CD-ROM: Peripheral Nerve Blocks: Lower Limb and Upper Limb. By Alain Delbos, James Eisenach, Patrick Narchi, and Louis Brasseur. Philadelphia, Lippincott-Raven, 1998. Two-CD set. Price:$295.00.

A multimedia approach seems particularly appropriate for teaching and learning regional anesthetic techniques. The CD-ROM set Peripheral Nerve Blocks: Lower Limb and Upper Limb comes very close to fulfilling the quality one would expect from its well-respected international authors. From perusing its interactive tutorial to checking that last anatomic relationship, the user discovers a medium that is truly "multi." Click on a peripheral block from the index and you can elect to view animation, video, or even a reference library. Narrated animation walks the student through an entire block, from indications and anatomy, to required equipment, to which muscle movements are acceptable when elicited by a peripheral nerve stimulator. The video choice shows the block being performed on a patient as each individual step is narrated. Subtopics are linked to a library that provides more than 600 references, many of them accompanied by an abstract. On my G3 Macintosh computer (Apple, Cupertino, CA), the pictures were crisp, the sound was clear, and movement through the program was smooth and moderately fast. Discs are readable in either a PC or Mac format.

The authors are to be congratulated for this bold undertaking, as it comes together extremely well. The lower extremity portion includes single-shot and continuous approaches to the lumbar and lumbosacral plexi, plus techniques at the knee and ankle. The upper extremity disc details standard brachial plexus techniques and also includes infraclavicular and midhumeral approaches, along with selective nerve blocks at the wrist and elbow. Highlight a specific block with the pointer and the expected sensory distribution changes color on the accompanying illustration. Although not as good as the artistry in Brown's atlas, the illustrations are nonetheless accurate and provide a dynamic layering of anatomic detail. Despite its success, this work has several minor shortcomings. Drawings for the axillary approach include dissection toward the neck, rendering them somewhat disorienting. Instruction often errs on superficiality. For example, five axillary block techniques are described, but few in enough detail to truly learn them. Similarly, opioids and clonidine are mentioned as potential local anesthetic adjuvants without acknowledging what I interpret as less-than-compelling data supporting their use. Some arguably important topics are curiously absent, such as alkalization of local anesthetics, awareness of intraneural injection, and sedation. Finally, a peripheral nerve stimulator is frequently recommended as necessary equipment for blocks, even when, as in the case of blocking the radial nerve at the wrist, a purely infiltration technique is described.

Overall, Peripheral Nerve Blocks is an excellent resource, but at $295, the price is imposing. Acquiring it for a resident library is worthwhile. Residents of all levels would benefit from its dynamic demonstration of anatomy and needle placement before and after actual performance of a regional technique. Similarly, the CD could be a valuable adjunct to introductory lectures. For the practicing anesthesiologist with some prior experience with a needle, this CD-ROM should provide the necessary review and motivation to renew dormant regional anesthetic skills.

Joseph M. Neal, M.D.

Virginia Mason Medical Center; Seattle, Washington 98111

(Accepted for publication March 18, 1999.)