Peripheral Regional Anesthesia: An Atlas of Anatomy and Techniques, 2nd Edition.

Abstract

Mayo Clinic, Rochester, Minnesota. duncan.christopher@mayo.eduPeripheral Regional Anesthesia: An Atlas of Anatomy and Techniques, 2nd Edition. Edited by Gisela Meier, M.D., and Johannes Buettner, M.D. Stuttgart, Germany, Georg Theime Verlag, 2007. Pages: 253. Price: $159.95.A detailed understanding of anatomy is a key component to the successful practice of regional anesthesia. The ability to visualize the anatomical landmarks and their relationship to the nerves is crucial to successful neural blockade. Drs. Meier and Buettner’s Peripheral Regional Anesthesia: An Atlas of Anatomy and Techniques , 2nd Edition, assists the practitioner of regional anesthesia in the understanding of the anatomical relationships necessary to successfully complete peripheral nerve blockade.There are many regional textbooks and regional anesthesia atlases currently available. Drs. Meier and Buettner have created one of the most comprehensive regional anesthesia anatomical atlases currently available. The combination of cadaveric pictures, artistic illustrations, and live model surface landmark imaging provides the reader with a true appreciation of the landmarks and relationships involved in regional anesthesia techniques. In addition, the atlas provides detailed descriptions, illustrations, and anatomic dissections of multiple approaches for each type of peripheral nerve block.This atlas provides insights into regional anesthesia for both the beginning regional anesthesia practitioner and the regional anesthesia expert. For example, chapter 3 on infraclavicular brachial plexus blockade presents the two main approaches to the block with the original technical descriptions referenced and multiple illustrations, including pictures of human models with surface landmarks drawn and needle insertion position and orientation represented, along with cadaveric pictures with the needle in place to demonstrate proper needle position in relation to the nerves.In addition to a thorough anatomical review of the regional anesthesia, Drs. Meier and Buettner begin each chapter with a detailed review of the relative anatomy for each described block and conclude each chapter with (1) the expected sensory and motor effects; (2) the indications and contraindications; and (3) the complications, side effects, and method-specific problems.Unfortunately, this atlas has limitations. The use of ultrasound in the practice of regional anesthesia is becoming more prominent and is the focus of many of the current discussions in regional anesthesia. This atlas does not include any significant ultrasonic imaging. I believe this is a major shortcoming to any new atlas of regional anesthesia. This is especially disappointing given the terrific anatomical illustrations present in the book; the inclusion of ultrasound imaging had the potential to make this a defining regional anesthesia atlas. Another shortcoming of the book is the lack of attention paid by the publisher to the relation of the text to the illustrations. The text seems to be placed in any open page space. This type of text insertion makes for an especially disjointed reading of the technical descriptions and makes the reader constantly flip pages to view the illustration being referenced.In summary, this is an excellent atlas of regional anesthesia with a thorough description of multiple techniques for each block type. The cadaveric pictures, artistic illustrations, and accompanying radiographic images are well done and printed on high-quality paper. Unfortunately, ultrasonic imaging is not significantly included, and the text is interspersed with the images, making for a difficult, broken read. Overall, this book is competitively priced at $159.95 (Amazon.com) and provides a very good reference to the traditional practice of regional anesthesia for both the novice and the expert.Mayo Clinic, Rochester, Minnesota. duncan.christopher@mayo.edu