Atlas of Pain Injection Techniques. By Therese O’Connor, Steven Abram. London, England, Churchill Livingston, 2003. Pages: 141. ISBN: O44306380X. Price: $75.00.
An atlas is a book of tables, charts, and/or illustrations that deal with a specific subject. O’Connor and Abram provide such a work focusing on common injection techniques in pain medicine. They make no attempt to compete with more comprehensive atlases covering regional anesthesia, all of the interventional techniques of contemporary pain management, nor the advanced pain therapies. Rather, the major topics covered are autonomic and somatic blocks with moderate attention to epidural techniques, trigger point injections, and joint injections. The authors use a standardized format for each block with the general outline including the relevant anatomy, the necessary equipment and common drugs, the patient position, the needle puncture and technique, the clinical tips, and the potential problems. The information is generally up-to-date, succinct, and accurate. For example, there is a laudable three pages devoted to transcutaneous electrical nerve stimulation, and the mechanisms of pain are concisely presented in two pages. However, some clinicians may be disappointed that the book does not detail the indications for each block. The index is appropriate and useful. The bibliography is a short “suggested reading” list with the inclusion of some major textbooks published in the 1990s (some readers will eventually use only these textbooks after consulting them, given the abundance of ancillary information and figures). The appendices at first reading seem to add little to the body of the text, but perhaps the ones on corticosteroids, resuscitation drug doses, and dermatomes of a body figure in many positions will be valued by some readers.
The authors are to be commended for advocating the placement of IVs, the use of standard monitors for most procedures, and the ready availability of resuscitation equipment. They appropriately acknowledge in the preface that nerve blocks are but one modality of an otherwise comprehensive treatment program in the management of persistent or severe pain, debunking the old-fashioned mode of practice that stressed “the block.” The lack of color in the abundant illustrations will disappoint some when this text is compared to others, but I found them to be contributory and accurate. This exclusive use of black and white is especially noticeable in the nervous system diagrams in the autonomic blockade section. When fluoroscopy is mentioned in the text, a corresponding picture of a successful clinical circumstance is nearly always included. Suprascapular and intrabursal techniques for shoulder pain and bursitis are not included and more emphasis is given to facet joint injections than the more common median branch block (the title for which is not even included in the index). Perhaps this latter comment is explained by the predominant United Kingdom influence in the book, also evidenced in some of the language and spelling, the preference for recumbent positions during epidural placement, and the inclusion of steroids in the drug list for many blocks.
The “Potential Problems” sections demonstrate a thorough appreciation for the possible complications of the techniques, a feature especially evident in the discussion of neurolytic blocks for cancer pain management. This is a useful feature, as the precise, step-by-step descriptions of the blocks risk oversimplifying the hazards of each technique (the authors have added a “Special Circumstances” statement right at the beginning of certain block sections such as for trigeminal and stellate ganglion blocks).
In summary, this is a reasonably inclusive, elementary, and economical primer of injection techniques in pain medicine that is written in the “how-to” motif. Although not innovative, it is more convenient in size than many like books. The physician who does the occasional block will find the book a ready source of concise refresher information (down to specific instructions for performing some of the techniques as a right or left hand–dominant person). Practitioners and students of all specialties, and especially nonanesthesiologists and those early in their careers, will find this text a useful and reliable guide.