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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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 Preface to the First Edition

Anesthesia, comprehensively administered, is a blend of art and science. The proper proportion of each is often difficult to articulate and often depends on the individuals involved. In regional anesthesia the need to blend art with science has long been recognized and promoted. One of the principal thrusts of my effort in creating this Atlas of Regional Anesthesia is to utilize a heavy proportion of art (i.e., illustrations) in the “mix.” I believe these images will provide physicians an improved understanding of the anatomy and the technical details necessary for the successful use of regional anesthesia.

Over the years my interest in regional anesthesia has led me to consult many regional anesthesia texts and atlases. Review of these books has convinced me that a large number of the illustrations have been developed from a common lineage; sometimes out of necessity but occasionally simply perpetuating the biases of this common lineage. My goal with this atlas is to combine my daily approach to the practice of regional anesthesia with an understanding of regional block anatomy. Cross-sectional anatomy is emphasized, since it is crucial to really learning regional block techniques and developing a three-dimensional concept of block anatomy. The anatomical illustrations are supplemented with newer clinical imaging views to add another perspective to these important anatomical concepts. Nevertheless, the aim throughout this work is to simplify rather than make the images complex. For example, this text is not referenced in the classic manner; rather, regional anesthesia references are listed in the appendix for consultation when necessary. I hope that this atlas is useful to anesthesiology trainees (residents and fellows) and to practicing anesthesiologists interested in making regional anesthesia “work” in their practices. Throughout the Atlas each block has been organized around the three big “P”s—block perspective, block placement, and block pearls. The division Perspective is subdivided into patient selection and pharmacologic choice. The division Placement includes subdivisions—anatomy, position, needle puncture, and potential problems. Finally, the division, Pearls, highlights some clinical tips to make regional anesthesia really work in clinical practice.

This Atlas would not be possible without the help and encouragement of many colleagues and friends. Lewis Reines approached me years ago with the idea of a regional anesthesia atlas, and without his encouraging perspective the project probably would not have gotten off the ground. Richard Zorab deserves credit for being the major facilitator of the work. He managed to keep both the artistic and practical issues anchored, so that the project was completed. Lois Newman, Ph.D., anatomist at Thomas Jefferson University Medical School also deserves thanks for providing a thoughtful and detailed review of the anatomy so important to this work. Gale E. Thompson, M.D., a colleague and friend in Seattle, deserves thanks for collaborating on the concepts for the work while initial ideas were being developed. Denise J. Wedel, M.D., my colleague and friend at the Mayo Clinic, also deserves thanks for critically reviewing the text.

Perhaps most important to the projects completion was the opportunity I had during my years in Seattle with the Virginia Mason Clinic to practice in an anesthesia department with a rich history of successfully incorporating regional anesthesia into clinical practice. Daniel C. Moore, M.D. and L. Donald Bridenbaugh, M.D. both deserve special thanks for encouraging my interest in regional anesthesia, as well as simply being friends. Another, special friend that deserves thanks is Randall L. Carpenter, M.D., whose presence in the department in Seattle provided not only encouragement but an unequaled sounding board for ideas. The organizational and secretarial skills of two co-workers and friends, Maureen Beaulieu and Barbara Hughes, were also essential to the completion of this work.

Finally and importantly, this work would not have been possible without the dedication and artistry of Jo Ann Clifford. Through her art she brings to life many concepts that I attempt to articulate but that are made so much clearer in her illustrations.

David L. Brown

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