Nearly six years have passed since the third edition of our tutorial on „Peripheral Regional Anaesthesia", and a good deal has changed during that time; this calls for our attention. The second „Compact" Version which appeared in 2009 was already expanded to include ultrasound-guided puncture techniques for a number of blocks; animated illustrations for modern smartphones etc. are now available for downloading, and now at last it is also time for the „classical text version" to provide updated information material together with a new DVD. There is no doubt that ultrasonography in peripheral regional anaesthesia represents an enormous enrichment, with a wealth of valuable information; nevertheless this technique is by no means permanently available to all of our medical colleagues in the operating theatre. It is our conviction that for this reason nerve stimulation continues to have its own justification and place and will do so for a long time. Especially in deeper blocks (i.e. psoas, proximal sciatic) the simutaneous use of ultrasound and nerve stimulation is recommended even by renowned fans of ultrasonography. This procedure, which is also described as „Dual Guidance", is in our opinion a valuable instrument for the newcomer as well because it permits verification of the structures of the ultrasonic image via a motor response, thus making it possible to achieve bit by bit the required degree of certainty in interpreting the sonographic image. However, the basis for successful peripheral blocks and continuous analgesia procedures is and always will be an understanding of (cross-sectional) anatomy, no matter what technique is used to detect the plexus and the nerves. The present text takes well-established techniques as its foundation and adds to this a description of successful and current developments. My particular thanks go here to my predecessor and the initiator of the „Tutorial Series", Prof. H.-H. Mehrkens M.D., who has assisted us even in retirement at all times in word and deed. I also owe a debt of deep gratitude to my Assistant Medical Director Jörg Winckelmann M.D. for his untiring commitment in bringing out the new edition. Last but not least I wish to thank the B. Braun Melsungen Company, without whose support this project could never have been realized, and Prof. „Honigpumpe", who brought it to life with the technology of media.
Ulm, August 2011 Peter Geiger, M.D.