This handbook connects the connective-tissue architecture of the peripheral nerve — endoneurium, fascicle, perineurium, epineurium — and the injection-pressure physiology that makes intraneural injury preventable, then carries that foundation through every major regional anesthesia target: brachial plexus, lumbar and sacral plexus, truncal fascial planes, head and neck, and neuraxial technique. Built around the Sono-Trajectory Decision System, a five-part clinical reasoning framework — The Target, Sono-Signature, The Trajectory Decision, Trap Logic, and Block Anchor — repeated at every anatomic site, it teaches the pattern behind the procedure, not forty-four isolated techniques. Written for anesthesiology residents, regional anesthesiology and acute pain medicine fellows, and practicing anesthesiologists sharpening ultrasound-guided technique.
Named vascular and pleural hazards at every target, bony-contact-first trajectory planning, and a consolidated, cross-referenced Atlas turn dense sonoanatomy into a decision you can defend at the bedside.
Inside, You Will Learn How To
• Confirm extraneural spread and injection pressure safety — recognize an atypical local anesthetic systemic toxicity presentation before it becomes cardiovascular collapse.
• Target the interscalene groove and supraclavicular corner pocket — trunk- and division-level trajectories with the trap logic that separates a nerve mimic from the real target.
• Walk the posterior psoas compartment to the lumbar plexus — bony-contact trajectory planning that keeps the needle out of the epidural space.
• Choose among paravertebral, erector spinae plane, TAP, and quadratus lumborum block — fascial plane selection for thoracic and abdominal coverage without crossing the pleura.
• Manage intercostal and interpleural technique's pneumothorax risk — rib walk-off and pleural-sliding confirmation at this book's closest pleural proximity.
• Integrate neuraxial and peripheral technique — combined spinal-epidural placement, cumulative dosing, and epidural hematoma vigilance for major joint and thoracic surgery.
• Adapt technique for pediatric, obstetric, and obesity-related practice — caudal epidural access, ideal-body-weight dosing, depth-adapted equipment selection.
• Build and sustain a regional anesthesia program — credentialing pathways, quality assurance structure, and the genicular and medial branch blocks that extend a program into chronic pain.
Equip yourself to defend every trajectory decision you make — for the patient on the table now, and the one after.
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