications. This Tutorial will cover the relevant anatomy, a description of the posterior approaches to blocking the lumbar plexus using a landmark technique and its potential complications.Lumbar Plexus Block – Landmark Technique (263) - June 18, 2012

It is very common to encounter patients on strong opioid medication. These patients present particularly challenging pain management difficulties in the peri-operative period due to behavioural, psychological and pharmacological consequences of opioid treatment. This article discusses the key concepts in the anaesthetic management of patients taking strong opioids and steps that can be taken to ensure optimum peri-operative care.Peri-operative Management of Patients on Strong Opioids (260) - May 21, 2012

Stellate ganglion blockade is a specialist technique which may be employed to aid with diagnosis of and relief from certain pain conditions. This tutorial gives a summary of the technique including indications, relevant anatomy and a guide to common approaches.Stellate Ganglion Block (256) - March 26, 2012

The femoral nerve block (FNB) is one of the easiest peripheral nerve blocks to master. FNB can be performed to provide perioperative analgesia for fractured neck/shaft of femur, knee surgery and some lower leg surgery. It can also be used to provide surgical anaesthesia, usually in combination with a sciatic nerve block. The article will cover relevant anatomy, potential uses and block technique along with a brief trouble shooting section.Femoral Nerve Block – Landmark Approach (249) - February 6, 2012

The Transversus Abdominis Plane (TAP) Block is a local anaesthetic block used to provide analgesia to the anterior and lateral abdominal wall. This tutorial will outline the relevant anatomy, describe both landmark and ultrasound techniques, and discuss some of the evidence for their use.Transversus Abdominis Plane (TAP) Block (239) - September 5, 2011

This tutorial explains that pain resulting from nerve injury, or neuropathic pain is produced from a differnt mechanism from pain due trauma. The physiology of the condition, and the clinical pharmacology are described. How to diagnose and asses the patient with neuropathic pain are covered and there is a brif introduction to non pharmacological forms of treatment.Neuropathic Pain (234) - August 1, 2011

Interscalene blocks can provide excellent anaesthesia and/or analgesia for operations on the distal clavicle, shoulder and proximal arm.This article describes the anatomy and technique of ultrasound guided interscalene block.Ultrasound Guided Interscalene Brachial Plexus Block (233) - July 25, 2011

Adjuvants are drugs that increase the efficacy or potency of other drugs when given concurrently. This tutorial aims to summarise some of the adjuvant agents that are in common use in neuraxial anaesthesia and analgesia.Neuraxial adjuvants (230) - July 4, 2011

Phantom pain is a common and frequently difficult to treat sequelae of amputation. This tutorial reviews current knowledge of the condition and its management.Phantom Pain (229) - June 27, 2011

Thoracic paravertebral blocks (TPVB) can be used for analgesia for abdominal, thoracic and breast surgery. Recent studies have suggested it may reduce the incidence of chronic pain and breast cancer recurrence. This article discusses the indications, anatomy and technique for TPVB.Paravertebral Block, Landmark Technique (224) - May 24, 2011

When using ultrasound for regional anaesthesia it is essential to have a good understanding of basic ultrasound physics in order to obtain the best possible image. Part 2 of The Physics of Ultrasound will examine ultrasound phenomena, such as anisotropy and artefact, to understand how these can affect image quality and what practical steps can be taken to reduce their effects. The article will also look at the Doppler effect before finishing with a few practical hints and tips on how to ensure the best images are obtained.The Physics of Ultrasound – part 2 (218) - March 21, 2011

Acute pain is a fundamental part of anaesthetic practice with multiple neurochemical and psychological factors influencing its perception. The relevant anatomy and physiology are discussed in this tutorial.Acute pain management part 1 – Anatomy & physiology (213) - February 14, 2011

Using ultrasound-guidance, the median and ulnar nerves can be easily blocked in the forearm and the radial nerve just above the elbow to provide analgesia for hand surgery, or to augment or expedite a more proximal brachial plexus block.Ultrasound guided local anaesthetic forearm blocks (208) - January 10, 2011

Part one of this series examines the physical principles behind ultrasound. An understanding of this is important in interpreting ultrasound images.The physics of ultrasound – part 1 (199) - October 4, 2010

Rectus sheath catheters provide blockade of the anterior division of T6 - T11 thoraco-abdominal intercostal nerves for post-operative analgesia. This tutorial describes a technique of surgical placement of these catheters under direct vision. This can be a useful alternative to epidural block.Surgically placed rectus sheath catheters (195) - September 6, 2010

The fascia iliaca compartment block is a low-skill, inexpensive method to provide peri-operative analgesia for surgery on the thigh, hip joint and/or the femur.Fascia Iliaca Compartment Block (193) - August 23, 2010

This tutorial covers the anatomy and practical aspects of performing an ankle block. For those lucky enough to have access to an ultrasound, the sonoanatomy is also discussed.Ankle block. Landmark and ultrasound techniques (178) - May 10, 2010

The axillary brachial plexus block is a popular nerve block for forearm, wrist and hand surgery. This article reviews the anatomy of the brachial plexus and looks at the various methods to perform the block using a landmark techniqe.Axillary brachial plexus blocks: Landmark techniques (165) - January 11, 2010

A variation of the interscalene approach to blocking the brachial plexus.Subclavian perivascular brachial plexus block (156) - October 19, 2009

Discusses the history, electrophysiology and practical use of the electronic peripheral nerve stimulator in assisting peripheral nerve blockade.Nerve stimulators for peripheral nerve blockade (149) - August 31, 2009

18th May 2009 Dr Kim Russon, Consultant Anaesthetist Dr Helen Findley, ST3 Anaesthetics Dr Zoe Harclerode, ST3 Anaesthetics Rotherham General Hospital, UK Correspondence to russonkim@doctors.org.uk    QUESTIONS Before continuing, try to answer the following questions.  The answers can be found at the end of the article, together with an explanation. 1.    TRUE or FALSE: On [...]Peripheral nerve blocks – Getting started (134) - May 18, 2009

This tutorial discusses the pharmacology of local anaesthetic agents.Pharmacology for regional anaesthesia (49) - March 26, 2007

This series of tutorials is adapted from Dr J. Hyndman's handbook or regional anaesthesia, written for anaesthesia practitioners in resource poor areas. This tutorial deals with the advantages, disadvantages and contra-indications to regional anaesthesia.Introduction to regional anaesthesia (47) - March 12, 2007

To be read along with ATOTW 36, this describes the factors which affect spread of local anaesthetic within the CSF.Spinal anaesthetic spread (37) - November 28, 2006

The greatest challenge in spinal anaesthesia is to control the spread of local anaesthetic through the cerebrospinal fluid (CSF) to provide a block which is adequate for the proposed surgery without unnecessary extensive spread, and increased risk of complications. This tutorial will cover the assessment of spinal anaesthetic block.Assessment of spinal anaesthetic spread (36) - November 1, 2006

An overview of the physiology of pain transduction, transmission, modulation and perception.The physiology of pain (16) - December 15, 2005

An overview of complications of neuraxial analgesia and anaesthesia in obstetrics and their managementComplications of regional anaesthesia in obstetrics (15) - December 1, 2005