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Atlas of Ultrasound-Guided Procedures in Interventional Pain Management 2011 ed. [Hardback]

  • Formāts: Hardback, 372 pages, height x width: 279x210 mm, weight: 1269 g, 2 Tables, black and white; 350 Illustrations, color; 115 Illustrations, black and white; XXVIII, 372 p. 465 illus., 350 illus. in color., 1 Hardback
  • Izdošanas datums: 16-Dec-2010
  • Izdevniecība: Springer-Verlag New York Inc.
  • ISBN-10: 1441916792
  • ISBN-13: 9781441916792
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  • Formāts: Hardback, 372 pages, height x width: 279x210 mm, weight: 1269 g, 2 Tables, black and white; 350 Illustrations, color; 115 Illustrations, black and white; XXVIII, 372 p. 465 illus., 350 illus. in color., 1 Hardback
  • Izdošanas datums: 16-Dec-2010
  • Izdevniecība: Springer-Verlag New York Inc.
  • ISBN-10: 1441916792
  • ISBN-13: 9781441916792
Citas grāmatas par šo tēmu:
This book is the first and definitive reference in the growing field of ultrasonography in pain medicine. Each chapter details all you need to know to perform a specific block.  Comparative anatomy and sonoanatomy of the various soft tissues are featured, and tips and tricks for correct placement of the ultrasound probe and admimistration of the injection are described in detail.  All the major peripheral nerve blocks are discussed as well as the various injections of the spine, pelvis, and musculoskeletal system.

This book offers comprehensive coverage of ultrasound-guided pain medicine (USPM). It is aimed at physicians who manage acute and chronic pain syndromes who are beginning to use US-guided pain procedures and would like to shorten their learning curve.

Recenzijas

e tool for developing their knowledge and skills. a must-read for novices as well as experts performing invasive procedures for pain relief. (Devi E. Nampiaparampil, Journal of the American Medical Association, March, 2011)The content and generously annotated illustrations complement each other to form an enjoyable and instructive whole. The reader benefits from the references made to recent and anticipated future developments . the anatomical drawings and specimens, and the corresponding ultrasound images will make the Atlas of Ultrasound-Guided Procedures in Interventional Pain Management a clear and indispensable tool for every interventional pain specialist wishing to include ultrasonography as a safe, office-based procedure in his or her treatment armamentarium. (Matthias Karst, Journal of the American Medical Association, Vol. 307 (15), April, 2012)

Foreword vii
Vincent W. S. Chan
Preface ix
Acknowledgments xi
Contributors xxv
I Imaging in Interventional Pain Management and Basics of Ultrasonography
1 Imaging in Interventional Pain Management
3(10)
Marc A. Huntoon
Introduction
3(2)
C-Arm FDCT
5(2)
Ultrasound
7(3)
Intra-Articular Injections
8(1)
Trigger Point and Muscular Injections
8(1)
Zygapophyseal and Medial Branch Blocks
8(1)
Epidural Blocks
9(1)
Sympathetic Blocks
9(1)
Combined US and CT/Fluoroscopy
10(1)
Conclusion
10(1)
References
11(2)
2 Basics of Ultrasound Imaging
13(8)
Vincent Chan
Anahi Perlas
Introduction
13(1)
Basic Principles of B-Mode US
14(1)
Generation of Ultrasound Pulses
14(1)
Ultrasound Wavelength and Frequency
14(1)
Ultrasound-Tissue Interaction
15(3)
Recent Innovations in B-Mode Ultrasound
18(1)
Conclusion
19(1)
References
