Secondary Logo

Journal Logo

In Response

Hebl, James R. MD; Lennon, Robert L. DO; Jacob, Adam K. MD; Smith, Hugh M. MD, PhD

doi: 10.1213/ANE.0b013e3182580fa2
Letters to the Editor: Letters & Announcements

Department of Anesthesiology Mayo Clinic Rochester, MN (Hebl, Lennon, Jacob, Smith)

The repetition of medical illustrations is not only a useful learning aid, but a common practice among many major medical texts. In fact, this practice was introduced nearly a century ago in one of the earliest regional anesthesia textbooks published in the United States.1

Each chapter of our textbook2 was specifically designed to function as a stand-alone chapter so that readers would not have to page back-and-forth to other sections of the atlas to view relevant images. Thus, although a limited number of images could have been eliminated, this would have significantly reduced the utility (and intent) of each chapter to provide a comprehensive overview of the anatomy, patient–provider orientation, needle insertion site, and technique for each individual block.

Also, Dr. Liu3 is simply inaccurate with his claim that “nearly half” of the illustrations are repeated within the text. To be precise, the atlas contains 221 unique illustrations of which only 31 (14%) are repeated in the text without modification. Furthermore, many (if not most) of these repeated illustrations do not occupy an entire page of the atlas as suggested by Dr. Liu.

In contrast to Dr. Liu's comments that the repetition of a limited number of anatomically useful illustrations is distracting, we believe quite firmly in the classic Latin teaching: “repetitio est mater studiorum”—repetition is the mother of all studies and learning.

James R. Hebl, MD

Robert L. Lennon, DO

Adam K. Jacob, MD

Hugh M. Smith, MD, PhD

Department of Anesthesiology Mayo Clinic

Rochester, MN

Back to Top | Article Outline


1. Labat G. Regional anesthesia: its technic and clinical application. 1st ed. 1922: W.B. Saunders, Philadelphia, PA
2. Hebl J, Lennon R. Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade. 1st ed. 2010: Oxford University Press, USA
3. Liu J. Excessive repetition is a waste. Anesth Analg 2012;115:208–9
© 2012 International Anesthesia Research Society