Local and Regional Anaesthesia.

Abstract

Virginia Mason Medical Center, Seattle, Washington. anejep@vmmc.orgLocal and Regional Anaesthesia.Edited by Per Rosenberg. Cornwall, United Kingdom, BMJ Books, 2000. Pages: 164. Price: $25.00.Local and Regional Anaesthesia is one of three titles published annually in the Fundamentals of Anaesthesia and Acute Medicine Series. The purpose of this series, which is edited in the United Kingdom, is to bring the reader up to date with authoritative reviews of the principle topics in the specialties of anesthesia, acute medicine, and intensive care. The current title, multiauthored and edited by Per Rosenberg, focuses on contemporary concepts in the clinical use of local and regional anesthesia and does not attempt to enter the already crowded field of all-encompassing textbooks about regional anesthesia. As such, the book is lightweight, portable, and very readable.This text consists of nine chapters written by a variety of European experts. Basic review chapters include clinical pharmacology, toxicity, and complications of regional anesthesia. Common local and intravenous blocks are reviewed, as are the recent practice patterns in ambulatory and obstetric anesthesia. Additional chapters include technical advances and current controversies in regional anesthesia. As with most multiauthored texts, several topics appear more than once, and a couple of topics (continuous peripheral catheters, anticoagulation) do not appear. However, overall, the book is thorough and fulfills the goal of reviewing contemporary regional anesthesia controversies.The chapters emphasizing the basis of safe practice (pharmacology, toxicity, and complications) are easy to read and a solid review. The chapter about clinical pharmacology of local anesthetics is terrific, with good information in a well-written format. In addition to basic pharmacology and a discussion of individual local anesthetics, new information, such as liposomal local anesthetics, is reviewed. The chapters about toxicity and complications cover all the important topics (except the test dose, which was found in other chapters), including cardiac, neural, and skeletal muscle toxicity.By necessity, the chapters about common local anesthetic blocks and intravenous regional anesthesia are brief but complete. Figures for block performances are limited, and readers would probably find more information about how to perform specific blocks from larger textbooks. All the information needed to perform intravenous regional anesthesia safely is included. A large portion of the chapter about common local anesthetic blocks is devoted to the topic of local infiltration anesthesia in ambulatory surgery. Although this part of the chapter may be less clinically useful to anesthesiologists, it is well-written, advocating combining different techniques to minimize complications and decrease discharge times. This chapter also contains a brief discussion of a variety of peripheral nerve blocks, including intercostal, brachial plexus, femoral, and sciatic nerve blocks, as well as a discussion of neuraxial blocks. There is additional discussion of these same techniques with an emphasis on drug selection and discharge times in the section about local anesthesia for ambulatory surgery.One of the most interesting chapters is that about controversies in the clinical practice of regional anesthesia. This was a practical discussion of three pertinent topics: the best technique for axillary brachial plexus block, the use of the epidural test dose, and transient neurologic symptoms after spinal anesthesia. All three topics are extremely well-covered with an extensive reference list and should be read by anyone with an interest in regional anesthesia. The advice and conclusions were practical and useful—well worth the price of the book.Technical aspects of regional anesthesia is another chapter full of new and interesting information. The history and development of needles, catheters, stimulators, and patient-controlled analgesia pumps is thorough and fascinating. It is interesting to note the differences in product availability in Europe versus the US. The information about new epidural systems (two-cannula systems) and spinal microcatheters is of particular interest because these products currently are not available in the US market.Overall Local and Regional Anaesthesia fulfills the goal of a brief discussion of current topics of interest in regional anesthesia. The book is probably more appropriate for clinicians with some previous experience and knowledge about the topics discussed than for residents in training. The fact that the book is lightweight and inexpensive and that each chapter can be completed in a 30-min StairMaster session makes it ideal for the busy clinician with an interest in the current controversies in regional anesthesia.