Ultrasound-Guided Nerve Blocks on DVD: Upper and Lower Limbs Package. Edited by Alain Delbos, M.D. Philadelphia, Lippincott Williams & Wilkins, 2008. Price: $329 (package price), $179 (each DVD).

The Ultrasound-guided Nerve Blocks (Upper and Lower Limbs)  interactive DVDs are excellent comprehensive sources of teaching nerve blocks using ultrasound techniques. Because of their success with two previous DVDs focused on regional anesthesia using nerve stimulators, the authors followed the same approach for teaching regional anesthesia using ultrasound.

This DVD set contains two parts—the first DVD looks at regional blocks of the upper limb and the second at regional blocks of the lower limb. They demonstrate the regional blocks that are most commonly performed. Both the animation and the video sections are equipped with a voiceover narration feature that explains every step in a very clear way.

The Upper Limbs DVD includes brachial plexus blocks using interscalene, supraclavicular, infraclavicular, and axillary approaches. It also presents the median nerve at both the elbow and at the forearm, the radial nerve block at the elbow, and the ulnar nerve block at the forearm. The Lower Limbs DVD includes blocks of the femoral nerve including a block of the fascia iliacus compartment; sciatic nerve with transgluteal, subgluteal, and popliteal fossa approaches; and saphenous and tibial nerves.

Every individual block is presented in the following sections:

The Animation section describes the indications and contradictions and uses well-presented, three-dimensional images that explain the anatomy and technique in a very easy-to-remember and comprehensive way.

The Video section provides video clips of every block and illustrates how they are performed on manikins. On the same screen you see every step of each procedure synchronized with an animation and ultrasound clips. This approach gives the viewer a clearly understandable explanation of each block, and also demonstrates in-plane and out-of-plane ultrasound techniques. This section also shows clips for catheter placements.

The Library section presents links to relevant literature for each block.

The Simulation section is what really distinguishes these DVDs from others. It allows for the performance of real-time virtual ultrasound blocks. It enhances the user’s level of learning by adding an interactive method rather than having only a passive teaching experience. At the start of the simulation, there is a brief tutorial on how to use the simulation software. This application is very advanced and allows the user to draw lines and curves to outline landmarks. It also allows for the navigation of an ultrasound probe and gives an option to advance needles to different depths during the performance of a simulated block. Two of the most innovative elements of this section are the presence of a hide-and-show feature that allows visualization of the underlying structures for better anatomic orientation, and the presence of ultrasound images that parallel the actions simulated in a separate window on the same screen.

The Anatomy section gives an in-depth understanding of the anatomy through cross-sectional approaches and three-dimensional pictures that have show/hide, rotating, translating, and zooming capabilities.

Although the simulations are equipped with tutorials on how to use them, it may not be very simple for users who are not comfortable using computers. This may distract from focusing on the scientific material in this section. Because of its relatively high price, many medical students and residents may be unable to afford the cost. Another limitation is that the DVDs only work properly on computers with Windows XP and Vista Pentium 3 or higher operating system and with 512 MB RAM-1GB. Computers with the MAC operating system would not be suitable for optimum use.

To summarize, these two DVDs offer a very comprehensive and practical way to learn and digest ultrasound-guided regional anesthesia. These DVDs are excellent tools for all anesthesia residents as they learn ultrasound-guided regional anesthesia.

These products will most likely have the same success of the authors’ previous two DVDs for nerve stimulator guided regional anesthesia.

*Staff Anesthesiologist, John Cochran VA Medical Center, St. Louis, Missouri. boasaad@yahoo.com