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Comprehensive Atlas of Ultrasound Guided Pain Management Injection Techniques

Ferrell, Shelly C. MD

doi: 10.1213/ANE.0000000000000676
Media Reviews: Media Review

Department of Anesthesiology, University of Kentucky, Lexington, Kentucky,

Comprehensive Atlas of Ultrasound Guided Pain Management Injection Techniques by Steven D. Waldman is a print and online textbook that contains 168 chapters describing ultrasound-based blocks from head to toe (literally). The print version comes with a code that is redeemed for a downloadable digital edition that is largely a direct electronic copy of the print version with electronic assists such as the ability to take notes, cycle through all images, jump to certain page numbers, and jump to other chapters.

The digital edition comes with multiple platforms for download, including Mac, Windows, Apple iOS (iPhone, iPad), Kindle Fire, and Android. Additionally, there is an online access Web address on the inside cover. The editions were loaded easily on a Mac computer and iPad via a free app from the digital publisher VitalSource and as above included exact content from the print version. No additional videos or links were appreciated from the digital content.

The textbook starts with head and neck ultrasound-guided nerve blocks (28 chapters) and includes many color photos of anatomy (drawn structures, computed tomographic images, and ultrasound views), distribution of nerve blocks, and photos of ultrasound probe placement locations. The content for the head and neck is very extensive including all of the commonly used blocks (occipital, superficial cervical plexus, and auricular) and many of the uncommonly placed blocks (sphenopalatine, third occipital nerve, and alanto-occipital). Some of the chapters are dedicated to specific branches of anatomically juxtaposed structures. As such, the chapters are nearly identical repetitions of anatomy and imaging examples with minimal text changed to direct the reader to the subtle change in approach for the block. Overall, however, these chapters provide very good descriptions and photos instructing the reader to the mechanics of the placement of the blocks with ultrasound.

The text progresses to an extensive description of shoulder and upper extremity ultrasound-guided blocks (51 chapters), including common brachial plexus blocks and less common distal branch blocks and intra-articular injections. These chapters provide a very inclusive organized approach with pictures and process description, as is the format for the entire text. However, some of the illustrations lack description of needle insertion points (infraclavicular), and the description of nerve locations from the axillary block chapter did not fully clarify anatomic orientation relative to laterality and ultrasound probe alignment. The descriptions of some of the ultrasound orientation make the assumption that the reader is an advanced user and could be confusing to a novice user not accustomed to varying ultrasound placement sites.

Next the book transitions to trunk and abdomen blocks (25 chapters), including common descriptions of paravertebral, transversus abdominus plane, and intercostal ultrasound-guided blocks. Less common ultrasound blocks include anterior celiac plexus approach, lumbar sympathetic blocks, and paramedian approaches to epidural and subarachnoid spaces. These chapters do provide many different interventional approaches to well-described pain syndromes. However, similar to other areas of the book, text repetition and initial procedure description have substantial overlap except for adjustments specific to chapter-relevant content. The description of the ultrasound image longitudinal orientation to spine with view of transverse process segments relative to Neptune’s trident appears in at least 6 chapters. Other content notably does have unique descriptive approaches including imaging of the sternum and articular processes involving interventional procedures for joint injections. The description of imaging for paramedian approach to thoracic and lumbar epidurals was well written for procedural execution, but use of another provider for imaging while the proceduralist operates the needle advancement provides an additional layer of complexity challenging to the procedure. Finally, while overall extensively covered for approaches, this section could have included further technique pointers to include the need for imaging needle tips for out-of-plane techniques to prevent unwanted puncture planes and an image illustrating the description of optimal hydrodissection patterns for transversus abdominis plane blocks.

Finally, the book covers hip/pelvis and lower extremity blocks (64 chapters). Again the authors describe common blocks (femoral, sciatic, and ankle) and less common interventions (intra-articular injections and pain syndrome treatment blocks). To echo other sections in the book, there is again some repetition in anatomic descriptions understandably as many of the coccygeal blocks described use close anatomic visualizations with ultrasound capture. The femoral nerve block chapter provides adequate basic procedural description but does not further delineate some anatomic variants and adjustment techniques necessary for unusual cases. Description of a confirmatory nerve stimulator for motor-type nerve blocks does not have notable use mentioned in these sections. Variance in approach in sciatic imaging is not expanded upon in these sections. Given these limitations, the remainder of the lower extremity ultrasound interventions includes many useful procedural options for well-known pain generators.

Overall, the contents of the text do provide a comprehensive description of an extensive collection of ultrasound-based blocks as the title indicates. The approach to descriptions does have more of a chronic pain interventional viewpoint with some verbiage describing acute pain utilities as well. The text starts with the assumption that the reader has at least an intermediate to masterful knowledge of ultrasound use and omits an introductory chapter on ultrasound and using it facilitate performing nerve blocks. That lack of basic content would alienate novice ultrasound users from fully using this as a core introductory text. Additionally, anatomic variances are given only occasional mention in the text, but clinical practice will yield imaging wildly divergent from the clean-labeled pictures in the book. Readers very familiar with anatomic relations will be able to adapt imaging variants, but less experienced ultrasonographers will struggle to translate the techniques to practice.

Dr. Waldman has compiled an outstanding array of approaches for delivery of nerve blocks throughout the entire body. Many advanced practitioners will find this text helpful to expand a core of interventional procedures. Because the use of ultrasound technologies and techniques continues to grow, this text will gain relevance as a core reference. The true use of Dr. Waldman’s book, however, will find best translation to advanced pain interventionalists very experienced in ultrasound use.

Shelly C. Ferrell, MD

Department of Anesthesiology

University of Kentucky

Lexington, Kentucky

© 2015 International Anesthesia Research Society