19(2)
3 Essential Knobology for Ultrasound-Guided Regional Anesthesia and Interventional Pain Management
21(14)
Alan J. R. MacFarlane
Cyrus C. H. Tse
Richard Brull
Introduction
22(1)
Frequency and Probe Selection
22(1)
Depth
23(2)
Gain
25(1)
Time Gain Compensation
26(1)
Focus
26(2)
Presets
28(1)
Color Doppler
29(1)
Power Doppler
30(1)
Compound Imaging
31(1)
Tissue Harmonic Imaging
32(1)
Optimization Button
32(1)
Freeze Button and Image Acquisition
33(1)
References
33(2)
4 How to Improve Needle Visibility
35(44)
Dmitri Souzdalnitski
Imanuel Lerman
Thomas M. Halaszynski
Introduction
35(1)
Training and Phantom Simulation
36(4)
Training with Adequate Mentorship
36(1)
Phantoms
36(1)
High-Fidelity Simulation
37(1)
Combined Ultrasound and Flouroscopic Phantom Simulators
38(2)
Procedural Needle-Related Visibility Factors
40(11)
Basic Sonography and Needle Image Interpretation
40(2)
Acoustic Impedance as the Basis for Procedure Needle Visualization
42(1)
Size (Gauge) of the Procedure Needle and Its Echogenicity
43(1)
The Skin Insertion Site Selected and Angle of Procedure Needle Passage
44(2)
Echogenic Procedure Needles
46(3)
Procedure Needle Tip
49(2)
The Ultrasound Device and Procedure Needle Visibility
51(7)
Ultrasound Imaging Artifacts and Procedure Needle Visibility
51(1)
Impact of Various Sonographic Modes on Procedure Needle Visibility
52(5)
Recent Advances in Ultrasound Imaging and Procedure Needle Visibility
57(1)
Needle-Probe Alignment
58(8)
Need for Procedure Needle and Ultrasound Probe Alignment
58(1)
"In-Plane" and "Out-of-Plane" Needle Approach: Classical Probe-Needle Interpositions
58(2)
Oblique Plane Needle Approach for Ultrasound-Guided Pain Management
60(1)
Biplane Needle Imaging Approach for Ultrasound-Guided Pain Management
61(1)
Mechanical and Optical Procedure Needle Guides
61(1)
Advanced Procedure Needle Positioning Systems
62(2)
The "ART" of Scanning for Better Procedure Needle Visualization
64(1)
Ergonomics for Better Procedure Needle Visibility
65(1)
Enhancement and Techniques to Improve Procedure Needle Localization
66(5)
Basic Sonographic Effect of Enhancement
66(1)
Enhancement with Priming, Insertion of Stylet or Guide Wire, and Vibration
67(1)
Hydrolocalization of the Procedure Needle
68(1)
Procedure Needle Visibility by Agitated Solutions or with Ultrasound Contrast Agents
69(2)
Localization of the Procedure Needle Tip with the Aid of Nerve Stimulation
71(1)
Summary
71(1)
References
72(7)
II Spine Sonoanatomy and Ultrasound-Guided Spine Injections
5 Spine Anatomy and Sonoanatomy for Pain Physicians
79(28)
Bernhard Moriggl
Introduction
79(1)
Basic Spine Anatomy
80(10)
Cervical Spine
80(3)
Thoracic Spine
83(1)
Lumbar Spine
84(3)
Sacrum
87(3)
Sonoanatomy of the Cervical Spine
90(6)
Superficial
90(2)
Deep
92(4)
Sonoanatomy of the Thoracic Spine
96(2)
Superficial
96(1)
Deep
97(1)
Sonoanatomy of the Lumbar Spine
98(5)
Superficial
98(3)
Deep
101(2)
Sonoanatomy of the Sacrum and Sacroiliac Joint
103(4)
Superficial
103(1)
Deep
104(3)
6 Ultrasound-Guided Third Occipital Nerve and Cervical Medial Branch Nerve Blocks
107(12)
Andreas Siegenthaler
Urs Eichenberger
Anatomy
107(1)
Indications for Cervical Medial Branch Block
108(1)
Why Ultrasound-Guided Facet Nerve Block? The Literature and Our Experience
109(1)
Possible Advantages of Ultrasound for Cervical Facet Nerve Blocks
110(1)
Limitations of Ultrasound
110(1)
Ultrasound-Guided Technique for TON and Cervical Medial Branch Block
