Atlas of Ultrasound- and Nerve Stimulation-guided Regional Anesthesia.  By Ban C. H. Tsui, M.D. Consulting Editors: Vincent W. S. Chan, M.D., Brendan T. Finucane, M.B., B.Ch., Thomas Grau, M.D., Ph.D., and Anil H. Walji, M.D., Ph.D. New York, Springer Science+Business Media, 2007. Pages: 302. Price: $170.00.

Regional anesthesia has made rapid advancement over the past 30 yr with the introduction of electrical stimulation to guide needle placement and the most recent addition of ultrasound. The key to a successful block is to deliver the local anesthetic to the target nerves. Atlas of Ultrasound- and Nerve Stimulation-guided Regional Anesthesia  illustrates how to combine ultrasound and nerve stimulation to advance the art of regional anesthesia to a more scientific approach.

The book’s first two chapters are brief introductions into the logistics of establishing a block room and garnering the supplies needed. They also include a comprehensive review of the physics of nerve stimulation and features of the equipment needed. The authors emphasize that nerve stimulation can be very helpful to novices as they learn to incorporate ultrasound into their regional practices, with the goal of confirmation that nerves on images and reactive to stimulation are actually nerves.

Chapters 3 and 4 provide an elementary look at the ultrasound basics, including physics and workings of the ultrasound machine. These chapters provide guidance in choosing the correct ultrasound probe (linear vs.  curved array), which is essential for obtaining adequate images that will identify nerves. Tissue sonoanatomy, required to identify the various structures within ultrasound images, is introduced. After identifying the nerve, one of the more difficult issues to learn is to track the needle to the target nerve. Practical tips are given to assist clinicians in observing and maintaining the trajectory of the needle. The author introduces a “training wheel” laser light attachment system that he has developed to aid the beginner in aligning the ultrasound beam with an in-plane technique in guiding the needle to the nerve.

The remainder of the book is divided into chapters describing the most common regional blocks. The author is consistent with his stepwise approach to convey an easy and clear method in performing the various blocks with introduction of clinical anatomy followed by surface anatomy. Anatomical dissections, corresponding magnetic resonance imaging images, and ultrasound images are used for comparison to provide clinicians with a comprehensive view of anatomy. The message is clear that performing a successful regional block is dependent on a thorough understanding of anatomy. The chapters describe how to position the ultrasound probe to obtain the best images to perform the block. Comparison ultrasound scans of labeled and unlabeled images are educational tools used to learn the sonoanatomy of the different blocks. Appropriate motor responses to nerve stimulation are listed for each of the individual target nerves. Clinical pearls and troubleshooting suggestions are detailed at the end of each chapter.

Chapter 16 explores the role of ultrasound with regional catheter placement and stimulating catheters. As the author notes, there is not an abundance of information in the literature regarding ultrasound guidance of catheters and stimulating versus  nonstimulating catheters. The chapter is based primarily on the author’s clinical experience and gives several helpful suggestions on placement of catheters.

One of the challenges of ultrasound imaging is learning sonoanatomy and being able to identify nerves. Examples of the ultrasound images throughout the book were adequate but challenging. In several of the images, it was difficult to clearly see the nerves, a problem that is unfortunately realistic and often the case when performing ultrasound-guided nerve blocks. For the beginner, it may be helpful to be able to compare both ideal and mediocre ultrasound images.

In summary, the authors are to be congratulated for a well-designed book that explains their approach to performing regional blocks with the aid of nerve stimulation and ultrasound. The book offers an easy-to-follow stepwise introduction of ultrasound for beginners and several advanced ultrasound techniques for experienced clinicians. The book provides numerous practical suggestions on how to safely perform regional blocks with high success rates. This is an excellent resource for any clinician performing regional blocks.

Mayo Clinic, Jacksonville, Florida.