Atlas of Peripheral Nerve Blocks and Anatomy for Orthopaedic Anesthesia

Abstract

Atlas of Peripheral Nerve Blocks and Anatomy for Orthopaedic Anesthesia Boezaart AP. Philadelphia: Saunders Elsevier, 2008. ISBN 978-1-4160-3941-9. 242 pages + DVD, $179.00. In the era of perioperative patient care, utilization of peripheral nerve blocks for intraoperative anesthetics as well as postoperative pain management is becoming increasingly common. As such, there is a great need for anesthesiologists to understand the key anatomical principles and techniques necessary to successfully perform peripheral nerve blocks. In this text and DVD, Boezaart presents the most relevant and commonly performed peripheral nerve blocks utilized for orthopedic surgery. The book is comprised of 19 chapters organized logically from cervical to sacral nerves. Prior to discussion of each peripheral nerve block, there is a chapter discussing pertinent anatomical principles, mainly through full-color illustrations, gross anatomy images, and surface anatomy figures. Concise text accompanies these images to further the reader's understanding of nerve location, motor innervation, and sensory innervation (including dermatomes and osteotomes). Subsequently, 16 peripheral nerve blocks are described in a step-by-step manner, including single injection and continuous catheter techniques. Coinciding detailed clinical photographs taken during actual peripheral nerve block placement solidify the text descriptions. Additionally, basic ultrasound images depict anatomical structures during ultrasound-guided approaches. References in the text to correlating DVD segments provide the reader reinforcement of anatomical principles as well as short video clips of single injection and continuous catheter techniques. The DVD narration is succinct and the video images are of high resolution with readily identifiable anatomical landmarks and easy to follow techniques. Beyond describing techniques, the author includes guidance on the appropriate choice of peripheral nerve block for specific types of orthopedic surgery, especially indications for placement of continuous peripheral nerve catheters. The author also provides practical advice for choosing local anesthetics for both single injection and continuous catheter peripheral nerve blocks based on type of surgery, anticipated postoperative pain, and postoperative physical therapy goals. Specific doses as well as recommendations for patient-controlled bolus doses through continuous catheters included in the text and DVD are very helpful especially for novice practitioners. Furthermore, the author has included a section on common “pitfalls” in regional anesthesia and what to do to prevent their occurrence. It focuses on appropriate indications for use of peripheral nerve blocks, utilizing the correct technique and equipment, and rules to follow to avoid complications such as nerve ischemia. Despite the important information contained in this chapter, side effects or complications of peripheral nerve blocks, such as phrenic nerve block, Horner's syndrome, pneumonthorax, and development of block-related neuropathy, are not consistently discussed within the peripheral nerve block chapters. These are important considerations the regional anesthesiologist and patient must be aware of when performing these procedures. While this text provides readers with a concise resource of common peripheral nerve blocks, as the author mentioned in his preface, the text is not a comprehensive collection of all peripheral nerve blocks or all approaches. However, the focused nature of this atlas makes it an easily portable, quick read. Also, although the gross anatomy images contain detailed dissections, they lack sufficient structure identification. Additional labeling of the structures would improve the reader's understanding of the relationship between these structures. Overall, Dr. Boezaart has provided more than just an atlas with his latest publication. This text provides a step-by-step guide to performing peripheral nerve blocks for orthopedic surgery through text, images, and video clips. In addition, this text provides the reader a solid foundation of anatomical knowledge to utilize in selecting peripheral nerve blocks, understanding landmark-based techniques, and avoiding complications. It is an excellent addition to the regional anesthetist's library. Jennifer A. Sposito, MD Resident [email protected] Stuart A. Grant, MD Assistant Professor of Anesthesiology [email protected] Department of Anesthesiology Duke University Durham, North Carolina