Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Block

An obvious question that arises with the publication of the new Mayo Clinic Atlas is, “Do we need another textbook of regional anesthesia?” The answer obviously depends on the goal of the text, and these authors have chosen a highly desirable target, especially in the view of the escalating role of ultrasound guidance in performing peripheral nerve blocks. Although there have been several “definitive” textbooks on regional anesthesia, as well as ultrasound manuals and practical guides published recently, these authors have attempted to fulfill the need for a book designed to be “a practical guide for residents in training and clinicians, but not intended to be a comprehensive or exhaustive review.” The secondary goal of these authors was to provide an overview of ultrasound-guided regional anesthesia in this rapidly changing and expanding field. This textbook offers a significant contribution to fill the existing gap in regional anesthesia using ultrasound technology, while still supporting the traditional techniques. The strong points of the book are the generous use of full-color anatomical illustrations, including visual descriptions of expected nerve stimulation responses and the practical visualizations of provider–patient positioning. The juxtapositions of anatomical drawings with the ultrasound images in each of the practical chapters are particularly valuable to the novice practitioner. This technique enhances the reader's understanding of ultrasound techniques, while emphasizing the importance of having a thorough knowledge of the anatomy. The basic introductory sections on neuroanatomy and ultrasound technology are also helpful for the beginner. There is inevitable repetition of text and illustrations in the subsequent practical chapters, but this only serves to enhance the learning experience. The practical sections cover all of the peripheral nerve block techniques that would be of use to the resident-in-training or the practitioner with limited or no experience with ultrasound techniques. The depth of the discussion of the anatomy, positioning, and techniques, as well as ultrasound alternatives and complications, is appropriate for “the beginner.” Although there is certainly room for a more “in-depth” discussion of these topics, this was clearly not the authors' primary objective in writing this text. There are some shortcomings for a textbook of “regional anesthesia” (e.g., no discussion of spinal or epidural techniques). There are also the inevitable limitations of a multiauthored textbook despite the use of authors from the same anesthesia department. This text is the ultimate culmination of Denise Wedel's “recreation” of regional anesthesia at the Mayo Clinic (as mentioned in the foreword), and the consistency of both style and approach is evident in each of the chapters. This also creates a potential limitation in that the preferences reflect primarily the Mayo Clinic perspective. For example, in the chapter on “History,” the authors describe the Mayo brothers' adventures with regional anesthesia before Halsted's, who was actually the first to experiment with regional anesthesia in the United States. Likewise, the chapter on local anesthetics does not mention the shorter-acting drug 2-chloroprocaine. There are other minor issues (e.g., the use of the ultrasound approach to obturator and paravertebral block are slighted). Despite the illustration of the sensory distribution of the medial antebrachial cutaneous nerve on the ulnar side of the forearm, the role of blockade of this nerve is not discussed. In the end, however, these authors have achieved their goals in writing this textbook. They have produced a very readable introductory text that includes abundant illustrations of classical anatomy, block techniques, and new ultrasound techniques. Although there are other books and manuals with ultrasound blocks, the rapid changes occurring in this subspecialty make this publication a useful addition to the library of residents and anesthesia practitioners who are just now beginning to explore this new technology. Although the size and weight of this book do not make it easily portable to the operating room, beginners in the field of ultrasound-directed regional anesthesia will find it to be a very helpful approach to performing peripheral nerve blocks. Michael F. Mulroy, MD Virginia Mason Medical Center Seattle, WA [email protected]