Book, Multimedia, and Meeting Reviews: Media Reviews
Expertise in regional anesthesia has assumed increased importance in the modern practice of anesthesia. The impact of regional anesthesia on surgical outcome is far-reaching and these benefits have been demonstrated in numerous clinical studies involving a wide spectrum of surgical procedures. Anesthesiologists with extensive training in regional anesthetic techniques are highly sought after by both academic teaching departments and private practice anesthesia groups. Experienced anesthesia providers are flocking to regional anesthesia workshops to reestablish their skills and to add new regional block techniques to their armamentarium. In short, there is high demand for quality educational resources in regional anesthesia, especially since the introduction and evolution of ultrasound-guided procedures. As they say, “old dogs are keen to learn new tricks”!
The fourth edition of David Brown's Atlas of Regional Anesthesia has been reorganized and subdivided into 8 sections, highlighting specific anatomical locations (e.g., upper extremity, head and neck, neuraxial, and truncal). Its 51 chapters span the clinical practice of regional anesthesia and pain medicine, commencing with a thorough review of drugs and equipment and proceeding through the spectrum of regional blocks for acute and chronic pain. Technique chapters following a consistent format allows for quick and easy reference of indications, choice of medication, anatomy, positioning, needle placement, and clinical pearls and pitfalls. Section 6, Truncal Blocks, includes the book's only new chapter on the increasingly popular transversus abdominis plane block.
As with the second and third editions, the cover illustration foreshadows one of the main updates in the newest version, namely, ultrasound-guided regional anesthesia (UGRA). Interscalene, supraclavicular, infraclavicular, axillary, sciatic, popliteal, and femoral chapters have each been expanded with sections on ultrasound-guided regional block techniques. Also, an overview of ultrasound physics and a discussion of the principles of UGRA have been added to chapter 1. These new contributions represent the collaborative effort of 2 renowned and highly respected UGRA specialists, Brian Sites and Brian Spence. The Sites-Spence team has produced concise descriptions of the various block techniques, illustrations of anatomy and probe positioning, and ultrasound images that demonstrate the anatomy and block technique. In addition, these authors included a simple, but very useful quick reference icon in the upper right corner of each ultrasound image to highlight the recommended frequency and needle approach for each application. As a bonus, book owners are given electronic (“e”) access to all text, illustrations, and ultrasound images, as well as valuable instructional videos of ultrasound-guided techniques via a web-based version of the textbook.
Atlas of Regional Anesthesia, fourth edition, has a few limitations worth mentioning. Ultrasound images throughout the book are relatively small compared with other UGRA textbooks and reference manuals (and even other illustrations in this book). Companion illustrations to the ultrasound images would have also been useful to reinforce the anatomy and spatial relationships. Finally, technique illustrations, particularly in the chapters for upper and lower extremity blocks, are largely unchanged from the earlier editions of this textbook, and in some cases may not reflect modern practice (e.g., injection via control syringe).
Overall, the newest edition of Brown's Atlas of Regional Anesthesia is a well-written and well-organized reference manual for the beginning and experienced regional anesthesiologist. The inclusion of transversus abdominis plane blockade, ultrasound-guided techniques, and access to an e-textbook adds a new dimension to this well-known guide and provides the innovation necessary to educate future specialists in regional anesthetic techniques.
Adam K. Jacob, MD
Department of Anesthesiology