Pain Management and Regional Anesthesia in Trauma.

Abstract

Université Catholique de Louvain School of Medicine, St Luc Hospital, Brussels, Belgium. singelyn@anes.ucl.ac.bePain Management and Regional Anesthesia in Trauma. By Andrew D. Rosenberg, Christopher Grande, Ralph L. Bernstein. Philadelphia, WB Saunders Ltd., 2000. Pages: 456. Price: $120.00. Francois J. Singelyn, M.D., Ph.D., Université Catholique de Louvain School of Medicine, St Luc Hospital, Brussels, Belgium. singelyn@anes.ucl.ac.beThis textbook is the most recent in the trauma care series produced by the International Trauma Anesthesia and Critical Care Society. Its goal is to provide a “how to” text for administering pain management in trauma patients. It is dedicated to trauma care providers, particularly anesthesiologists. A useful list of abbreviations used in medical English opens the text. An outline of the content, which is helpful for the reader, starts each chapter. The text is divided into four sections and 23 chapters. The first section, Basics: Interface of Trauma and Pain, creates a foundation for the understanding of the basics of pain, pain pathways, and pharmacologic treatment in trauma patients. Its chapters are well-written and illustrated. In the chapter about pharmacology, this reviewer would have preferred more discussion about the use of acetaminophen in its different forms (oral, rectal, intravenous), about the newer long-acting local anesthetics (ropivacaine, levobupivacaine), and about the adjuvants (opioids, α2-agonists, and others) to local anesthetic solutions. Current references on these topics are sparse. The second section, Location-Based Pain Management: Concepts and Considerations, discusses pain management of the trauma patient in different settings as prehospital, emergency room, or rehabilitation center. The use of peripheral nerve blocks in such situations are rightly emphasized. Unfortunately, the different chapters are somewhat redundant. The chapter about pain management in the rehabilitation center is particularly interesting. The third section, Perioperative Pain Management in Trauma: Techniques and Applications, describes how to perform specific techniques of pain management, such as intravenous patient-controlled analgesia, epidural, plexus blocks, and others. Of course, most of these techniques are better detailed in more specific textbooks. However, the chapters about patient-controlled analgesia and use of continuous extremity nerve blocks are well-written, even if the most recent references on these topics are lacking. The fourth section, Pain Management for Specific Trauma Patient Populations and Injured Organ Systems, is dedicated to different populations that frequently present to the traumatologist, such as pediatric, burn, pregnant, or orthopedic patients. Moreover, the management of chronic pain as a result of trauma is discussed in the two last chapters. The chapter about pediatric patients is well-illustrated and complete with current references. The next chapters (particularly chapters 19 and 21) are somewhat redundant with previous ones. The heading of the last chapter, dedicated to the invasive management of chronic pain syndrome, is somewhat confusing.This reviewer suggests that the textbook merits a place in the bookshelf of every anesthesiology department involved in trauma care. It provides a practical approach to most facets of analgesia in trauma patients. In case of a second edition, it should be suggested to the authors to reorganize the redundant chapters. This would make the textbook even more pleasant to read.