Regional Anesthesia for Ambulatory Surgery

Abstract

Edited by John J. Laur, M.D., M.S., and Brian A. Williams, M.D., M.B.A. Hagerstown, Maryland, Lippincott Williams & Wilkins, 2011. Pages: 196. Price: $176.00.As a practicing anesthesiologist, it is apparent that ambulatory surgery accounts for the overwhelming majority of surgical procedures staffed by a typical anesthesia practice. Anesthesiologists thus are routinely challenged with delivering an anesthetic to medically complex patients that is not only safe and efficient but also confers lasting comfort with minimal side effects postoperatively. In many instances, regional anesthesia is uniquely suited to meet the demands of ambulatory patients. It is no surprise, then, that regional anesthesia continues to be a popular topic for the anesthesiology readership. International Anesthesiology Clinics published its single bestselling issue, a symposium on regional anesthesia in ambulatory surgery, in the summer of 2005. The sequel to that issue is a ‘trilogy,’ spanning three issues of International Anesthesiology Clinics, Volume 49 (Numbers 3 and 4) and Volume 50 (Number 1). The Fall 2011 issue, Regional Anesthesia for Ambulatory Surgery: Anatomy, Applied Tools and Techniques, and Pharmacology, is the second of the three-part series.The issue begins with a basic primer on nerve anatomy as it relates to regional anesthesia, highlighting inconsistencies in nomenclature. It establishes a framework in which to introduce the concept of intrafascicular injection and espouses a multimodal approach in avoiding it during peripheral nerve blocks. This topic is further advanced in separate chapters by a detailed discussion of injection pressure monitoring and advances in nerve stimulation.The book early on devotes two chapters to discussing whether the use of ultrasound imparts any benefit in regional anesthesia. Both reviews are well referenced and offer diverse perspectives on the debated topic. The chapters, Opinion/Editorial and Review of the Recent Literature, successfully help the reader understand where the use of ultrasound has yet to make a difference, based on the current evidence.This volume also devotes two chapters to technical aspects of ultrasound physics and imaging, including artifacts. They are extremely useful and surprisingly easy to follow, considering the complex nature of the topic.There are a few chapters related to pharmacology. In our opinion, the chapter on using lipid emulsion to treat local anesthetic toxicity is relevant for any practicing anesthesiologist and is a highly recommended review. The following chapter on local anesthetic additives, which discusses pharmacologic principles and associated risk for neurotoxicity, is very practical and complete. Thereafter, the use of multimodal systemic pharmacotherapy and intraarticular injections for postoperative pain control in the ambulatory setting is examined, followed by a discussion on the important subject of regional anesthesia and postoperative nausea and vomiting.With an ever-increasing number of diabetic patients presenting for ambulatory surgery, the review of regional anesthesia in patients with preexisting neuropathy is especially relevant. The chapter also discusses various other commonly seen neuropathies and the experts' input is very beneficial for our clinical practice. The book concludes with a chapter on the complex topic of thromboprophylaxis and regional anesthesia in the ambulatory setting. The author here offers valuable information from the current literature.This issue of International Anesthesiology Clinics is indeed a treat to read for any anesthesiologist interested in regional anesthesia for ambulatory surgery at either the trainee or attending level. The reviews are well crafted, with extensive referencing. They are written by notable clinicians in the discipline and presented with vetted evidence balanced by personal clinical experience. As the practice of regional anesthesia continues to grow, in some ways driven by monetary incentives, this compendium may serve as a resource in implementing its safe application.