Atlas of Ultrasound-Guided Regional Anesthesia.

Abstract

University of Utah, Salt Lake City. jennifer.davis@hsc.utah.eduBy Andrew T. Gray, M.D., Ph.D. Philadelphia, Saunders Elsevier, 2010. Pages: 365. Price: $165.00.For those of us who perform regional anesthesia, ultrasound technology has revolutionized our practice in many ways. As the literature supporting the use of ultrasound guidance in regional anesthesia continues to mount, it has been a daunting task for practitioners who trained before this technology was in use to incorporate it into their practice. Atlas of Ultrasound-Guided Regional Anesthesia is a unique and extremely informative resource for practitioners who are attempting to learn ultrasound-guided regional anesthesia as well as experienced regionalists who want to expand their block armamentarium.The Atlas consists of 62 concise chapters and two appendices of self-assessment questions and answers. Each chapter, which is up to 11 pages long, begins with a detailed description of the topic, followed by suggested techniques where applicable, clinical pearls, and extensive pictures.The first 15 chapters of the book discuss the fundamental principles of ultrasound and its terminology. The author discusses various imaging techniques, transducer manipulation, and needle approaches. During many of the workshops I teach, participants express their frustration at not being able to “get a good image” when no one with experience is around to guide them. These pages clearly and concisely explain the ultrasound concepts that are essential to becoming a skilled ultrasonographer and safely performing ultrasound-guided blocks.The book's second section describes the ultrasound appearance of comingled structures, such as tendons, blood vessels, lymph nodes, pleura, and bone. The remainder of the book addresses ultrasound-guided techniques for upper extremity blocks, lower extremity blocks, trunk blocks, and head and neck blocks in a great deal of breadth but without too much depth on any given procedure. The final section is devoted to adverse events in regional anesthesia and using ultrasound for both prevention and recognition thereof. It is noteworthy that this book has the benefit of being available online so practitioners have ready access to the text and numerous pictures.The Atlas is a valuable addition to our literature on ultrasound-guided regional anesthesia. Before the publication of this book, there were very few texts of this nature available to practitioners who are attempting to introduce ultrasound to their practice. The descriptions of ultrasound fundamentals are well written and well illustrated. The pictures in the book are plentiful, of outstanding quality, and clearly labeled—an essential feature for learning ultrasound-guided regional anesthesia.The author gives helpful suggestions for block techniques. However, I would caution the reader to remember that many of the techniques described in this book represent regional preferences. With an adequate understanding of anatomy, there are a number of acceptable techniques for each block. A nice addition to this book would have been online video clips for each block, with transducer position as a correlate. Such a feature would allow demonstration of ultrasound principles and transducer manipulation, with corresponding changes in image appearance. Although still images are important, video clips add a great deal to a reader's understanding of block performance.Overall, this book is extremely useful and well done. The Atlas is a much-needed addition to our literature and will be a valuable resource for practitioners who are learning ultrasound-guided regional anesthesia.University of Utah, Salt Lake City. jennifer.davis@hsc.utah.edu