Pain management injection techniques have traditionally involved the use of fluoroscopy alone and/or landmarks. However, the use of the ultrasound has become the “new normal” while performing many of these procedures. People are finding new approaches and new injection sites for ultrasound pain management procedures every day. As an attending pain physician, I was very excited about reading a text that would add to my armamentarium of performing and teaching ultrasound-guided pain management procedures.
Comprehensive Atlas of Ultrasound-guided Pain Management Injection Techniques provides such a guide, with clear illustrations and concise, step-by-step instructions to perform pain injections at every site in the body that could possibly be injected. In the preface, Dr. Waldman provides five great reasons more pain physicians should learn the “language of ultrasound: ultrasound leads to better diagnosis because of the real time dynamic information received; ultrasound leads to better treatment in that there is often more accurate visualization of needle placement; there is no radiation involved and pain physicians can avoid this health risk; ultrasound is great for teaching because of its mobility and dynamic imaging of functional anatomy associated with the procedure; and the ultrasound equipment continues to improve with better image quality, economic efficiency, portability, and reliability.”
The book can seem overwhelming, with its 1,224 pages, but the text is organized into 10 sections and much of the text consists of images or illustrations. Each section represents a region or part of the body where pain injections are done: head, neck, shoulder, elbow/forearm, wrist/hand, chest wall/trunk/abdomen, low back, hip/pelvis, knee/lower extremity, and ankle/foot. The sections consist of short and point chapters focusing mainly on nerve and joint injections of the corresponding body region. A large portion of the text addresses upper and lower extremity injections, but all other areas are also thoroughly covered.
The chapter format is consistent throughout the book. It begins with a clinical perspective providing an overview of clinical situations that may warrant the injection. This is followed by a discussion of the clinically relevant anatomy of that area and a description of the ultrasound-guided technique, including patient and transducer positioning. Often multiple approaches are explained, along with the appropriate medication to use. The chapters are completed with a discussion of possible complications and clinical pearls to consider. At the end, there is a list of suggested readings, not to be confused with separate references for each chapter. All the figures, tables, pictures, and anatomical illustrations throughout the book are easy to read. The ultrasound images are very high grade, with optimal resolution often with Doppler added to help visualize important vascular structures. The book also has an accompanying Web site, with access to the full text and that presents many of the techniques from the chapters as videos, which is an added benefit to visualize the image dynamically.
The book succeeds on many levels. Each chapter reinforces others, yet stands on its own. However, there are some considerations for the next edition. It is assumed that the reader is already familiar with standard ultrasound technique because there is no explanation of basic principles. It is also assumed that the procedure takes place under ideal conditions because there is no detailed discussion of the limitations of techniques in difficult situations, like the size of a patient (e.g., obese), previous surgeries, or anatomical variations. Some of the more complicated injections may be somewhat oversimplified, as there is not a great discussion of real fine points or how to optimize injection techniques.
Overall, the book is a very comprehensive interventional pain management guide that Dr. Waldman has again contributed to the ever-changing specialty of pain medicine that will help further the application of ultrasound. It is relevant for physicians of multiple disciplines, including anesthesiologists, physical medicine and rehabilitation specialists, orthopedic surgeons, rheumatologists, and sports medicine physicians. It is easy to reference, even during a busy clinic. Trainees like pain fellows will also find the book very useful. All will likely use it as a reference for years to come.