Regional Anaesthesia, Stimulation and Ultrasound Techniques

Abstract

This pocket-sized handbook is an addition to the existing Oxford Specialist Handbook series in anaesthesia. Regional anaesthetic techniques have had a resurgence in recent years since the introduction of ultrasound. This was a much awaited and needed publication, as Oxford Handbooks are renowned as quick and practical guides to a speciality or subspeciality, and regional anaesthesia is increasingly used as a sole anaesthetic and for providing supplemental analgesia. The editors of this book include a physician's assistant, an anaesthetic consultant with an interest in pain management and two senior anaesthetic consultants with extensive backgrounds in regional anaesthesia. The book is about half the size of the Oxford Handbook of Anaesthesia and has 557 pages divided into 50 chapters. The book has six subsections, including general considerations, head and neck, upper limb, trunk blocks, lower limb and neuraxial blocks. The first section begins with a brief history of regional anaesthesia and is followed by chapters on pain, local anaesthetics, nerve localisation, the physics of ultrasound and general principles of regional anaesthesia. In this section the authors have included topics such as wound infiltration techniques, paediatric regional techniques, peripheral catheters and training in regional anaesthesia. The first chapter, ‘A brief history of regional anaesthesia’, is interesting and provides a reasonably detailed account of the development of regional anaesthesia. The second chapter on the physiology of acute pain contains enough information for trainees appearing for the final Fellow of the Royal College of Anaesthetists examination and beyond. This is followed by a discussion on local anaesthetics and additives. The presentation between these two chapters varies, as the chapter on pain is predominantly text, while the chapter on local anaesthetics is supported with diagrams and pictures, which are helpful for a learner with a visual style. The authors discuss the use of adrenaline as an additive and adding adrenaline to local anaesthetic in two separate places, which may have been better in one place. In addition, some statements such as ‘there is no evidence that dexamethasone is more effective’ as an additive or via the intravenous route lacks support from references. All other chapters in the first part, e.g. local anaesthetic toxicity, basic physics of ultrasound, principles and practice of anaesthesia and paediatric anaesthesia, have been brilliantly written and supported by the appropriate images. One of the highlights of the book is the chapter on training and assessment in regional anaesthesia. This chapter not only provides a worldwide view on training and assessment, but also offers regional anaesthetists an easy tool to assess their own competence and progress. The remaining five parts of the book deal with all blocks that are routinely practiced in anaesthesia. The only missing blocks are newer techniques such as pectoralis interfascial blocks and serratus anterior plane blocks. All block descriptions follow the same structure, i.e. background, landmark technique, peripheral nerve stimulator technique, ultrasound technique and suggested reading. As an example, the chapter on axillary block begins with indications for the block. This is followed by a brief introduction and detailed anatomy. The anatomical cross section of the axilla depicts the spatial relationship of various structures. The authors then discuss the complications and side effects. The peripheral nerve technique and the ultrasound technique are described in detail supported by line diagrams for positioning and an ultrasound image of the axillary area. The highlight of the chapter is the ‘clinical notes’ section, which stems from the experience of the contributing author. The ultrasound image is indistinct, but nonetheless demonstrates and identifies all structures including vessels and nerves. The book includes other uncommon techniques such as palatine, ethmoidal, superior laryngeal and recurrent laryngeal nerve blocks. In summary, this handbook is an essential pocket book for trainees undertaking the Royal College of Anaesthetists examinations (FRCA), advanced regional anaesthesia fellowships, the European Diploma of Regional Anaesthesia (EDRA) examinations and while on regional anaesthesia rotation during their training. The book will also come in handy as a quick reference for blocks that an anaesthetist does not perform on a regular basis.