James C. Eisenach, M.D., Editor

Regional Anesthesia: An Illustrated Procedural Guide, Second Edition. By Michael F. Mulroy. Boston, Little Brown and Company, 1995. Pages: 327. Price:$69.95.

This practical manual represents the experience of regional anesthesia as it is practiced at the renowned Virginia Mason Medical Center. The text is spiral bound for easy handling and reference in the operating suite. The first five chapters of the manual provide background information essential to the safe performance of regional anesthetic techniques. Physical properties and clinical characteristics of local anesthetic solutions, including EMLA[registered sign] and ropivacaine, provide clinically relevant information on the selection of dose, concentration, and volume of local anesthetic solution and on the use of additives such as vasoconstrictors and opioids. Complications of regional anesthesia, premedication and monitoring, and equipment are also discussed in this section.

The next section is organized into chapters describing specific regional anesthetic techniques of the neuraxis, thorax and abdomen, upper and lower extremities, and the head and neck. Each chapter reviews the relevant anatomy, indications, drug selection, and a detailed description of the technique. The many figures and illustrations guide the reader through the procedure. Considerations and complications unique to the regional technique are also included. The last chapters are clinical applications of the regional anesthesia subspecialties of pediatrics, obstetrics, and acute and chronic pain management. The chapter on pediatric regional anesthesia, written by Linda Jo Rice and Lynn Broadman, emphasizes the differences between pediatric and adult regional anesthesia and provides practical information on peripheral and central neural blocks commonly performed in children. The chapter on obstetrics contains current information on labor analgesia with opioids and combined spinal epidural anesthesia. The final two chapters on management of acute and chronic pain syndromes and postoperative analgesia represent new topics only superficially included in the first edition. Management of common pain problems, including herpes zoster, back pain, and reflex sympathetic dystrophy, are discussed briefly. The chapter on postoperative analgesia is especially useful to those who only sometimes manage postoperative epidural infusions. Guidelines for selection and dosing of a local anesthetic or opioid solution in patients receiving epidural analgesia and management of complications are included.

This handbook is a clinically oriented guide designed for residents or new practitioners of regional anesthesia. It is not a reference text. The reader is encouraged by the author to consult the anatomic atlases, definitive texts, and original articles included in the references at the end of each chapter.

This is an excellent manual for those new to the art of regional anesthesia. The text and illustrations provide a step-by-step description of block techniques and are easily referenced in the operating suite. This manual promises to be a “hands on” favorite and is a key addition to every departmental library.

Terese T. Horlocker, M.D.

Associate Professor; Department of Anesthesiology; Mayo Clinic; Rochester, Minnesota 55905