110(6)
Scanning Before Injection
110(1)
Identifying the Correct Level: Method 1
110(4)
Identifying the correct Level: Method 2
114(1)
Practical Performance of Block
114(2)
Conclusion
116(1)
References
116(3)
7 Ultrasound-Guided Cervical Zygapophyseal (Facet) Intra-Articular Injection
119(6)
Samer N. Narouze
Anatomy of the Cervical Facet Joints
119(1)
Indications for Cervical Zygapophyseal Joint Intra-Articular Injection
120(1)
Literature Review of Ultrasound-Guided Cervical Facet Injections
120(1)
Ultrasound-Guided Technique for Cervical Facet Intra-Articular Injection
120(2)
Lateral Approach
120(1)
Posterior Approach
120(2)
References
122(3)
8 Ultrasound-Guided Cervical Nerve Root Block
125(8)
Samer N. Narouze
Anatomy of Cervical Nerve Root
125(1)
Indications
126(1)
Limitations of the Fluoroscopy-Guided Techniques
126(1)
Literature Review of Ultrasound-Guided Cervical Nerve Root Block
126(1)
Sonoanatomy of the Cervical Spine and Identification of the Cervical Level
127(1)
Ultrasound-Guided Technique for Cervical Selective Nerve Root Block
128(2)
References
130(3)
9 Ultrasound-Guided Thoracic Paravertebral Block
133(16)
Manoj Kumar Karmakar
Introduction
133(1)
Anatomy
134(1)
Mechanism of Blockade
135(1)
Techniques of TPVB
136(1)
Ultrasound-Guided TPVB
136(2)
Sonoanatomy Relevant for TPVB
138(6)
Basic Considerations
138(1)
Transverse Scan of the Thoracic Paravertebral Region
139(2)
Sagittal Scan of the Thoracic Paravertebral Region
141(3)
Techniques of USG TPVB
144(2)
Transverse Scan with Short-Axis Needle Insertion (Technique 1)
144(1)
Paramedian Oblique Sagittal Scan with In-Plane Needle Insertion (Technique 2)
144(1)
Transverse Scan with In-Plane Needle Insertion or the Intercostal Approach to the TPVS (Technique 3)
145(1)
Conclusion
146(1)
Acknowledgment
147(1)
References
147(2)
10 Ultrasound-Guided Lumbar Zygapophysial (Facet) Nerve Block
149(8)
David M. Irwin
Michael Gofeld
Introduction
149(1)
Anatomy
150(1)
Literature Review
150(1)
Scanning Technique
151(3)
Injection Technique
154(2)
Lumbar (L1-L4) Zygapophysial Medial Branch and L5 Dorsal Ramus Nerve Block
154(2)
Limitations of Ultrasound-Guided Zygapophysial Nerve and Joint Injection
156(1)
References
156(1)
11 Ultrasound-Guided Lumbar Nerve Root (Periradicular) Injections
157(4)
Khus Galiano
Hannes Gruber
Introduction
157(1)
Ultrasound-Guided Technique
158(1)
Limitations of the Ultrasound-Guided Technique
158(1)
References
159(2)
12 Ultrasound-Guided Central Neuraxial Blocks
161(18)
Manoj Kumar Karmakar
Introduction
161(1)
History
162(1)
Ultrasound Imaging of the Spine
163(8)
Basic Considerations
163(1)
Axis of Scan
163(1)
Spinal Sonoanatomy
164(1)
The Water-Based Spine Phantom
165(1)
Ultrasound Imaging of the Sacrum
166(2)
Ultrasound Imaging of the Lumbar Spine
168(2)
Ultrasound Imaging of the Thoracic Spine
170(1)
Ultrasound-Guided CNB
171(4)
Caudal Epidural Injection
172(1)
Lumbar Epidural Injection
173(1)
Thoracic Epidural Injection
174(1)
Spinal Injection
175(1)
The Evidence
175(1)
Education and Training
175(1)
Conclusion
176(1)
Acknowledgment
176(1)
References
177(2)
13 Ultrasound-Guided Caudal, Ganglion Impar, and Sacroiliac Joint Injections
179(14)
Amaresh Vydyanathan
Samer N. Narouze
Ultrasound-Guided Caudal Epidural Injections
180(3)
Anatomy
180(1)
Indications for Caudal Epidural Injection
180(1)
Limitations of the Landmark "Blind" Technique
180(1)
