Atlas of Pain Injection Techniques
T. O'Connor, S. Abram
Churchill Livingstone: Edinburgh, UK, 2003, 141 pp; indexed, illustrated
ISBN: 0-443-06380-X; Price £49.99
Being the author of a technical manual carries with it a great responsibility. The text must be easy to understand with no ambiguity. Similarly, diagrams and photographs must be of a high standard with clear labelling. Unfortunately, relatively few manuals of technique reach this high standard.
Therese O'Connor and Stephen Abram appear to have tried to achieve a text of excellence by focusing on a relatively small number of basic techniques. Their approach has been to cover the methodology in a systematic manner. Unfortunately, this gamble does not appear to have paid off. This has resulted in introductions that are too brief and descriptions of technique that are repetitive. Important variations in technique are lost in the text because of the presentation and, as a result, there is a risk of making a mistake. When I compared their description of some techniques to other texts that are available, I usually found the other books easier to follow! There was no justification of the approach used in their book over any other and the text is not supported by references.
O'Connor and Abram certainly have some very nice line diagrams, but labelling was poor and Figure legends hidden in the text. It is much easier to read the legend close to the diagram and not as a part of the text! Many of the diagrams appeared to be an over simplification and some simple line diagrams were repeated on numerous occasions. The quality of the radiograph and computerized tomography reprints was low by today's standard.
Whereas I accept that there will always be a personal touch to procedures, I was disappointed by the approach that they used for certain techniques. For instance, I was surprised to see radiographs being used, as opposed to continuous imaging, to confirm needle placement for facet joint injections. Also, I wonder about the use of Esmarch bandages, presumably for patients with complex regional pain syndrome, in their description of intravenous regional sympathetic blocks. I doubt that my patients would tolerate this.
This book needs a better introduction on general principles and the chapters on drugs used need to be expanded. In addition, a chapter on block needles and nerve stimulators needs to be considered. Unfortunately, this book will sit on my shelf and be rarely used by trainees or myself.