Regional anesthesia and the role of anatomy today

Regional anesthesia is enjoying an ever increasing popularity, and for the first time in its history, sophisticated technology is playing an important role. Although, it is likely that the concept of local anesthesia, understood as the action of alleviating pain by acting somewhere “locally” at the affected site, might be as old as humankind, the actual accomplishment is relatively new. The injection of substances in the vicinity of nerves, for the purpose of producing anesthesia, had to wait until the mid-1800s for a hollow needle and a syringe to become available. Along with the introduction of cocaine into clinical practice by Koller in 1884, they are the two most important developments that launched the field of regional anesthesia. Since then, and until the second half of the 20th century, regional anesthesia was practiced mostly as an art, using unsophisticated equipment and at a relatively low cost. Its success was closely tied to the “artist” performing the technique. The most important requirement for the regional anesthesiologist was to know his/her anatomy well. Is this still the case today?