OpenAnesthesia Regional Expert of the Month: March 2015


Jean-Louis Horn, MD, Professor of Anesthesiology, Perioperative and Pain Medicine at the Stanford University Medical Center

Current Institution:

Stanford University Medical Center

Current Position:

Chief, Division of Regional Anesthesia, Stanford University (2013 – Present)

Regional Fellowship (where and when):

Pain Fellowship at Vanderbilt University, Nashville, Tennessee, 1994-95

Who would you consider your greatest mentor?

John Bonica and his masterpiece The Management of Pain, published in 1953. He was the founding father of the study of pain management and a visionary.

Specific interest in regional anesthesia/acute pain:

Long-term outcomes of acute pain management and safety of regional anesthesia.

Least favorite block and why?

Adductor canal block because the world is jumping on this new block with little data on its efficacy and no data on its safety. Human nature likes to believe in magic, a great potential block with minimal side effects and great outcome. It sounds theoretically perfect, but what is the incidence of saphenous neuropathy or of femoral artery dissection. A word of caution: shouldn’t we pause before routinely recommending this block?

Favorite journal Article in the last 2 years:

Sviggum HP, Jacob AK, Mantilla CB, Schroeder DR, Sperling JW, Hebl JR. Perioperative nerve injury after total shoulder arthroplasty: assessment of risk after regional anesthesia. Reg Anesth Pain Med. 2012 Sep-Oct; 37(5):490-4.

Favorite journal article of all time:

Bernards CM. Sophistry in medicine: lessons from the epidural space. Reg Anesth Pain Med. 2005 Jan-Feb; 30(1):56-66.

Favorite (featured) block:

The lumber plexus block

Why is it your favorite block?

It is a complex block that requires excellent understanding of 3D anatomy. Large target area combined with ultra sound mapping and neuro stimulation makes this block easy for the expert.

3-5 articles about the block?

  1. Marino J, Russo J, Kenny M, Herenstein R, Livote E, Chelly. Continuous lumbar plexus block for postoperative pain control after total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. 2009 Jan; 91(1):29-37.
  2. Capdevila X, Macaire P, Dadure C, Choquet O, Biboulet P, Ryckwaert Y d’Athis. Continuous psoas compartment block for postoperative analgesia after total hip athroplasty: New landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002 Jun; 94(6):1606-13, table of contents.
  3. Ilfeld BM, Mariano ER, Madison SJ, Loland VJ, Sandhu NP, Suresh PJ, Bishop ML, Edward K, Donohue MC, Kulidjian AA, Ball ST. Continuous femoral versus posterior lumbar plexus nerve blocks for analgesia after hip arthroplasty: A randomized, controlled study. Anesth Analg. 2011 Oct; 113(4):897-903.
  4. Karmakar MK, Li JW, Kwok WH, Soh E, Hadzic A. Sonoanatomy relevant for lumbar plexus block in volunteers correlated with cross-sectional anatomic and magnetic resonance images. Reg Anesth Pain Med. 2013 Sep-Oct;38(5):391-7.
  5. Ilfeld BM, Loland VJ, Mariano ER. Prepuncture ultrasound imaging to predict transverse process and lumbar plexus depth for psoas compartment block and perineural catheter insertion: a prospective, observational study. Anesth Analg. 2010 Jun 1;110(6):1725-8.

2-5 ultrasound images/videos of block:


Pearls, tips, and tricks for success:

Good positioning with ultra sound mapping for exact measurements of depth of the transverse process and lumbar plexus. Do not advance more than 3 cm pass the transverse process. Identify the angle to drive the needle and the direction to avoid (spinal cord, kidney, etc.) Perform a test does to exclude an intra-vascular or an intra-thecal placement. Keep volume low with ten to twenty ml of local anesthetics.

A few more things about you:


Family first, then Fine arts, good food & beverage, and life; enjoy it, share it, and spread happiness

Person you most look up to:

My two beautiful children, Audrey & David, and my wife who is my best supporter

Favorite iPad app:

Haven’t found one yet. I envision technology to help us rather than being enslaved by it.

Favorite thing about OpenAnesthesia:

The very nature of having open access to everyone.