In the past decade, interventional pain management has experienced tremendous growth as a result of both improvements in understanding of the pathophysiology of various pain syndromes and advancements of imaging tools to aid in diagnosis and treatment. Atlas of Image-guided Intervention in Regional Anesthesia and Pain Medicine is an excellent interventional pain management resource, depicting as it does the most common image-guided pain management procedures performed today. The book presents pain management providers with a quick, concise reference to assist in the evaluation of anatomic details of radiographic images with respect to common clinical procedures, to provide evidence-based recommendations regarding each technique, and to provide procedural steps to guide practitioners in the safest possible manner.
In its second edition, Atlas of Image-guided Intervention in Regional Anesthesia and Pain Medicine is written for clinicians, fellows, and residents involved in interventional pain management. It consists of four sections (basic techniques and radiation safety, spinal injection, sympathetic and peripheral nerve blocks, and implantable devices) presented in 240 pages divided into 16 chapters. It is specifically designed to serve as an effective comprehensive guide for some of the key principles of the most commonly performed treatment procedures for acute, chronic, and cancer-related pain.
A wonderful aspect of the second edition is a clear summary of the current evidence supporting the use of each clinical technique. For each technique, there is a chart summarizing the quality of scientific evidence and internationally accepted guidelines for grading the strength of the recommendations. This is particularly a useful way to provide pain practioners evidence to support their efficacy, which in turn improves patient care.
The chapters begin with a brief, but clear, overview of the topic to be discussed. The section is further divided into relevant anatomy and patient selection, which is often overlooked. The description of the technique contains clinical applications, adverse events, and clinical outcomes. Moreover, the description is accompanied by an illustration using simple drawings and plain x-ray images, with and without labels that illustrate the relevant anatomy, which we found to be particularly interesting and useful. The accompanying text is supported by three-dimensional computed tomography reconstruction graphics. The placement of fluoroscopic radiographs adjacent to the high-quality anatomy graphics is very useful when interpreting each radiograph. The text allows the reader to easily comprehend the systematic approach of describing the block techniques, stressing the importance of patient positioning, and identifying anatomical landmarks and needle positioning. A short list of current references is also included at the end of each chapter.
The fluoroscopic radiographs and three-dimensional computed tomography images presented in the procedure sections are at high quality and demonstrate classic findings clearly and accurately. The text also includes ultrasound techniques on procedures such as stellate ganglion and intercostal nerve blocks, which are becoming a popular choice of imaging modality of many pain practioners and are rarely found in recently published pain medicine texts. In general, the preprocedural images in each section are an excellent addition and benefit the understanding of the postprocedural radiographs therein. The abundant use of arrows and outline overlays on the images to depict relevant anatomy is also very helpful.
An added benefit is the online access, which is complimentary with the purchase of the hardcover book. It offers an online version of the book with fully searchable text and images. A minor drawback is that only one view of the image is offered and no method is provided to add notations or notes.
Overall, the variety and content of the image-guided procedures are appropriate and would be useful for physicians in training and experienced clinicians because it provides focused examination of radiologic diagnoses, procedural techniques, and expected outcomes of common image-guided procedures encountered by pain management clinicians. However, the text does not discuss many of the peripheral regional anesthesia techniques and, therefore, should be viewed as a comprehensive high-quality pain management atlas that deserves a permanent place in the reference collections of all interventional pain practices regardless of practitioner’s skill level.
