Peripheral Nerve Blocks: A Color Atlas. Edited by Jacques E. Chelly, M.D., Ph.D. Philadelphia,Lippincott Williams & Wilkins, 1999. Pages: 223. Price: $95.00.
The editor’s goal with the creation of this atlas is to provide simple, practical instructions for the performance of peripheral nerve blocks that “maximize success and minimize complications.” There are 30 contributing authors, and the atlas is organized into four main sections: general concepts (including patient preparation, nerve stimulators, and local anesthetics), single-injection peripheral blocks, continuous peripheral blocks, and pediatric peripheral blocks. Each chapter regarding a particular block begins with brief notes about indications, patient position, and recommended needle type and local anesthetic volume. The bulk of each chapter is made up of figures (mostly color photographs), anatomic landmarks, technique, tips, and suggested additional reading. There is some inconsistency in the level of detail, use of figures, and content of the tips section among authors.
The atlas is modest in size, but it is unique in its focus on peripheral nerve block for surgery and postoperative analgesia. Most current regional texts include considerable information regarding central blocks and blocks for chronic pain management. The section about continuous techniques (40 pages) is particularly useful, with emphasis on the variation in approach needed with catheter versus single-shot techniques. The concept of choosing various local anesthetics for each portion of a peripheral block for targeted differential recovery also is presented. Nearly every chapter includes a valuable and current additional reference list, and the table of contents and index are thorough.
This atlas is seriously flawed, however, by a remarkable number (more than 50) of errors in text and figures. Minor errors include word substitutions, such as “pilocarpine” for “prilocaine,” and decimal shifts, such as 15 mA for 1.5 mA. Incorrect figures with mislabeled muscles and nerves are presented. More significant errors, including the substitution of adduction for abduction, lateral for medial, and distal for proximal, will hinder a trainee’s ability to apply block descriptions. Although most of the figures are useful, some contradict the description in the text, some show too limited a view, and some do not appear to be the correct figure for the text. One figure, which appears in four places, shows eversion of the foot to be the result of stimulation of the tibial nerve. Finally, there are phrases that are wholly incomprehensible; perhaps these are the result of translation errors from international contributors. In the preface, the editor states:“Thus, a transarterial approach necessitates the performance of axillary blocks.” In another section, the superficial cervical (plexus) block is described:“Twenty to 25 ml of 1% lidocaine is infiltrated into the subcutaneous from C3 anteriorly toward the mastoid process to a point 2 cm superior to the clavicle.” There is no diagram to aid the perplexed reader.
In summary, this atlas may be valuable for the clinician who wishes to expand into performance of pediatric regional or continuous blocks and is familiar enough with regional techniques to recognize and ignore the errors. A resident, fellow, or clinician new to performing regional blocks, however, may have difficulty applying this text to clinical practice until the unacceptable number of errors has been corrected.
