While sitting in the anesthesia conference room, I find myself discussing with a resident why the last epidural catheter placed for labor analgesia failed to work. Although dysfunctional epidural catheters are frequently a source of frustration for anesthesia providers and dissatisfaction for patients, the causes are not always understood. When a failed epidural catheter cannot be attributed to inexperience of the provider or technical difficulties during placement, we default to a possible structural variance of the human anatomy.
Epidural Anaesthesia: Images, Problems and Solutions, by Clive Collier, is a correlation of epidurograms with clinical scenarios, with which the author intends to fill a knowledge gap on dysfunctional epidural analgesia and anesthesia.
Dr. Collier has carried out the impressive job of collecting epidurogram images for over 30 years and has kindly shared his work and knowledge in this book in a concise, but detailed, approach. Organized in 10 chapters, the book first decribes the epidurography technique. An epidurogram is a contrast-assisted radiograph of a patient who has had epidural anesthesia. After descriptions of typical epidural blocks and their corresponding images, the author goes on to describe case scenarios of epidural blocks with complications and their corresponding images. The author describes some novel anatomical regions, such as the fourth “intradural” space, as well as multicompartment blocks.
As the book is directed to anesthesia providers regularly delivering neuraxial analgesia/anesthesia, a basic understanding of the epidural space and its adjacent spaces and structures is essential. The reader will certainly be able to follow the descriptions, thanks to the numerous images and the author’s writing style that facilitate the learning. Electron microscopy images and diagrams contained in this book help support the author’s findings.
This book provides access to a companion website that contains all of the images from the printed book, a library of moving images, and sample material from the book. Although the images and videos are of good quality, the latter would have benefited from an audio narrative. In addition, although the right (R) or left (L) orientation of the figures seems logical, having an R or L on the corresponding side of the figure would better orient the reader throughout the descriptions.
Overall, I recommend this book by Dr. Collier to anesthesia providers seeking a better explanation of common and uncommon causes of failed epidural catheters. The technique of acquiring the images is thoughtful and shows the many years of experience and the passion of the author. Although epidurography may not be a technique that is commonly used, the images give us an insight into what can go wrong. This information can be helpful because the knowledge of where the epidural catheter can be located is a great tool when counseling patients after a failed or complicated neuraxial block.