Acute Pain Management: A Practical Guide, 2nd Edition P. E. Macintyre and L. B. Ready Philadelphia: WB Saunders, 2001. ISBN 0-7020-2581-x. 258 pp, $34.95.
Acute Pain Management is the second edition of this text that is intended for use as a practical guide. It is written by Pamela Macintyre, the Director of Acute Pain Services in Adelaide, Australia, and Brian Ready, the anesthesiologist credited with developing the first acute pain service.
The authors emphasize that this is by no means an all-encompassing textbook. It is intended as a guide for any healthcare personnel in management of acute pain. Despite its attempt to be just a practical guide, the book is also useful as a resource for acute pain management. There are numerous tables, references, and formulas to assist those practicing acute pain management with their daily practice. Most useful are the materials for management of parenterally administered drugs as well as the use of neuraxially administered agents. Numerous examples are given and charts summarize the succinct points from the chapters. Importantly the references do not attempt to be exhaustive but include the major references that have affected acute pain management in the last 10 to 15 yr.
The three chapters on opioid pharmacology and clinical use are a complete practical guide. The pharmacology of local anesthetics is reviewed in a practical manner. Neuraxial analgesia, a mainstay of most anesthesia-based acute pain services, and regional analgesic techniques are also discussed. The chapter on other drugs used in acute pain highlights the utility of non-opioid adjuncts, emphasizes a practical approach, and introduces the concept of COX-2 inhibitors for acute pain management. The authors note the limited utility of NMDA receptor antagonists and alpha-2 adrenergic agonists.
This edition has new chapters on managing the opioid-dependent patient, managing patients with acute neuropathic pain, and pain management in the elderly. Acute pain services will continue to care for the opioid-dependent patient after surgery like the cancer pain patient who has persistent pain preoperatively and requires extensive surgery. This can represent a particularly difficult pain management patient in the acute postoperative period. Those interested in pain management in the pediatric patient will require another resource as the authors have chosen not to review the extensive information in acute pediatric pain management.
All in all, I find the goals of the author clearly met by developing a practical guide for acute pain management for students, nurses, and physicians in training. Anyone wanting to update their background in acute pain management will also find the book easy to read and quite comprehensive in many areas. The practitioner initiating an acute pain service at their hospital will find this book particularly useful in developing guidelines and parameters for institutional strategies to enhance acute pain management.
Timothy J. Brennan, PhD, MD
Associate Professor of Anesthesia
University of Iowa Hospitals and Clinics
Iowa City, IA