Review: Textbook of Regional Anesthsia and Acute pain management

As one of the faculty members responsible covering our Acute Pain Service and Regional Anesthesia rotation, I am often asked by the residents to recommend a textbook. I have always provided a list of a few that I considered adequate with the caveat that there is a vast amount of information available on various regional anesthesia Web sites, thus allowing trainees to earmark their educational allowances for board review materials instead. That is until now. With the recent publication of Textbook of Regional Anesthesia and Acute Pain Management by Admir Hadzic, there is now a definitive text for any and all topics related to perioperative analgesia. Dr. Hadzic has taken excellent chapters written by an international group of expert authors and compiled them in an organized manner to produce a comprehensive resource on the subject of regional anesthesia and acute pain management. The result is a continuation of the same high-quality work that we have come to expect from the New York School of Regional Anesthesia founded by Hadzic and long-time collaborator Jerry Vloka, M.D., Ph.D. (Department of Anesthesiology, Saint Luke's-Roosevelt Hospital Center, New York, New York), in 1994.

The book begins with an interesting review of the historical aspects of local anesthesia that should be of great interest to any practitioner. This is followed by a basic science section that provides a thorough review of anatomical, physiologic, and pharmacologic basis for neural blockade that make regional techniques possible. There is even a chapter dedicated to embryology and development of the nervous system. In the initial chapters, we receive our first glimpses of the detailed and informative illustrations present throughout the book.

The next part of the book, devoted to the clinical practice of regional anesthesia, is the largest and the one upon which most readers will focus. The chapters enhance and expand on the tutorials found on the New York School of Regional Anesthesia Website and present and present a wide variety of regional techniques. Each block is thoroughly reviewed by recognized experts in the field with discussions of indications, contraindictions, relevant anatomy, necessary equipment, variant techniques, perioperative management, and adverse events. Of special note are excellent chapters on regional techniques for tracheal intubation and oral and maxillofacial anesthesia, concepts that are not always present in regional text.Probably the most impressive features round in this section of the book are the clinical pearls and tables, which emphasize the important information for each block, thus providing essential knowledge for both the novice and experienced practitioner to advance and enhance their regional abilities. The "how to' part of the book is then followed by several well written chapters on new

concepts, including ultrasound guidance, that are as current as possible for such a comprehensive text with references as recent as 1 yr before publication. The book then focuses attention on special patient populations such as obstetrics, pediatrics, patients with various systemic diseases, critically ill patients, and out patients. Again, the clinical pearls and tables in these sections provide extremely useful and practical information. Also included in this area of the book are chapters on controversial topics such as regional anesthesia for patients with preexisting neurologic disease and the implications of acute compartment syndrome of the extremities. Opposing arguments are presented that examine these often highly debated issues.

One of the latter parts of the book that is perhaps one of the most essential for those who wish to tailor their practice to emphasize regional techniques addresses the neurologic complications of regional anesthesia. These chapters provide the most up-to-date information on pathophysiology, mechanisms of injury, diagnosis and management, and perhaps most importantly, means of prevention. The final sections of the book focus on practice management topics, including chapters on medical economics, outcomes, and organization of acute pain services. There is an outstanding chapter on procedure documentatio. Another interesting chapter is on discussing the controversial topic of preemptive analgesia, again with varying viewpoints presented.

Although I deliberately searched for weaknesses in this book, I was unable to find any significant faults with the content. The only complaint i can honestly muster is that some might feel that the book may be too large to be comfortably portable. Despite its size, it will serve its purpose well as a reference to be kept at home, in a regional block area, or in an anesthesiology department library or workroom. The New York School of Regional Anesthesia Web site serves as an outstanding supplement to this text. Hopefully, an electronic edition or multimedia version will be in the not too distant future, allowing remote access from any point of care location via personal data services.

In summary, Textbook of Regional Anesthesia and Acute pain Managment has set the standard for other regional textbooks to follow. The book is a "must have" for anyone interested in successfully practicing regional anesthesia, from trainees to teachers. It is as comprehensive as current as can be expected from a reference, yet is is extremely readable, artfully illustrated and well organized. Through it, the reader has access to the vast amount of knowledge and expertise available from many of the world's masters of regional anesthesia and analgesia.