Landmarks for Peripheral Nerve Blocks Upper and Lower Extremities

Abstract

The second edition of the pocket book Landmarks for Peripheral Nerve Blocks is written for use as a memory refresher at the point of care in the anaesthetic room. What is impressive is that although pocket-sized and easy to carry around, the book contains all the relevant knowledge that underpins nerve stimulator-guided upper and lower extremity blocks. The book has excellent pictures of the dermatomes, myotomes, and the osteotomes for the upper and the lower limbs. These coloured slides are useful for confirming the selection of an appropriate block for any surgery on an upper or lower limb. The upper extremity section starts with the anatomy, surgical field, and the neurostimulation characteristics of the individual nerves, that is, axillary, musculocutaneous, radial, median, and ulnar nerves. The section then moves on to describe the various approaches at the levels of the brachial plexus, elbow, and wrist. For each block, there is a labelled colour diagram showing the surface anatomy. For some of the more commonly used blocks, there is also a colour plate of the cross-section of the area, for example, axillary and mid-humeral blocks. Cross-sections relevant to other blocks throughout the book would have probably enhanced the understanding of the surface anatomy for these blocks. The authors have discussed most of the commonly used approaches to the brachial plexus but perhaps the Miere approach to the interscalene brachial plexus should also have been included. The lower extremity block section starts with the anatomy of the sciatic nerve followed by descriptions of the posterior, lateral, anterior, and distal approaches to sciatic nerve block. The section then covers the anatomy relevant to lumbar plexus, femoral nerve and fascia iliaca blocks. The section ends with descriptions of obturator nerve, lateral femoral cutaneous nerve, saphenous nerve and ankle blocks. All the blocks are adequately described, but it was curious that the inguinal crease was listed as a landmark for the femoral nerve block but with no mention of how to use the landmark when performing the block. One very useful feature of the book is the spiral binding and the nicely labelled bookmarks for each block: the latter enable rapid navigation to find the block of interest. To reaffirm, the book is designed for anaesthetists with understanding and familiarity of nerve blocks and the use of nerve stimulator techniques. This handbook is a reference and I agree with the author's comments that the book is not a replacement for a regular atlas or textbook of regional anaesthesia. In the current situation, where ultrasound is replacing the nerve stimulator as the preferred method to perform many blocks, most handbooks should also include the use of ultrasound. The book may also be useful for trainees as a quick reference to revise peripheral nerve blocks for the FRCA examinations.