Complications of Regional Anesthesia and Pain Medicine. Edited by Joseph M. Neal, M.D., and James P. Rathmell, M.D. Philadelphia, Saunders Elsevier, 2007. Pages: 400. Price: $105.00.
We are all aware of the increasing roles of regional anesthesia and pain medicine in today’s patient care. This book, edited by Drs. Neal and Rathmell, draws on the current literature—from large randomized trials to case reports—to identify, discuss, and quantify (when possible) complications in these two subspecialties. Its editors and their internationally known 42 coauthors discuss in-depth these complications from the common to the uncommon and from the minor to the catastrophic.
This 35-chapter book, with over one-third of its references published between 2000 and 2006, is divided into three sections: Regional Anesthesia (16 chapters); Pain Medicine (16 chapters); and Medicolegal Perspective (3 chapters). The Regional Anesthesia chapters cover the often discussed complications such as bleeding, infection, and nerve injury, as well as the less-recognized complications such as myotoxicity. The chapters in the Pain Medicine section focus on complications from specific treatments and procedures such as chronic steroid therapy, epidural injections, radio-frequency treatment, and spinal cord stimulator placement. The last section covers medicolegal issues that can arise from complications, treatment, and nontreatment. Specifically, it discusses the results of closed claims analyses, the legal issues of opioid therapy, and informed consent documentation.
One shortfall of this book is that it lacks an in-depth discussion of ultrasound guidance and its potential impact on complications. In fact, the index does not contain the word “ultrasound” or its synonyms. We found only two sentences in the entire book that briefly discussed the use of ultrasound guidance. Granted, before 2007, few “large” studies specifically addressed how ultrasound-guided techniques affect complications. However, given its increased use in the last decade, this area deserved greater discussion. Finally, regional anesthesia and pain medicine overlap in terms of interventions, tools, and complications, resulting in some redundancies between chapters. However, with a few exceptions, the redundancies are small and the reader is quickly referred to an appropriate chapter for greater detail.
Each chapter in the first section has a similar outline, helping to ensure that the topics are presented consistently and that specific subtopics can be found quickly. This is less true in the second section, but enough so that the flow of reading from chapter to chapter is rather similar. All the chapters range between 6 and 18 pages. The authors make good use of “white space” and headings of varying font sizes to create a clean, easy-to-read layout. In addition, there is ample use of boxes, tables, illustrations, and images, all in a surprisingly esthetic monochromatic gray. They summarize key points, display anatomy, and illustrate techniques. However, there is a tendency in most chapters to exhaustively relist information in the text that is already nicely presented in boxes and tables.
The editors dedicated the book to patients, trainees, and colleagues, as well as their families. Did the editors accomplish their goal to produce a text that will benefit all? Yes, the editors clearly achieved their goals. The book is the right size for its content, breadth and scope. Any greater detail would likely lose an audience of professionals.
On the whole, this book is well written, well organized, nicely illustrated, and, most importantly, informative. Every anesthesiology department should have a copy; regional anesthesiology experts and pain physicians should have one as well!
*University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. herlicha@upmc.edu
