By James R. Hebl, M.D., Robert L. Lennon, D.O., Editors, Adam K. Jacob, M.D., Hugh M. Smith, M.D., Ph.D., Associate Editors, John V. Hagen, Illustrator. New York, Oxford University Press, 2010. Pages: 488. Price: $125.00.

The application of ultrasonography to obtain real-time visualization of nerves, vessels, needles, and spread of local anesthetic has recently challenged the traditional methods of performing peripheral nerve blocks (PNB) and has prompted numerous studies to compare their efficiency, efficacy, and safety. Regardless of the method employed, a solid foundation of neuroanatomy is a prerequisite for regional anesthesia. Successful placement of an ultrasound-guided PNB also requires an understanding of ultrasound equipment, principles of sound wave propagation, and scanning techniques to correlate relevant anatomy to its corresponding sonoanatomy. Because of the relatively rapid and recent introduction of ultrasound to regional anesthesia, few currently available textbooks focus on ultrasound-guided nerve-block techniques. The Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade  is a refreshing book that truly lives up to its name as an atlas and provides a concise, informative review of ultrasound-guided regional anesthesia.

The purpose of this book is to be a practical guide to regional anesthesia for residents and practicing anesthesiologists, an overview of ultrasound-guided regional anesthesia, and a review of fundamental principles of ultrasound-guided PNB. The section on ultrasound-guided regional anesthesia consists of three chapters dedicated entirely to the principles of ultrasonography and the application of ultrasound to regional anesthesia, including clear explanations of sound wave propagation and tissue densities, probe selection, and image optimization with changes in frequency, depth, gain, and probe movements (sliding, angling, rotating, tilting, and pressure). These chapters also describe the advantages and disadvantages of in-plane and out-of-plane approaches; use of hydrodissection to avoid nerve trauma from needle contact; employment of color Doppler ultrasound for detecting fluid movement during injection; and common errors, particularly intraneural and intravascular injection. Each chapter in the section on upper extremity and peripheral nerve-block techniques consists of a brief summary of clinical indications for each nerve block; a review of pertinent anatomy; recommendations on patient positioning; description of nerve stimulation technique; and an in-depth explanation of ultrasound-guided techniques, including an evaluation of in-plane and out-of-plane approaches. Each chapter in this section concludes with a discussion of side effects and potential complications. When applicable, the technique of continuous peripheral nerve catheters is also outlined. These focused and succinct explanations, combined with ample images, enable the reader to quickly gain an understanding of basic ultrasound principles and become familiar with various ultrasound-guided techniques.

The use of ultrasonography requires correct interpretation of ultrasound images, and this book, aptly titled an atlas, strikes a perfect balance between text and illustration. The study of sonoanatomy is greatly facilitated by detailed and enlarged anatomical illustrations that are juxtaposed with their corresponding ultrasound images on the same page, allowing readers to easily correlate vessels, tendon, muscle, fascia, bone, and nerve. Drawings of patient positioning, probe orientation, and needle introduction also serve as a guide for readers to improve ultrasound image visualization and ergonomics, especially for those new to ultrasound-guided techniques. In addition, the inclusion of nerve stimulation techniques, with supplemental illustrations of relevant anatomy and surface landmarks, can be helpful for those who choose to employ both nerve stimulation and ultrasound-guided techniques.

One of the exciting aspects of ultrasound-guided regional anesthesia is the potential for new applications and techniques. With the time lapse inherent in the creation and publication of a textbook, it is unlikely that a single book can keep up with the rapid progress of ultrasound application to regional anesthesia. This book does not include descriptions of all potential ultrasound-guided PNB techniques (e.g. , paravertebral and posterior lumbar plexus blocks), but, although it is not a comprehensive review, it accomplishes its purpose to provide the necessary groundwork for ultrasound-guided PNB. As novel ultrasound-guided PNB techniques are developed, the challenge remains for the clinician to stay informed of the latest innovations.

Although many questions about ultrasound-guided regional anesthesia techniques remain, the application of ultrasonography has revolutionized the practice of regional anesthesia in a relatively short time and is here to stay. The Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade  effectively summarizes the available ultrasound-guided PNB techniques to date and makes a timely entrance as an excellent resource for residents and clinicians. Indeed, the common adage, “a picture is worth a thousand words,” applies seamlessly to this atlas.

Veterans Affairs Palo Alto Health Care System, Regional Anesthesia and Perioperative Analgesia Service, Palo Alto, California.