Atlas of Regional Anesthesia, Second Edition. By David L. Brown, M.D. Philadelphia, WB Saunders Company, 1999. Pages: 376. Price:$125.00.

The second edition of this comprehensive regional anesthesia atlas has been updated and expanded. Dr. Brown has achieved his goal of using clear, simple images to describe the three-dimensional anatomy and approach needed to successfully perform a variety of nerve blocks. The use of color, magnetic resonance imaging, and cross-sectional anatomy with trademark “pane-of-glass” views make the art work very effective, and the shading and clarity of many of the diagrams have been enhanced in this edition. The atlas is organized first by regional anatomy, and then each block is described by perspective (indications, patient selection, drug choice), placement (anatomy, position, problems), and pearls (tips from the author's experience.) As in the first edition, one often has to flip pages to find figures referenced in the text, but this is a result of the number of large figures relative to text.

The chapters on brachial plexus block are thorough and well-illustrated, and this is clearly (and not surprisingly) today's best reference for infraclavicular and “plumb-bob” supraclavicular approaches. A bit more detail regarding needle angle to skin and recommended volumes of local anesthetic would be helpful.

Lower extremity peripheral blockade is gaining popularity, and the chapters regarding femoral, lateral femoral cutaneous, obturator, and sciatic block are beautifully illustrated and detailed. The sections about lumbar plexus and popliteal block need expansion, however. Injection of air before psoas block is outdated, and the fascia iliaca block goes unmentioned. The lateral approach to popliteal block and sciatic block at the level of the ischial tuberosity would be useful additions.

The chapters regarding head and neck, airway, and somatic and sympathetic blocks of the trunk are excellent and essentially unchanged in this edition. Although concern for local anesthetic toxicity is mentioned frequently, recommended maximum dosages for various blocks are not.

New chapters in the second edition include infraclavicular, facet, sacroiliac, and superior hypogastric block, with the last three added for particular benefit to clinicians in pain management. The epidural section is substantially expanded, with superb detail of thoracic and cervical approaches.

There is further updating with the mention of continuous peripheral blockade (brachial plexus and femoral) and the question of subarachnoid lidocaine “neurotoxicity.” The author's bias against single-shot perivascular techniques is apparent, and some would take umbrage (again) at the statement that those who recommend the use of nerve stimulators do more to impede than to advance regional anesthesia. Those criticisms aside, I recommend this atlas to residents and experienced clinicians who consider regional anesthesia to be a significant part of their practice. The price is average at $125, and the improvements make this edition even more valuable than the first to help make regional anesthesia “work.”