Literature Review of Ultrasound-Guided Caudal Epidural Injections
180(1)
Ultrasound-Guided Caudal Injection Is Better than the "Blind" Technique
181(1)
Ultrasound-Guided Technique for Caudal Epidural Injection
181(1)
Limitations of the Ultrasound-Guided Technique
182(1)
Ultrasound-Guided Ganglion Impar Block
183(1)
Anatomy
183(1)
Indications
183(1)
Limitations of the Current Technique
184(1)
Literature Review on Ultrasound-Guided Ganglion Impar Block
184(1)
Technique of Ultrasound-Guided Ganglion Impar Block
184(1)
Limitations of the Ultrasound-Guided Technique
184(1)
Ultrasound-Guided Sacroiliac Joint Injection
184(4)
Anatomy
184(2)
Indications for SIJ Injection
186(1)
Literature Review on Ultrasound-Guided SIJ Injection
186(1)
Technique of Ultrasound-Guided SIJ Injection
186(1)
Limitations of Ultrasound-Guided SIJ Injection
186(2)
References
188(5)
III Ultrasound-Guided Abdominal and Pelvic Blocks
14 Ultrasound-Guided Transversus Abdominis Plane (TAP) Block
193(6)
Samer N. Narouze
Introduction
193(1)
Anatomy
194(1)
The Classic Approach
194(1)
Ultrasound-Guided Technique
195(1)
Summary
196(1)
References
197(2)
15 Ultrasound-Guided Celiac Plexus Block and Neurolysis
199(8)
Samer N. Narouze
Hannes Gruber
Introduction
199(1)
Anatomy of the Celiac Plexus
200(1)
Current Techniques for Celiac Plexus Block
200(1)
The Anterior Percutaneous Approach
201(1)
Advantages of US-Guided Anterior Approach
202(1)
Limitations of US-Guided Anterior Approach
202(1)
Sonoanatomy of the Epigastrium and Relevant Structures
202(1)
Percutaneous Ultrasound-Guided Celiac Plexus Block Technique
203(3)
References
206(1)
16 Ultrasound-Guided Blocks for Pelvic Pain
207(20)
Clain-Wern Chan
Philip W. H. Peng
Introduction
207(1)
Ilioinguinal, Iliohypogastric, and Genitofemoral Nerves
208(6)
Anatomy
208(2)
Literature Review on the Injection Techniques for Ilionguinal, Ihohypogastric, and Genitofemoral Nerve Block
210(1)
Ultrasound-Guided Technique of Ilionguinal, Ihohypogastric and Genitofemoral Nerve
211(3)
Piriformis Syndrome
214(4)
Anatomy
215(1)
Literature Review on Piriformis Muscle Injections
216(1)
Ultrasound-Guided Technique for Piriformis Muscle Injection
216(2)
Pudendal Neuralgia
218(2)
Anatomy
218(1)
Literature Review on the Pudendal Nerve Injections
219(1)
Ultrasound-Guided Technique for Pudendal Nerve Injection
219(1)
Conclusion
220(1)
References
221(6)
IV Ultrasound-Guided Peripheral Nerve Blocks and Continuous Catheters
17 Ultrasound-Guided Nerve Blocks of the Upper Extremity
227(12)
Anahi Perlas
Sheila Riazi
Cyrus C. H. Tse
Introduction
227(2)
Brachial Plexus Anatomy
228(1)
Interscalene Block
229(1)
Anatomy
229(1)
Indication
229(1)
Procedure
229(1)
Supraclavicular Block
230(2)
Anatomy
230(1)
Indication
230(1)
Procedure
230(2)
Infraclavicular Block
232(1)
Anatomy
232(1)
Indication
232(1)
Procedure
232(1)
Axillary Block
233(1)
Anatomy
233(1)
Indication
233(1)
Procedure
234(1)
Distal Peripheral Nerves in the Upper Extremity
234(2)
Summary
236(1)
References
236(3)
18 Ultrasound-Guided Nerve Blocks of the Lower Limb
239(20)
Haresh Mulchandani
Imad T. Awad
Colin J. L. McCartney
General Considerations
239(1)
Femoral Nerve Block
240(3)
Clinical Application
240(1)
Anatomy (Figures 18.3 and 18.4)
240(1)
Preparation and Positioning
241(1)
Ultrasound Technique
241(2)
Sciatic Nerve Block
243(3)
Clinical Application
243(1)
Anatomy
244(1)
Preparation and Positioning
244(1)
Ultrasound Technique
