Atlas of regional anesthesia, 2nd edition

Atlas of regional anesthesia, 2nd edition

Regional Anesthesia and Pain Medicine 24(6): 587-589, 1999 Book Reviews want specific details, including controversies regarding preoperative manage...

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Regional Anesthesia and Pain Medicine 24(6): 587-589, 1999

Book Reviews

want specific details, including controversies regarding preoperative management. Second, the monograph could also serve as reference for primary care physicians and surgeons. Unfortunately, physicians outside of anesthesiology are little inclined to peruse our reference materials. Perhaps a revision of the text could be directed toward referring physicians. An understanding of anesthesiologists' concerns by other physicians would enable those physicians to take a more active role in preoperative evaluation and treatment themselves. Patients at risk could be better identified and treated even before anesthesiologist's preoperative assessment, thus preventing surgical delays and decreasing the patients' risk further.

Problems in Anesthesia: Preoperative E v a l u a t i o n i n a n Era o f C o s t C o n t a i n m e n t Volume 9, Number 2 ISBN: 0889-4698 Lee A. Fleisher and Donald S. Prough Lippincott-Raven, Philadelphia, 1997, 127 pp.

$38.00 This monograph examines the most com m on medical problems, as encountered by anesthesiologists, and puts them into the perspective of preoperative assessment. We n o w practice medicine under the scrupulous eye of "cost containment." Thus, the book encourages physicians to treat patients by first using the "art of medicine," and secondly, subsequent laboratory testing if necessary. In reading this book, one is inspired to ask, "What additional information will this test give me? Do I need that information to care for the patient safely, and h o w likely is it that I will change m y management because of the test I ordered?" These are questions that are now being asked by every physician to optimize the value in health care. In general, the objectives of this monograph are succinctly accomplished. Although the authors stipple their chapters with reference to related studies in order to lend credence, this practice is not burdensome. The "forest is not lost for the trees." The monograph is divided into I2 parts based on the abnormality/organ system discussed. Each contributor identifies the abnormality and the major concerns associated with anesthetic management. A strategy is then discussed as to how to proceed with the preoperative evaluation in patients who are suspect for such problems. The chapters are "rounded out" with the authors making recommendations concerning specific testing, preoperative optimization of medical management, and risk assessment. This monograph has the capacity to appeal to a wide range of physicians who are seeking information pertaining to preoperative assessment and management. First, the work succeeds as a guide to preoperative evaluation for anesthesiologists at all levels of training and practice. The information will satisfy physicians who are searching for an overview of the topic, and it will not disappoint those who

Leslie R. DeLaney, M.D.

University of Pennsylvania Health System Acceptedfor publicationMay 14, 1999.

Atlas of Regional Anesthesia, 2nd Edition Edited by David L. Brown, M.D. W.B. Saunders Company, Philadelphia, 199% 400 pp., $125.00

The second edition of Brown's Atlas of Regional Anesthesia, an atlas with a clinical focus, contains 44 chapters that cover a wide array of regional blocks and their clinical applications and techniques. Compared with the first edition, the author has taken great efforts to make some very significant revisions to improve and refine the discussion of traditional regional blocks. He has also expanded the book to include chronic pain blocks by adding five new chapters on the infraclavicular block, sacroiliac joint injection, superior hypogastric plexus block, facet blocks, and cervical and thoracic epidural blocks. The first chapter is a concise summary of local anesthetic pharmacology and common regional anesthesia equipment including various needles, catheters, and the role of nerve stimulators. There are six brief anatomy chapters divided among the upper extremity, lower extremity, head and neck, airway, truncal, and neuraxial anatomy. These chapters



