Professor of Anesthesiology; Mayo Clinic; Rochester, MN
Regional Anesthesia. The Requisites in Anesthesiology series. Rathmell JP, Neal JM, Viscomi CM. Philadelphia: Elsevier Mosby, 2004. ISBN 0-323-02042-9. 218 pp, $79.95.
Regional Anesthesia by Drs. Rathmell, Neal, and Viscomi is one of several books in the series The Requisites in Anesthesiology edited by Roberta Hines, MD offering concise reviews of specific topics for trainees preparing for board-certification examination. In that aspect, it succeeds admirably. At about 200 pages, it can easily be carried to the work area. Organized into straightforward topics, this book is enhanced by highlighted lists of key points and numerous figures. All three authors are well recognized in this field, collectively covering a broad range of expertise.
The text is organized into five logical sections: Anatomy and Physiology, Pharmacology, Techniques, Complications/Outcomes, and Specialty Considerations. Wisely, given the brevity of the book, the authors do not venture far from the regional anesthesia focus. The chapter on sympathetic blocks might fit better in a book dealing with pain techniques, however the succinct final chapter on management of acute pain includes important information on adjuncts to block techniques. The numerous gray scale figures throughout the text include excellent original drawings and redrawn classic figures with very complete legends. A reader can easily glean much of the salient information on each topic by scanning the figures and highlighted key concept boxes in each chapter. The occasional clinical cases presented in the boxes were distracting to this reviewer. Either they should be offered consistently in each chapter, or deleted—preferably the latter. The text is generally pithy and well written, providing appropriate depth of information. The short ‘suggested reading‘ lists provided at the end of each chapter were less useful, often simply providing titles of classic texts or review articles. Space limitations prohibit an exhaustive list; perhaps the reader should be trusted to do a computer literature search if further information is desired.
Not surprisingly the text format works better for some topics than others. The first three chapters cover the basic science of neuroanatomy and pharmacology. These are important but unexciting topics, and the authors do a good job of providing the information in an easily accessible format. The illustrations in the chapter on neuroanatomy are excellent, and the chapter on local anesthetic additives is highly readable. There are some puzzling elements in the chapter on local anesthetics, such as a highlighted case study involving bupivacaine in an obstetrical patient and a key point box regarding transient neurologic syndrome, both of which are covered more appropriately in the final chapters on specialty considerations. Overall the eight chapters in the Techniques section are very well done. The first chapter in this section gives a brief, but helpful overview of equipment and monitoring. The subsequent chapters cover anatomically grouped techniques. There are obvious space and format limitations. Techniques requiring more visual description, such as ultrasound needle guidance, receive minimal attention. The authors tend to emphasize more common techniques. It is difficult to balance brevity and comprehensiveness, and though I might quibble with the choice of supraclavicular block technique or the equal emphasis on interpleural and paravertebral blocks, overall the authors do a superlative job. The three chapters covering complications and outcomes are superb. The authors do not hesitate to clarify controversial areas and provide evidence-based suggestions.
Several color plates are provided at the beginning of the book. This has become an obligatory addition to block technique texts, and the figures are borrowed from well-known texts. The prints include a variety of techniques, including brachial plexus, celiac plexus, and centroneuraxial anatomy. While the prints themselves are visually captivating, I would have preferred classic approaches to commonly used blocks. Most trainees will not be performing the plumb bob approach to the supraclavicular block or celiac plexus blocks for surgical procedures. Color anatomy plates of the lower extremity to complement the upper extremity plates would have been more cohesive.
However, this is a minor quibble. This well-edited text admirably fulfills its promise to provide succinct and useful information to the anesthesiologist or trainee preparing for the examination process.
Denise J. Wedel, MD
Professor of Anesthesiology