As the field of regional anesthesiology continues to grow, so too does the need for a comprehensive text that emphasizes both the fundamental and technical knowledge behind peripheral nerve blockade. In the past, the practicing clinician would rely on his or her (likely limited) training or the experience of a colleague to perform a regional nerve block.

In 2006, the New York School of Regional Anesthesia (NYSORA) gave us Amir Hadzic’s first book on regional anesthesia, Textbook of Regional Anesthesia and Acute Pain Management, and, subsequently, the immensely popular and informative website, Included in this text was regional anesthesia’s first color description of landmark-based peripheral nerve blocks along with a detailed depiction of technique, anatomy, and theory.

Hadzic’s Peripheral Nerve Blocks and Anatomy for Ultrasound-guided Regional Anesthesia, Second Edition, improves upon the first edition by including description of ultrasound-based peripheral nerve blockade. This is achieved largely by adding sections on ultrasound physics, ultrasound-guided peripheral and neuraxial blocks, and a 158-page atlas of ultrasound-guided anatomy near the end of the book. Also, and perhaps more significantly, the second edition is considerably smaller than the first (about 500 fewer pages), which allows for both portability and affordability (the first edition sold for $259).

The text is organized into eight sections, with the principal sections still being the units on landmark- and ultrasound-based nerve blocks. The introductory section, “Foundations of Peripheral Nerve Blocks,” is informative and concise. While many authors with different writing styles contribute to various chapters in this section, the text is well organized and flows logically. The authors make good use of the many color pictures and tables, and great care seems to have been taken to simplify figures and cartoons to make them clear and comprehensible. For example, table 6-3 in the chapter “Foundations of Peripheral Nerve Blocks” illustrates the exact (pre-, intra-, and post-) anesthetic course for a variety of surgical procedures. This type of detail is extremely useful for providers without much experience in regional anesthesia. The sonoanatomy in both the ultrasound technique and atlas sections is consistently quality images, with excellent and clear identification of needle and anatomy, making it easy for the operator to navigate these structures. The atlas is printed in such a manner that the pictures of the probe placement (on live models), ultrasound image, and cadaveric slice can be visualized at one time, minimizing the need to turn the page for each block.

Also included in the book is a DVD detailing videos of the five commonly performed peripheral nerve blocks (interscalene, supraclavicular, axillary, femoral, and popliteal). The videos present a combined ultrasound- and nerve-stimulator-guided technique for the blocks. The videos are well made; they include high-quality video and audio, are well edited and well narrated, and display the entire process of the block, including preparation, scanning, needle placement, and complications. The videos should work on any DVD player, as well as on both PC and Mac.

I have only two minor criticisms of the text. The first is the separation of the sections on ultrasound-guided blocks from those on surface-based blocks may make it somewhat confusing for a provider referencing the text for the first time. For example, an interscalene block is depicted fully in two sections of the book, once on page 149 and again on page 353. Although I understand the need to include different pictures and descriptions, consolidating the information in one section would have made it easier for the provider to locate the information quickly. Nonetheless, I think this difficulty is easily overcome with some familiarity with the book. The second very minor critique is the loss of many interesting chapters from the first edition, such as those on acute pain management, regional anesthesia in specific patient populations, statistics, and regional anesthesia education. While I understand the need to cut this relatively low yield text, I believe it was a nice example of how our relatively small field has grown in such a short period of time.

Overall, I believe Hadzic’s Peripheral Nerve Blocks achieves its goals of providing us with a text that “minimizes presentation of theoretical considerations” and is “gleaned directly from the trenches of the clinical practice of regional anesthesia,” as mentioned in the preface of this new edition. Its use of color pictures and text, along with its clear, concise description of surface and ultrasound anatomy makes it an excellent reference for both novice and experienced regionalists alike. It is an excellent illustration of regional anesthesiology and should be a part of every anesthesia department library today.