Interventional Pain Management: Image-Guided Procedures, 2nd ed. Edited by P. Prithvi Raj, M.D., Leland Lou, M.D., Serdar Erdine, M.D., Peter S. Staats, M.D., Steven D. Waldman, M.D., Gabor Racz, M.D., Michael Hammer, M.D., David Niv, M.D., Ricardo Ruiz-Lopez, M.D., and James E. Heavner, D.V.M., Ph.D. Philadelphia, Saunders Elsevier, 2008. Pages: 623. Price: $119.00.

Dr. Raj has assembled an outstanding group of 35 internationally known authors to compose this in-depth revised edition of Radiographic Imaging for Regional Anesthesia and Pain Management  that had its premiere publication in 2002.

The second edition expands on interventional pain management while continuing to focus on regional anesthesia. This publication not only targets clinical and academic anesthesiologists, but it is also directed at interventionalists from various other specialties who perform interventional pain procedures.

This text is divided into 7 sections, comprising 37 chapters in 623 pages. It commences with general topics such as Imaging Techniques and Drugs Used. These are followed by five sections that narrow in on interventional injection techniques that literally range from head to toe. The final sections include new chapters such as Advanced Techniques and Emerging Techniques (e.g. , Cranial Stimulation and Percutaneous Therapeutic Procedures for Disc Lesions). Included with this expansive work is a DVD with educational video demonstrations of hypogastric plexus, as well as lumbar sympathetic and splanchnic nerve blocks.

My initial impression upon opening and surveying this book was the presence of an ample amount of very practical, relevant, and instructional black-and-white images about anatomy, C-arm positioning, injection techniques and equipment. Among the most helpful of these images are valuable x-rays about abnormal dye spread.

The editors comprise a group of outstanding physicians who have contributed significantly to the subspecialty of interventional pain medicine. The chapter on radiofrequency ablation (RFA) is an example of the talented lineup in this text. Maarten van Kleef, M.D., Ph.D., (Professor and Chairman, Department of Anesthesia and Pain Management, University Hospital Maastricht, Maastricht, The Netherlands) Menno Sluijter, M.D., Ph.D., (Consultant, Institue for Anesthesia and Pain, Swiss Paraplegic Center, Nottwil, Switzerland) and Jan Van Zundert, M.D., Ph.D., (Professor Emeritus, Department of Anesthesiology and Pain Management, University Hospital Maastricht, Maastricht, The Netherlands; and Department of Anesthesiology and Multidisciplinary Pain Center, Ziekenhuis Oost-Lumbirg, Genk, Belgium), all of whom have been prominent contributors to RFA literature for years, collaborated on this chapter. The result is that this section has an interesting overview of the history of RFA, an informative review of the modality, and theories regarding continuous and pulsed RFA. In addition, there is information about radio frequency generators, as well as support for clinical decision-making (e.g. , practical considerations, indications, and contraindications).

This didactic text is complemented by an abundance of instructional images that are selected with care and relevance to the teaching of the interventional procedure. All chapters are structured, with complete references and plentiful illustration and images, in the same manner as the RFA chapter. Moreover, all of the well-researched topics in the book are thoroughly referenced.

The chapter about lumbar spinal neuraxial procedures has excellent descriptions of transforaminal and selective nerve root blocks. The anatomy is well explained, including an image about the anterior medullary artery in relationship to the neuroforamen and several demonstrations of the “safe triangle.” The reader can see multiple pictures with appropriate and incorrect needle positioning as demonstrated by intradiscal, intravascular, and subdural dye spread. The C-arm positioning and injections are described using a step-by-step approach.

In general, all the topics in Interventional Pain Management  are meticulously researched and explained. Beyond this, an additional strength of this clinical text is the use of highly relevant anatomy and diagnostic images. The informative images of correct and incorrect dye spread alone merit the purchase and review of this text. The interventional procedures are all explained in sound and competent instructional detail, so that clinicians can readily integrate this information into practice. The fluoroscopic, magnetic resonance, and computed tomographic images coalesce well with the graphic anatomical drawings that create highly effective renderings of the proper positioning and performance of injections. The historical review of the evolvement of interventional pain management that is touched on in this work is both interesting and fascinating for any practitioner in this field. Each chapter of this text can sufficiently stand alone as an individual academic work, but together as a collection, the result is that Interventional Pain Management  is a landmark clinical instructional textbook.

If you are looking for a quick overview of the topic of interventional pain medicine, this is not your book. This text is not to be thumbed through; to give the subject matter its due attention, the reader needs to commit to this study project. At times the authors delve deeper into a particular topic than I feel is necessary. Some of the graphics and images appear to be somewhat dated and could have benefitted from a color presentation.

In general, the DVD was disappointing, as it offers relatively poor-quality depictions of only three procedures: a hypogastric plexus block, a lumbar sympathetic block, and a splanchnic nerve block. Not only are these procedures not among the most frequently performed, the video footage appears old, the transitions are often too rapid to follow, and in some sections, the visual and audio tracks are not precisely synchronized.

Overall, I believe that Interventional Pain Management  is an excellent resource for any pain interventionalist in training and practice. There are a few books that allow a better last-minute review, but this text is the most comprehensive. I immensely value this extensive collection and believe it is a living piece of medical history.

The University of Iowa, Iowa City, Iowa.