Section Editor: Norig Ellison.
Peripheral Nerve Blocks, Upper and Lower Limb, A. Delbos, J. C. Eisenach, P. Nardu, and L. Brasseur. Philadelphia: Lippincott-Raven, 1998. ISBN 0-7817-1494-x and 0-7817-1513-x. CD-ROM. $298.00.
The modern age is steadily moving toward a paperless society, and technology facilitates the use of electronic substitutes, such as e-mail and word processors. Anesthesiologists have always been among the leaders in field of medicine to incorporate new technologies into their practice. The days of using only textbooks for reference and study aids is over, for with computer advancement, the information age and electronic books are here. Previously, textbooks were merely digitally converted and presented as an electronic book. No attempts were made to use the full multimedia capabilities and to integrate the data and graphically present it in a comprehensive fashion.
The Peripheral Nerve Blocks CD-ROM series is a true multimedia approach to learning nerve blocks. The two CD-ROMs are divided into upper limb and lower limb. The minimal requirement is Windows 3.1 or Windows 95/98, 8 MB of RAM (for PC-compatible systems) and Macintosh: System 7.1 or higher and 8 MB of RAM. Both systems require a sound card and speakers, although most Macintosh systems include them. Installation is a simple process. Unlike most current software, which requires hundreds of megabytes of your precious hard disk space, the peripheral nerve software only installs a small utility program called "Quicktime" onto your hard drive. That program allows your computer to run video programs on the CD-ROMs. Other than that, the main program runs off the CD-ROM.
The upper limb CD explains and demonstrates the following nerve blocks: brachial plexus block: supraclavicular, infraclavicular, interscalene, axillary approach; midhumeral block; radial nerve block (at wrist and elbow); median nerve block (at wrist and elbow); and ulnar nerve block (at wrist and elbow). The lower limb CD focuses on the following blocks: lumbar plexus block: anterior, posterior approach and continuous blockade; saphenous nerve block; sciatic nerve block: posterior and lateral approach; tibial and common peroneal nerve: popliteal fossa block; common peroneal nerve block at the neck of the fibula; and ankle nerve blocks.
When the program is running, the graphic image is displayed with a choice of multiple types of blocks. When a specific block is chosen, the corresponding surface area effected by the block in highlighted in a different color. This is useful to review quickly which nerve supplies the sensory dermatomes to the skin. Once a specific block is chosen, the program automatically launches into a narrative explanation of the block. This can be stopped at any time by pressing the button with the two parallel lines. The control for the animation and video is set up like the control of your typical VCR. The program is divided into several subsections: animation, video, library, and index. During the animation and library sections, the next frame can be advanced at the user's discretion with a click of a button.
In the animation mode, the computer narrates the block using a combination of images, photographs, and animation. As the narrative progresses, the image is enhanced with animation to focus attention to specific areas of interest. The information is well organized and is presented in a concise and articulate manner.
In the library mode, the block is set up in a slide format divided into three sections: text, diagram, and photograph. The user can view slides with a click of the mouse. The text section has an interesting important feature and contains references to the particular block. By clicking on the highlighted reference, it produces an image of a textbook with the particular reference in question with regards to the author's name, the title, and the journal of origin. Most of the references (those highlighted in red) have a deeper layer, in that by clicking on the specific reference, a brief summary of the article is presented.
In the video mode, the screen is divided into two sections. The left screen is used for the actual video presentation of the block. The right screen displays the illustration of the relevant cross-sectional anatomy. This feature demonstrates why an electronic multimedia presentation is far superior to ordinary textbooks. Using Quicktime, the authors present the specific block in real-time video, while demonstrating the normal landmarks and techniques used to perform the peripherial nerve block. The user can also observe the motor response to the appropriate nerve stimulation and the results of the block. For learning to perform such peripherial nerve blocks, this is a vital teaching tool for students and residents.
For instance, Peripheral Nerve Blocks: Upper Limb shows multiple techniques for performing the brachial plexus block. The CD-ROM very simply identifies the anatomy and its relevant structures involved in the peripheral nerve block. It goes into detail, indicating multiple approaches including interscalene, supraclavicular, infraclavicular, axillary, the "plumb-bob" approach, etc. The program shows with animation the appropriate motor response which each nerve, such as the radial nerve and its motor functions (e.g., elbow extension, supination of forearm, and extension of wrist and fingers). This reviewer believes that motor responds presented in this fashion is much more memorable than reading about the action it describes.
One criticism is that this CD-ROM does not include the use of ropivicane or duration of the block. Anyone familiar with local anesthetics should know the duration of the drug used; however, a novice may not know this. However, this is only a minor point in what is excellent material.
In conclusion, this CD-ROM collection has truly shown what a multimedia approach to learning can be. It has weaved a consice and intergrated application involving the peripherial nerve blocks. One can only wait for the authors of these series to produce other CD-ROM, such as for the body or head and neck, in a similar fashion.
Young Oh, MD
Department of Anesthesia; University of Pennsylvania Medical Center; Philadelphia, PA 19104-4283