Regional Nerve Blocks in Anesthesia Handbook 2026

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.