Peripheral Nerve Blocks: A Color Atlas, 3rd Edition. By Jacques E. Chelly, M.D., Ph.D., M.B.A. Philadelphia, Lippincott Williams & Wilkins, 2009. Pages: 496. Price: $110.00.

Regional anesthetic techniques have long been employed as a means of providing operative, postoperative, and chronic analgesia. They have also been used as adjuncts to general anesthesia to reduce anesthetic requirements, which may be especially useful in patients with underlying disorders such as coronary artery disease. More recently, evidence indicating potential benefits in decreasing the incidence of certain postoperative complications with the use of regional anesthesia has contributed to a renewed interest in these techniques. The development of safer local anesthetic agents, the use of ultrasound guidance, and the availability of continuous block techniques have also played a role in the increasing application of regional anesthesia. As the scope of regional anesthetic practice continues to expand, references that incorporate information on new techniques and applications of regional anesthesia are needed to keep the practitioner up-to-date.

In this regard, Peripheral Nerve Blocks: A Color Atlas, Third Edition,  edited by Jacques Chelly, provides well-organized and updated information encompassing current regional anesthetic practices. It is suitable for the novice student of anesthesia as well as for the experienced anesthesiologist. The book is divided into sections that cover general topics such as equipment and medications used in regional anesthesia, single-shot and continuous nerve block techniques specific to body regions, ultrasound guidance for peripheral nerve blocks, the use of regional anesthetic techniques in the pediatric population, and even a section that covers common regional block techniques used in a pain management practice.

The author provides a concise and easy-to-follow guide for block performance. Block technique descriptions are accompanied by a variety of anatomic illustrations and photographs that demonstrate needle placement and landmarks used in performance of the block. Block techniques that can be accomplished by numerous anatomic approaches are well covered in distinct sections. Each description of a block technique begins with a summary of clinical indications, patient positioning, needle size and type, volume of local anesthetic to be administered, anatomic landmarks, approach and technique, block contraindications and side effects, and helpful technical tips. In addition, this reference is linked to an interactive Web site that provides access to the entire content of the book online, including a fully searchable and downloadable image bank. This provides the purchaser with ready remote access to the material when a hard copy of the text is not immediately available.

Beyond the sections describing single-shot and continuous peripheral nerve block techniques, there are chapters dedicated to nerve mapping techniques and the performance of ultrasound guided regional anesthetic techniques, which have become more widely used over the past decade. Both of these modalities are noninvasive and can facilitate nerve localization before needle insertion. The nerve mapping chapter includes a good discussion of the physical principles involved in nerve stimulation such as electrical pulse frequency, current amplitude, electrical pulse duration, and tissue electrical impedance, which play important roles in nerve mapping and localization. Likewise, the section on ultrasonography for peripheral nerve block guidance includes a good description of how various tissue properties may influence the quality of the images, as well as how different types of tissue (such as nerves and vessels) may be distinguished from one another when using ultrasound. Each chapter dedicated to the performance of a specific ultrasound-guided block includes images of anatomic cross sections paired with ultrasound images for anatomic reference. The comprehensive section on pediatric peripheral nerve blocks also includes a discussion on the use of nerve mapping and ultrasound techniques in children, and fully describes the use of single-shot and continuous nerve block techniques in this patient population.

The last section of the book is dedicated to pain blocks. This section is relatively brief but covers some common procedures performed in a pain management clinic setting, such as various sympathetic blocks, facet injections, occipital nerve blocks, trigger point injections, and sacroiliac joint injections. It includes information on the use of fluoroscopic guidance as well as drugs used for neurolytic procedures. As with the sections on peripheral nerve block techniques, the injection descriptions are accompanied by a brief description of technique-specific considerations such as patient positioning, needle selection, medications used, anatomic landmarks, approach, potential complications, and tips for block performance. This format provides a quick overview of the procedure and can be used as a ready reference for review before performance of a specific block technique.

Dr. Chelly has provided a useful and updated reference for the performance of regional anesthetic techniques. The book is well designed and the format makes it easy for the reader to quickly review the techniques described while still providing comprehensive information about each block. It includes a large volume of figures, tables, and photographic images which enhance the content and usefulness of the book. It is a welcomed addition to the available regional anesthesia literature.

University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.