James C. Eisenach, M.D., Editor

Regional Anesthesia: An Atlas of Anatomy and Techniques, by M. B. Hahn, P. M. McQuillan, and G. J. Sheplock. St. Louis, Mosby-Year Book, 1996. Pages: 311. Price: $135.00.

We are all well aware of the increasing role that computers play in our daily functioning in both clinical and academic capacities. However, it is rare that we witness a novel use of the computer that is so well suited to enhancing an aspect of medical education. Such is definitely the case with Regional Anesthesia: An Atlas of Anatomy and Techniques, which incorporates the highest quality of computer-generated handiwork.

This atlas is well organized, and is divided into 8 "parts" and 41 short chapters. It is nicely indexed and fairly well, but inconsistently, referenced. After the introductory two parts on Pharmacology and Guidelines for Regional Anesthetic Techniques, respectively, the remaining six parts focus on anatomy and approaches to blockade of regions of the body that are commonly anesthetized.

Chapters are written by 26 anesthesiologists, pain practitioners, and anatomists, 24 from the United States, 1 from Mexico, and 1 from Canada. Most of the authors are well recognized, and many are experts in the field. The editors' intent is to offer a three-dimensional understanding of applied human anatomy in a succinct format. The relevant anatomy is then stressed in each individual author's approach to the fairly complete repertoire of regional anesthetic techniques covered in the text. Anatomy for regional neural blockade of the head and neck, upper extremities, lower extremities, and sympathetic nervous system are then covered, followed by discussions of spinal, epidural, and caudal anesthesia. Perhaps the best is saved for last. In part 8, anatomy and approaches to neural blockade of multiple axial nerves are presented with detailed, computer-enhanced illustrations.

Overall, the clear strength and distinguishing characteristic of this atlas is the quality of the unique, clear, relevant computer-based illustrations by George Sheplock. Chapters are uniformly well-illustrated, but content varies according to the individual authors. Some chapters are more updated in terms of relevant literature than others, which appear as mere repetitions of standard regional anesthesia texts. Sections on brachial plexus anatomy and techniques are strongly presented, as are those on sympathetic nervous system, lower extremity, and spinal/epidural/caudal anatomy and techniques. The chapters covering individual peripheral nerve blocks incorporate photographs of surface anatomy with computer imaging of the underlying anatomic structure. These successfully convey a true "feel" for relevant surface landmarks. For example, the illustration of the interscalene brachial plexus and that of the femoral nerve anatomic relations allow one to achieve an instant understanding that otherwise takes much clinical experience to acquire. Also shown is where and how to place the needle-so often neglected in textbooks of regional anesthesia. The final chapters illustrate blocks of peripheral nerves seldom done by the most experienced clinician.

Overall, the text is somewhat too long. The atlas would be more effective if the illustrations and technique descriptions were accented by succinct anatomy, technique, and approach descriptions. To this end, the initial section on pharmacology is unoriginal, lengthy, and appears out of place.

Despite these few criticisms, this atlas would be a very useful and user-friendly addition to the library of any clinician who performs or desires to learn regional anesthetic techniques. Even a professional can benefit from a quick review of the excellent illustrations of peripheral nerve blocks.

William F. Urmey, M.D., Medical Director, Ambulatory Surgery Unit, Assistant Professor of Clinical Anesthesiology, Hospital for Special Surgery, 535 East 70th St, New York, New York 10021.