Peripheral Nerve Blocks. A Colour Atlas

Abstract

J. E. Chelly (Ed.) Lippincott Williams & Wilkins, 1999. 240 pp. This beautiful book reflects the growing interest in peripheral, as opposed to central, nerve blockade, and therefore makes no mention of spinal or epidural injections. The book is divided into four sections: General Concepts; Single Injection; Peripheral Blocks: Continuous Peripheral Blocks; and Paediatric Peripheral Blocks. Section One deals briefly with preparation, well with the use of a nerve stimulator and very briefly with local anaesthetic solutions. It does not set out to be a pharmacology textbook, but makes sensible suggestions as to the choice of local anaesthetic, additives and the avoidance of toxicity. The bulk of the book is made up of a beautifully illustrated practice guide to nerve blockade with over 200 of the 240 pages being dedicated to sections 2, 3 and 4. Each section is logically laid out, dealing with upper limb, lower limb and other blocks, in that order. Where there are several methods, these are given in the author's choice of order. Despite being a multi-author publication, the style is uniform throughout, and most descriptions are clear and understandable even by the inexperienced. As you read you feel that the authors are describing what they practice. Having said that, some blocks, the anterior approach to the sciatic nerve for instance, are much more easily described than performed, and I am unsure of the value of the author's variation on Beck's original approach. The sections on catheter techniques and paediatric blocks are a joy and a delight even for those who, like me, no longer practice paediatric anaesthetics. To have catheter techniques together in one section is valuable, and children definitely are different. References are limited in number with between two and eight being cited at the end of each description, but are sufficient to give depth to each section if required. Predominantly drawn on American publications, there is also a reasonable number from British and other European sources, especially French. Many of the English language references will be familiar to those interested in peripheral blocks but those in French may be less well known. The index is more than adequate, despite my best efforts to catch it out. There are, of course, oddities and niggles. It is surprising to find that Raj's supine approach to the sciatic nerve, which has the ischeal tuberosity, and the greater trochanter as landmarks, merits only three lines under ‘Anterior Approaches’. Metatarsal block is referred to as a successful alternative to ankle block, but not described. One manufacturer of insulated needles is named 60 times in the text, which eventually I found very annoying; I realised I was scanning each page for the offending name before I could read it. Other companies are also acknowledged but in what appeared to be a rather haphazard fashion, and certainly very much less often. Infinitives are split with gay abandon throughout, which still grates an old fashioned pedant like me. However, these are small points which do not, in the end, detract significantly from the value of the book, nor my enjoyment in reading it. Aimed at trainees and those more senior who wish to refresh or extend their knowledge of block techniques, it provides clear instruction in the art of peripheral nerve blockade which will support and underpin practical training. Every theatre where peripheral nerve blockade is practised should have a copy on the shelf and there will be many anaesthetists of all levels who will enjoy the book, because it is a lovely book, and learn from the descriptions, even of the blocks they do routinely.