Regional anesthesia in the upper extremity.

We have attempted to formulate a guide for surgeons who operate frequently on the hand and upper extremity and who wish to learn how to provide their own local anesthesia. The methods that we have presented are those that work well in our hands and are in frequent use in our practices. We recognize very clearly that there are other methods and that these work well for other surgeons. The method itself is not of great importance (given that it is safe and effective), but the philosophy of learning is. By observation and by practice, the surgeon will gain further mastery of his specialty; we feel strongly that local anesthesia is as much or more a part of surgery than it is of any other specialty. Reading and observation are important. Dissection, whether in the operating room as part of a surgical procedure or in the anatomy laboratory or morgue, is of great benefit in learning the whereabouts and relationships of the nerves that are to be blocked. In the end, however, the surgeon simply must try the various blocks himself on his own patients. Failure is not a calamity; we have tried to emphasize that there are ways to recover with a reasonable degree of grace. The worst calamity is not to learn, not become facile with techniques that are so ideally suited to surgery in the upper extremity.