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Atlas of Peripheral Regional Anesthesia Anatomy and Techniques, 3rd ed

Le-Wendling, Linda MD

doi: 10.1213/ANE.0000000000002378
Books, Multimedia, and Meeting Reviews

Published ahead of print August 3, 2017.

Department of Anesthesiology, Division of Acute and Perioperative Pain Medicine, University of Florida College of Medicine, Gainesville, Florida,

Published ahead of print August 3, 2017.

The Atlas of Peripheral Regional Anesthesia: Anatomy and Techniques is a 22-chapter book of beautiful illustrations and dissections of the peripheral nervous system macroanatomy. Basic regional anesthetic topics discussed in the book include blocks of the brachial plexus and its terminal nerves, blocks of the lower extremity (as proximal as the lumbar and lumbosacral plexi to their terminal branches), block considerations for the pediatric patient, and short synopses on the use of ultrasound, complications, and general principles. This atlas is a description of landmark-based approaches for common peripheral nerve blocks that the authors perform in their practice. It would serve well as a stepping stone for the budding regional anesthesiologist who would benefit from a simplistic approach to regional anesthesia.

Reading this atlas of regional anesthesia is like traveling back to a time when regional anesthesia was less reliant on ultrasound for block performance. Nerve stimulation is used as the primary end point for the majority of procedures. One element that was notably missing, however, was a description of the different motor responses that can be elicited and which motor responses yielded better block success.

The illustrations are very well rendered to demonstrate the relevant anatomy. The labeling of the images is organized, simple, and easy to grasp, especially for first-time learners. However, there are areas that could be improved, such as including ultrasonographic representations of the anatomy and offering more practical information on troubleshooting. The information discussed is, at times, vague and generalized, thus reducing its practicality and applicability. The authors provide real-life observations instead of relying solely on the literature and evidence, which adds authenticity to the book. On the other hand, there are instances of imprecise diction that reduce the clarity of the authors’ message.

For continuous blocks, the authors utilize nonstimulating catheters, and they propose a very simple approach to the placement of continuous blocks, recommending better needle alignment with the nerve and a reduction in catheter insertion length for improved success. While this might undermine the complexity of the placement of continuous blocks, their technique would be quite easy to implement when attempting to place continuous nerve blocks for the first time.

The videos in the video library are professionally made and demonstrate the authors’ technical prowess in performing the procedures presented in the atlas. The library contains a series of videos demonstrating patient positioning, needle entry point, and commonly accepted motor end points. The videos are concise, with an emphasis on the basic points of regional anesthesia, but they might not be enough to guide the novice proceduralist in improving block success and reducing complications in patients with a more challenging anatomy. In addition, the motor responses seen on the videos could have benefited from better labeling.

There are brief excerpts throughout the book that provide intriguing historical perspective, tips and clinical pearls, and commentary that are excellent in concept and serve to balance out the anatomy presented.

A notable highlight in this atlas is that most of the cadaver dissections are quite beautiful and helpful in understanding the anatomy. The anatomy in these dissections is presented from multiple perspectives. All of the anatomy presented here is macroanatomy in which the all-important fascia layers have been removed, as is typical for atlases of surgical anatomy.

I believe this book is good introductory material for the budding regional anesthesiologist and is designed for the individual interested in revisiting concepts in stimulation-guided regional anesthesia in the days before ultrasound was popularized.

Linda Le-Wendling, MDDepartment of AnesthesiologyDivision of Acute and Perioperative Pain MedicineUniversity of Florida College of MedicineGainesville,

Copyright © 2017 International Anesthesia Research Society