Complications of Regional Anaesthesia

B. T. Finucane (Ed.) Churchill Livingstone, 1999. £35.00. 340 pp. It has been a real pleasure to review this book on the complications of regional anaesthesia. The editor has assembled a group of authors of international repute and has produced an authoritative yet very readable reference work. The resurgence of interest in regional anaesthesia has produced many benefits for patients but, inevitably, as its use has increased so has the risk of complications – mostly minor but on rare occasions, major and permanent disability. The risk in writing a book solely about complications is that it might distort the balance of benefit and risk and discourage the reader from using regional anaesthesia. However, the editor has skilfully maintained a sense of proportion with this in-depth review, balancing it well against the overall value of regional anaesthesia. Chapter 1 is an overview of safe practice looking at pre-operative assessment, the side-effects of regional anaesthesia, equipment issues and some psychological aspects of safety, and it offers some sensible guidelines to safe practice. Chapter 2 is a synopsis of the benefits of regional anaesthesia on outcome from surgery and then follows a systematic review of complications in a series of chapters based on specific techniques, clinical subspecialties (obstetric, paediatric, acute and chronic pain) and problems (local anaesthetic toxicity, infection and neurological damage). Every chapter is worth reading, although the value of each chapter will be determined to an extent by the particular interests of the reader. The ophthalmic chapter should be compulsory reading for all anaesthetists engaged in this field and the chapter on brachial plexus complications, written by the editor, is outstanding. Some chapters go further than just reviewing complications; the chapter on paravertebral, intercostal and interpleural blocks not only covers the complications (which are few) but is also a useful tutorial on how to perform these under-utilised techniques. The review of obstetric complications is excellent and with such a high proportion of these patients having a regional technique, the authors rightly remind us of the numerous causes of nerve damage and other complications that are caused by the birth process itself rather than the block. As with other areas of practice, it is often easier to blame ‘the block’ than investigate the cause of the problem properly. Major, permanent nerve damage is a very rare but catastrophic complication of both general and local anaesthesia and the potential to render a patient paraplegic lurks just below the surface in many anaesthetists' minds when we make decisions about the use of central neural blockade. The chapter on major neurological injury is only nine pages long but it distils out all the essential information on this issue and is one of the highlights of the book. In combination with the chapter that follows on the evaluation of neurological injury, it provides a valuable source of knowledge and guidance on this area of major concern. The book is well produced, with a clear layout, good indexing and comprehensive references, although some of the most up to date literature is not included. The line drawings are concise and helpful, complementing the text well. There are a number of MRI images, which are well reproduced and add greatly to the chapter on evaluating nerve damage. Much of the information contained in this book is already available in other published literature although often fragmented and difficult to find; the real strength of this book is that it concentrates a wealth of data into one practical, informative and readable resource which is without equal in its field. At £35 it is a bargain – buy it for yourself and your department.