Atlas of Peripheral Nerve Blocks and Anatomy for Orthopedic Anesthesia.

Abstract

David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, Torrance, California. dthsu@msn.comAtlas of Peripheral Nerve Blocks and Anatomy for Orthopedic Anesthesia. By Andre P. Boezaart, M.D., Ph.D. Artwork by Mary K. Bryson. Philadelphia, Saunders Elsevier, 2008. Pages: 242. Price: $179.00.What do the following have in common? Boezaart, Hadzic, Brown, Benzon, Mulroy, Jankovic, Finucan, Rathmell, Castro, Raj, Reynolds, Peutrell, Wildsmith, Adriani, Moore, and Labat. They were all original first authors of at least 15 regional anesthesia text books published since 2000. With the advent of ultrasound technology for peripheral nerve blocks, I expect that more such texts will be written.This atlas is a supplement to Dr. Boezaart’s educational text, The Primer of Regional Anesthesia Anatomy . The primer and its DVD were intended to be visual guides to the static and dynamic functional anatomy of individual nerves, respectively. Through the use of illustrations, photographs, and nerve mapping via transcutaneous nerve stimulation and its corresponding motor response, the primer textbook was an excellent aid to the performance of peripheral nerve blocks. It was very well received, and the author was encouraged to expand on it. We now have this wonderful atlas as a supplement.Dr. Boezaart is the sole author, with Mary K. Bryson, M.F.A., M.A.M.S., C.M.I. (Bryson Biomedical Illustrations, Inc., Langhorne, Pennsylvania) as the medical illustrator and Susan McClellen (Medical Photographer, Creative Media Group, The University of Iowa, Iowa City, Iowa) contributing to the photographs. The book predominantly addresses the major and common nerve blocks used in orthopedic procedures. There are a total of 19 chapters. The first 10 chapters address the brachial plexus with its associated nerves and peripheral blocks pertaining to the upper extremity. The next 3 chapters involve the lumbar plexus, followed by 1 on the sacral plexus, 1 on sciatic, 2 on the ankle, and 1 for thoracic paravertebral block. The final chapter describes the pitfalls in regional anesthesia and how to avoid them.Each chapter on a major anatomical region begins with applied anatomy of the plexus and its underlying nerves and surrounding structures. The involved area is well illustrated with defined dermatome and osteotome artwork, photographs of anatomical dissections accurately annotated with arrows for specific location of relevant structures, and some beautifully painted surface anatomy portraits of nerves and muscles imposed on photos of the human body. The text is clear and succinct. For hands-on teaching, there are many excellent photographs of step-by-step procedural events such as needle or catheter insertion, tunneling, and securement. Occasionally, there are corresponding ultrasound images for the accurate identification of the nerves and plexus.The book has an accompanying DVD. It complements the text and reinforces the factual material. The subject topics are easy to navigate. The audiovisual is clear and the picture resolution is excellent.Because many anesthesiology residency training programs now offer a defined rotation in regional nerve blocks, I tried to see how this book could better fit the needs of the anesthesiology trainees. The addition of more ultrasound photographs would make the atlas even more outstanding. Dr. Boezaart deserves recognition for putting together such a concise but factual informational book for nerve blocks with their related anatomy for orthopedic surgery. Procedures are described in adequate detail to allow for the uncomplicated placement of the needle or catheter. The book is very well written, with excellent illustrations, annotations, and photographs.The reviewer highly recommends this book to all anesthesiology or nonanesthesiology trainees involved in the placement of peripheral nerve blocks. For the individual practicing anesthesiologist, this is an excellent procedure-orientated reference source to enhance major regional nerve block skills for orthopedic surgery.David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, Torrance, California. dthsu@msn.com