Regional Anesthesia and Pain Medicine Vol. 24 No. 6 November-December 1999

provide quick review color diagrams of dermatomes, sclerotomes, cutaneous nerve distributions, simplified three-dimensional anatomic drawings, fluoroscopic images, and MRI cross-sectional images. The rest of the book is divided into discussion of common blocks (i.e., femoral, sciatic, axillary, etc.). These chapters are organized to include "block perspectives," "placement" or technique, and "pearls." Block perspectives discuss historical issues, patient selection, and choice of drugs. Block placement emphasizes pertinent anatomy, patient position, needle placement, and potential problems. Block pearls highlight some of the author's personal tips to improve success with the traditional approaches and the new techniques. The easy to read diagrams and colored drawings are complemented throughout the book by appropriate radiographic images. The text is written clearly and organized logically. The author has even made efforts to simplify chapters by placing the references in the appendix. As with his first atlas, Dr. Brown continues to contribute to the ongoing training and development of anesthesiologists in regional anesthesia. The author has succeeded in achieving his goals of presenting a large volume of regional anesthetic techniques in a clinically focused manner which is easy to reference on a daily basis. This new edition ot a well-established atlas uses a more comprehensive multifaceted approach than the older edition, utilizing appropriate supplemental radiographic images and cross-sectional diagrams which the author believes will help clinicians improve their success with regional anesthesia techniques. The new color diagrams highlight nerves and structures of interest and allow the reader to easily discern pertinent structures. Compared with the first edition, the changes made in this textbook are quite significant. This text continues to improve the standard of regional anesthetic/analgesic teaching manuals and atlases. My only complaint is that, to the untrained eye, many of the MRI images could be improved. Some of the fluoroscopic images also could more clearly outline the targeted structures or joint spaces. Despite these minor nuisances, this excellent textbook will take its place as one of my most frequently referenced texts. It deserves to be a part of any anesthesia library. Robert D. Chen, M.D.

University of Pennsylvania Department of Anesthesiology Philadelphia, Pennsylvania Accepted for publication May 11, 1999.

Atlas of Interventional Pain M a n a g e m e n t ISBN 0-7216-7577-8 Steven D. Waldman W.B. Saunders, Philadelphia, 1998, 553 pp., $175.00 In this atlas, Waldman effectively reviews the indications, techniques, and complications of common and esoteric procedures performed by pain medicine specialists. Waldman takes a "head-to-toe" approach to anatomy with associated pain processes and descriptions of the appropriate procedural strategies organized by regional anatomy. The book is divided into seven sections related to body region and an eighth section of miscellaneous~advanced techniques. Contained within the typical chapter are appropriate CPT-4 codes, relative value units, indications, clinically relevant anatomy, techniques, side effects, complications, and clinical pearls. This is an excellent reference source for those physicians who practice interventional pain medicine. The book's organization is logical and consistent. The reader is able to locate the desired information without much "page turning" or perusing of the contents. Also, each chapter is concise and has the information necessary to understand and perform the block for the appropriate pain condition. From the straightforward peripheral nerve blocks to the more challenging procedures, one may easily conceptualize and confidently perform the blocks. This is all accomplished using no more than two pages of text per chapter. Furthermore, the atlas gives very useful clinical information--it is not just a "how to" for the "block Doc." Lastly, this book is well rounded. It has an appropriate balance of easily readable instructions, straightforward illustrations that have the necessary detail, and clinical information of which one must be cognizant before and during administration of the blocks. A criticism of the text centers around the somewhat unorganized use of roentgenographic illustrations. Of course, a comprehensive review of radiologic procedures pertaining to pain medicine is outside of the intended focus of the book. There is a relative lack of consistency pertaining to discussion of roentgenographic guidance and verification. Block techniques are described using various radiologic tests including fluoroscopy, computed tomography, ultrasonography, etc. No one procedure, however, mentions all of its most commonly used roentgenographic aids. This book gives instructions on a specific block with one mode of suggested radiographic guidance when another mode is more generally utilized in common practice. Similarly, for blocks such as lumbar sympathetic neural block, the text gives a technical description of the unaided technique when radiographic verification has clear