Brown's Atlas of Regional Anaesthesia, 2nd edition

Abstract

This is a lavishly produced book, as befits an atlas, and is more attractively designed than its 1992 predecessor. The new edition is 60 pages longer than the first edition and contains four new sections on infraclavicular brachial plexus, sacroiliac joint, superior hypogastric plexus and facet joint blocks. There is also an expanded chapter on epidural blocks with thoracic and cervical approaches covered in more detail. It is strongly bound, printed on high-quality paper and the front cover design actively encourages the reader to open the book and begin to explore, which is exactly what a trainee and I did when teaching some new techniques. Unfortunately, we searched in vain for the penile block (and all paravertebral block approaches). In addition, anatomical errors transcribed from the first edition in the diagram for inguinal field block remain uncorrected — the iliohypogastric nerve does not lie deep to the transversus abdominis muscle. Hardly an auspicious start! There is a consistent format throughout the book with a separate section for each block and the easily read text arranged conveniently around the full colour diagrams. Each section contains Indications, Patient Management, Block Performance, Complications and Clinical Pearls (practical tips and ‘tweaks’ to maximise the success of the block). One of the strengths of a single author work is the extent to which their obvious enthusiasm and expertise can be conveyed to the reader. The choice and detail of the techniques described reflects Dr Brown's own experience and it is fairly easy to work out the blocks with which he is most familiar. The text is more detailed and confident and the diagrams more informative. This gives the book a slightly unbalanced feel; for example, head and neck blocks occupy 25% of the book whilst only 15% is devoted to all central neural blocks. Some quite important peripheral nerve blocks are dealt with rather perfunctorily; blocks around the ankle meriting only one diagram and a single page of text and only two of the four approaches to the sciatic nerve are described. The author's views regarding the relative ease, success rates and usefulness of some techniques and the value of equipment such as peripheral nerve stimulators are somewhat didactic and will cause disagreement in other quarters and may confuse a trainee, especially as the strongly American emphasis means that a number of the drugs recommended are not available in other countries. The diagrams throughout the atlas are the work of a single artist and whilst the diagrams are drawn to a very high standard and often complement the text admirably, they lend the book a slightly dated appearance as many of them have a sepia tone background. There are a number of pencil drawings, which although accurate and informative, reinforce the incongruous ‘period’ feel, especially as several very informative MRI scans and plain X-rays contrast strongly with the rather dated style of the artwork. The book is well indexed and the comprehensive reference section concentrates on the practical aspects of the subject matter, although many references are somewhat dated for a new edition. So who should buy this book? It is probably not ideal for the novice practitioner as its size and cost do not lend it to being carried around the operating theatres but they should have access to a reference copy and any department with an interest in teaching regional anesthesia should have a copy on its library shelves. The emphasis on techniques for chronic pain management would certainly make it useful for specialists interested in developing their skills in that field.