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BOOK AND MULTIMEDIA REVIEWS

Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia

Assistant Professor; Director, Regional Anesthesia; New York University School of Medicine; New York, NY

Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia

Tsui BCH, Chan VWS, Finucane BT, et al. New York: Springer, 2007. ISBN 978-0-387-68158-0. 302 pages, $179.00.

The Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia presents a comprehensive and well-illustrated reference on the latest achievements in nerve stimulation and ultrasonography-guided nerve block techniques in regional anesthesia. Besides nerve stimulation, ultrasound guidance is rapidly becoming a popular approach for performing peripheral nerve blocks. Ultrasound assistance in regional anesthesia was first described in 1978.1 However, only with more recent improvements in ultrasound technology has ultrasound guidance become an increasingly popular alternative method of achieving regional anesthetics. There have been numerous scientific articles in this area during the recent years and, therefore, this all encompassing and visually elaborate atlas is a welcome and needed addition. The dual intent of this book is to facilitate the introduction of ultrasound-guided nerve block techniques for anesthesiologists who are new to this field and to promote further understanding among more experienced colleagues. The continuous comparison with, and extensive descriptions of, nerve stimulation techniques, encourages readers not to abandon more traditional methods, but rather to combine them with ultrasound-guided regional anesthesia. An explicitly visual and wide-ranging discussion on ultrasound and nerve stimulation-guided nerve block techniques with abundant anatomic graphics, and a variety of images obtained via anatomical photography, ultrasound imaging, and computer tomography/magnetic resonance imaging scans, combined with an impressive number of regional anesthesia device illustrations, provide a thorough and reliable reference for clinicians.

The volume is divided into 20 chapters. Each chapter contains one to seven sections, which are further divided into one to ten divisions. Chapters I–IV concern themselves with the regional block room setup, electrical nerve stimulation and ultrasound basics, and practical and clinical aspects of ultrasound and nerve stimulation-guided peripheral nerve blocks. Detailed descriptions of a wide variety of equipment and techniques for nerve stimulation and ultrasound-guidance are provided in an orderly fashion. An elaborate analysis of the echogenic appearance of nerves at different anatomical levels in contrast to surrounding tissues is presented. Alternative ways of locating nerve structures are discussed in a comprehensive manner. Advanced and innovative techniques such as the in-plane laser guidance for probe/block needle alignment are described.

In the following clinical chapters, initial descriptions of applicable anatomy with drawings and photographs from cadaver dissections and matching MRI and ultrasound images are typically followed by discussions and instructions on how to perform the specific blocks. Here are found detailed descriptions and illustrations on how to apply ultrasound probes, what needling techniques to use, and what nerve stimulation options there are in the various regional block situations.

Chapters V–X cover the clinical anatomy and specific techniques for upper limb blocks. The sections are discussed logically in an anatomical order, starting with various approaches to the different levels of the upper reaches of the brachial plexus, and followed by selective terminal nerve blocks of the upper extremity. Chapters XI–XV comprise instructions for lower extremity nerve blocks organized in the same manner as the upper extremity is covered in the previous chapters. Chapter XVI discusses catheter insertion techniques using ultrasonography and stimulating catheters and contains a concise review of catheter placements at the interscalene, infraclavicular, femoral, and sciatic nerve locations. Chapters XVII–XX go over the anatomy and techniques for paravertebral, intercostal, caudal, and epidural blocks. The coverage of electrical epidural stimulation is remarkable. Even more impressive is the presentation of multiple views of low versus high resolution sonographic images of the spine at both thoracic and lumbar levels.

The main strength of this atlas is its extensive number of illustrations facilitating the visual understanding of the matter. The authors have, nevertheless, integrated extensive interpretations with detailed directions on how to use the various tools and perform the vast numbers of regional anesthetics. While initially browsing through the book, this reviewer noticed that the ultrasound images did not always appear perfect and wondered how helpful this might be, especially to novices in the field. However, after spending more time with the atlas, the reviewer agrees with the preface that this should be seen to represent images from everyday practice, obtained by utilizing ultrasound transducers of differing qualities, and therefore be more representative of what our colleagues will come across in an average clinical day. Some of the most educational demonstrations are the frequent side-by-side comparisons of unlabelled versus labeled identical sonographic images. The placing of "clinical pearls" at important areas of the text is another notable enrichment.

Overall, the completeness of the book based on the most current technological advances in the field of regional anesthesia is laudable. This atlas represents an excellent educational tool for both neophytes and teachers of ultrasound and nerve stimulation-guided regional anesthesia. At the same time, it embodies a reference book of outstanding value for the more proficient regional anesthesiologists.

REFERENCE

1. La Grange P, Foster PA, Pretorius LK. Application of the Doppler ultrasound bloodflow detector in supraclavicular brachial plexus block. Br J Anaesth 1978;50:965–7[Abstract/Free Full Text]

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