Introduction to

A potential problem with web based education is that it is not subject to the same level of peer review as traditional medical journal articles (this may also be a problem with textbooks). All readers/students can do when determining the reliability of a web based educational resource is evaluate critically the experience and qualifications of a site's author(s).    

Credentials of the primary site author: 

1. Performed > 4500 ultrasound-guided peripheral nerve blocks in last 10 years.

2. Managed > 3000 ambulatory perineural catheters in last 10 years.

3. Ongoing clinical practice which includes six ultrasound-guided regional anesthesia half-day sessions/week.

4. Published 25 first author peer-review original article publications, 22 of which relate to ultrasound-guided regional anesthesia (RAPM, Anesthesiology, BJA, Anaesthesia, Anesthesia & Analgesia).

5. Associate editor of the journal, Regional Anesthesia and Pain Medicine.

Rather than provide instructions on how to perform several ultrasound nerve blocks for a given indication, the site is restricted to a small collection of peripheral nerve blocks covering the most common surgical requirements. The blocks described have been found, in our practice, to be the simplest, most efficient and often the most effective to get the job done. They may very well also be the safest. For example, for wrist and hand surgery, only single injection ultrasound guided infraclavicular block is described. Ultra low volume multi-injection axillary block (selectively targeting all four nerves) may be an elegant technique, which can achieve the same goal as single injection infraclavicular block (surgical anesthesia and/or postoperative analgesia), but it has not been shown to offer any significant advantage to patients. As multi-injection axillary block is, as the name suggests more complex, it is given little exposure on the site.

The site has a strong focus on the nuts and bolts of how to perform specific ultrasound guided blocks using the minimum of text to learn the key concepts. Notably, it contains key ultrasound nerve block procedural "PEARLS" and also has a strong focus on ambulatory infusions e.g. by elastomeric pump. Finally, most of the ultrasound images and videos are realistic – they may not be perfect images obtained in only a few patients, but they are images you can reasonably expect to acquire.

Although several experts in regional anesthesia have made significant contributions, a strength of the site is that it is written predominantly by one anesthesiologist. Therefore, the content presentation is standardised, and recommendations for practice consistent between blocks e.g. recommendations should not be contradictory unless specifically stated and justified. I have also tried to eliminate duplicated content (e.g. "the block area is prepped with antiseptic").

The vast majority of recommendations are evidence-based; that is, there is randomised controlled trial evidence to support them. Opinion based recommendations are only made for techniques/treatments where there is a lack of such evidence. That opinion is based on 10 years of avid ultrasound-guided regional anesthesia literature study, and our own clinical experience over the same time working out what does and does not work.

Most of the ultrasound nerve block techniques advocated have been self-taught. This is because the author started performing a large number of blocks during 2002, which coincided with two key developments in peripheral nerve block practice: ultrasound-guidance and perineural catheter techniques. Having gone through this learning experience using an early Sonosite machine, one of the author's goals for readers is to minimise trial and error.

The site is divided into surgical procedures, regional block techniques, and "controversies in regional anesthesia". The controversies section has been included because these issues are often not easily accessed from anesthetic journals or text books.  

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Michael J Fredrickson, MBChB, FANZCA, MD, PhD




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