244(2)
Sciatic Nerve Blockade in the Popliteal Fossa
246(2)
Clinical Application
246(1)
Anatomy
246(1)
Preparation and Positioning
246(1)
Ultrasound Technique
246(2)
Lumbar Plexus Block
248(2)
Clinical Application
248(1)
Anatomy
248(1)
Preparation and Positioning
248(1)
Ultrasound Technique
249(1)
Obturator Nerve Block
250(1)
Clinical Application
250(1)
Anatomy
250(1)
Preparation and Positioning
250(1)
Ultrasound Technique
250(1)
Lateral Femoral Cutaneous Nerve Block
251(1)
Clinical Application
251(1)
Anatomy
251(1)
Preparation and Positioning
251(1)
Ultrasound Technique
252(1)
Saphenous Nerve Block
252(2)
Clinical Application
252(1)
Anatomy
252(1)
Preparation and Positioning
253(1)
Ultrasound Technique
253(1)
Ankle Block
254(3)
Clinical Application
254(1)
Anatomy
254(2)
Preparation and Positioning
256(1)
Ultrasound Technique
256(1)
References
257(2)
19 Ultrasound-Guided Continuous Peripheral Nerve Blocks
259(14)
Edward R. Mariana
Brian M. Ilfeld
Introduction
259(1)
Applications
260(1)
Overview of Ultrasound-Guided Perineural Catheler Insertion
260(2)
Nerve in Short Axis, Needle In-Plane Approach
260(1)
Nerve in Short Axis, Needle Out-of-Plane
260(1)
Nerve in Long Axis, Needle In-Plane
261(1)
Preparation for Ultrasound-Guided Perineural Catheter Insertion
262(1)
Sterile Technique
262(1)
Standard Perineural Catheter Equipment
262(1)
Ultrasound-Guided Perineural Catheter Insertion Techniques for Common Surgical Procedures
263(5)
Interscalene CPNB
263(1)
Infraclavicular CPNB
264(1)
Femoral CPNB
264(1)
Subgluteal Sciatic CPNB
265(2)
Popliteal Sciatic CPNB
267(1)
Tranversus Abdominis Plane CPNB
268(1)
Conclusion
268(1)
References
269(4)
20 Ultrasound-Guided Cervical Sympathetic Block
273(6)
Philip W. H. Peng
Introduction
273(1)
Anatomy
274(1)
Existing Techniques
274(2)
Technique for Ultrasound-Guided Injection
276(2)
References
278(1)
21 Ultrasound-Guided Peripheral Nerve Blockade in Chronic Pain Management
279(14)
Anuj Bhatia
Philip W. H. Peng
Introduction
279(1)
Lateral Femoral Cutaneous Nerve Block
280(2)
Anatomy
280(1)
Literature Review of Injection Techniques
281(1)
Ultrasound-Guided Block Technique
281(1)
Suprascapular Nerve Block
282(3)
Anatomy
282(2)
Literature Review of Injection Techniques
284(1)
Ultrasound-Guided Block Technique
285(1)
Intercostal Nerve Block
285(4)
Anatomy
286(1)
Literature Review of Injection Techniques
286(1)
Ultrasound-Guided Block Technique
287(2)
Conclusion
289(1)
References
289(4)
V Musculoskeletal (MSK) Ultrasound
22 Ultrasound-Guided Shoulder Joint and Bursa Injections
293(14)
Michael P. Schaefer
Kermit Fox
Introduction
293(1)
Subacromial/Subdeltoid Bursa
294(2)
Anatomy
295(1)
Clinical Presentation
295(1)
Limitations of the Blind Approach
295(1)
Ultrasound-Guided Technique
295(1)
Biceps Tendon Sheath (Biceps - Long Head)
296(2)
Anatomy
296(1)
Clinical Presentation
297(1)
Ultrasound-Guided Technique
297(1)
Acromio-Clavicular Joint
298(2)
Anatomy
298(1)
Clinical Presentation
299(1)
Ultrasound-Guided Technique
299(1)
Glenohumeral Joint
300(3)
Anatomy
300(1)
Clinical Presentation
300(1)
Limitations of the Blind Approach
301(1)
Ultrasound-Guided Technique
301(1)
The Rotator Interval Approach
302(1)
Subscapularis Tendon/Subscapularis Bursa
303(1)
Anatomy
303(1)
Clinical Presentation
303(1)
Ultrasound-Guided Technique
303(1)
Sternoclavicular Joint
304(1)
Anatomy
304(1)
Clinical Presentation
304(1)
Ultrasound-Guided Technique
