Acute Pain Management Edited by Raymond S. Sinatra, M.D., Ph.D., Oscar A. de Leon-Casasola, M.D., Brian Ginsberg, M.B., B.Ch., and Eugene R. Viscusi, M.D. Cambridge, United Kingdom, Cambridge University Press, 2009. Pages: 726.
Acute pain management has become a topic of great interest to anesthesiologists and their patients. One need look no further than the vast array of regional anesthesia products (ultrasound machines, specialized needles, etc .) available at many anesthesia conferences to see that the market and patient pressure have dictated that we become interested in pain management. Our graduating residents report that prospective employers demand and expect that they will be experts in regional anesthesia. In many cases, these residents are expected to be able to train their new colleagues and champion acute pain management practice expansion. Fortunately, there is more to acute pain management then just regional anesthesia techniques and we must be more than mere needle jockeys if we are to be true masters.
Acute Pain Management provides a blueprint for practicing anesthesiologists to establish or improve the acute pain management service provided at their institutions. The book is divided into five sections. The first section focuses on pain physiology and pharmacology. These chapters offer a good review of subjects that many practitioners have likely not pondered since medical school. Chapter two, “Pathophysiology of Acute Pain,” provides good concise reasoning and literature support for the practice of acute pain management that could be useful when broaching the subject with surgical colleagues. Chapter three, “Patient Variables Influencing Acute Pain Management,” presents interesting research that attempts to explain how patient factors influence pain perception and management. This section also discusses in a fair and balanced manner complementary therapies, including hypnosis, virtual reality, and acupuncture. The chapters on pharmacology are well written and provide a useful review of drugs that anesthesiologists use daily but may not understand thoroughly. The chapter on opioid-induced hyperalgesia would be relevant to any practitioner struggling to deal with this newly recognized problem.
The second section contains the bulk of clinically relevant information. It begins by explaining pain scales as they are the basis for evaluating all of the acute pain management interventions that we make. The section continues by discussing the roles of epidural, regional, opioid, and multimodal analgesia and their effect on patient care. Portions of this section were compelling enough to convince me to change my own practice. Chapter 17, “Regional anesthesia,” was well written, with helpful pictures and ultrasound images but, given the vastness of the topic of regional anesthesia, it would likely not function as a stand alone text.
The third section discusses “Acute Pain Management in Special Patient Populations.” This section offers a wealth of helpful information that could otherwise be gained only by having previously gone through the painful process of establishing a pain service. It offers advice about how to plan and stock a block room, as well as examples of pain assessment tools, procedure notes, and analgesic order forms. Chapter 30, “Pediatric Acute Pain Management,” is well written but presents little information describing ultrasound guided regional anesthesia techniques. The remainder of the section is dedicated to dealing with specific troubling patient populations, including sickle cell, postcaesarian, and elderly patients. The problem of treating patients on chronic opioid therapy is dealt with in a logical and compassionate manner.
The fourth and fifth sections present the perspective of some of our perioperative pain management colleagues, including surgeons, emergency department physicians, nurses, and pharmacists. It also discusses the economics, research, and future of acute pain management.
This book is comprehensive, providing both the results of published research and expert opinion. Topics ranging from the use of opioid and nonopioid analgesics to the use of interventional pain management techniques necessary for safe and effective patient care are discussed thoroughly. Just as relevant and essential are the chapters dealing with the nuts and bolts of establishing a pain service. Acute Pain Management would make a valuable addition to the library of any practicing anesthesiologist.
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. email@example.com