305(1)
Conclusion
305(1)
References
306(1)
23 Ultrasound-Guided Hand, Wrist, and Elbow Injections
307(18)
Marko Bodor
John M. Lesher
Sean Colio
Introduction
307(1)
Ultrasound-Guided Carpal Tunnel Injections
308(3)
Anatomy
308(1)
Literature Review on Ultrasound-Guided Carpal Tunnel Injections
309(1)
Ultrasound-Guided Technique for Carpal Tunnel Injection
309(2)
Ultrasound-Guided Trigger Finger Injections
311(1)
Anatomy
311(1)
Literature Review on Ultrasound-Guided Trigger Finger Injections
311(1)
Ultrasound-Guided Trigger Finger Injection Technique
311(1)
Ultrasound-Guided Wrist Injections
312(4)
Anatomy
312(1)
Literature Review on Ultrasound-Guided Wrist Injections
313(1)
Ultrasound-Guided Technique for Wrist Injections
313(3)
Ultrasound-Guided Injections for Tendon Dysfunction
316(3)
Anatomy
316(1)
Ultrasound-Guided Technique for Tendon Dysfunction
317(2)
Ultrasound-Guided Elbow Injections
319(2)
Anatomy
319(1)
Literature Review on Ultrasound-Guided Elbow Injections
319(1)
Ultrasound-Guided Elbow Injection Technique
320(1)
References
321(4)
24 Ultrasound-Guided Hip Injections
325(6)
Hariharan Shankar
Swetha Simhan
Introduction
325(1)
Anatomy of the Hip Joint
326(1)
Intra-Articular Hip Injections
326(1)
Limitations of the Blind Technique
326(1)
Evidence for Ultrasound-Guided Hip Injections
327(1)
Technique of Ultrasound-Guided Hip Injections
327(2)
Conclusion
329(1)
References
329(2)
25 Ultrasound-Guided Knee Injections
331(6)
Mark-Friedrich B. Hurdle
Introduction
331(1)
Limitations of the Current Surface Landmarks Technique
331(1)
Technique for Ultrasound-Guided Knee Joint Injection
332(2)
Conclusion
334(1)
References
334(3)
VI Advanced and New Applications of Ultrasound in Pain Management
26 Ultrasound-Guided Peripheral Nerve Stimulation
337(8)
Marc A. Huntoon
Introduction
337(1)
Current Evidence
338(1)
Patient Selection and Role of Neurolysis
339(1)
Anatomical Considerations
339(1)
Radial Nerve Stimulation
339(1)
Ulnar Nerve
340(1)
Median Nerve
340(1)
Sciatic Nerve at Popliteal Bifurcation
341(2)
Posterior Tibial Nerve
343(1)
Conclusion
343(1)
References
343(2)
27 Ultrasound-Guided Occipital Stimulation
345(4)
Samer N. Narouze
Introduction
345(1)
Limitations of the Current ONS Technique
346(1)
Anatomy of the GON
346(1)
Occipital Field Stimulation vs. Peripheral Nerve Stimulation
347(1)
Technique of US-Guided ONS Lead Implant
347(1)
References
348(1)
28 Ultrasound-Guided Groin Stimulation
349(4)
Samer N. Narouze
Introduction
349(1)
Limitations of the Current Technique
350(1)
Anatomy of the Ilioinguinal and Iliohypogastric Nerves
350(1)
Groin Field Stimulation vs. Peripheral Nerve Stimulation
350(1)
Technique of Ultrasound-Guided IL/IH PNS Lead Implant
350(2)
Reference
352(1)
29 Ultrasound-Guided Atlanto-Axial and Atlanto-Occipital Joint Injections
353(6)
Samer N. Narouze
Introduction
353(1)
Anatomy of the Atlanto-Axial and Atlanto-Occipital Joints
354(1)
Ultrasound-Guided Atlanto-Axial and Atlanto-Occipital Joint Injection Technique
354(3)
References
357(2)
30 Ultrasound-Assisted Cervical Diskography and Intradiskal Procedures
359(4)
Samer N. Narouze
Introduction
359(1)
Limitations of the Fluoroscopically Guided Cervical Diskography
360(1)
Technique of Ultrasound-Assisted Cervical Diskography
360(2)
References
362(1)
Index 363
Samer N. Narouze, MD, MSc, DABPM, FIPP Chairman, Pain Management Department Summa Western Reserve Hospitals Cuyahoga Falls, OH, USA