Reviews

“The anatomical foundation of regional anesthesia and acute pain medicine. Macroanatomy, microanatomy, sonoanatomy, functional anatomy”.

Over the last decade, ultrasound - as a tool for performing regional anesthesia and acute and chronic pain treatment - has changed everyday practice for anesthesiologists around the globe. There is a plethora of books, atlases and educative websites available that all cover certain parts of the “performance process” of these techniques. Over the years, Professor Dr. Andre P. Boezaart, editor of the abovementioned textbook, has hammered the quintessential foundation and golden rule of every regional anesthesia techniqueinto residents, trainees, fellows and colleagues: know your anatomy! If one knows where the nerve lives, knows the membranes and fascia that surround itand knows what its function is, the local anesthetic agent will be deposited in the right place and performing regional blocks will be straightforward. This mantra is mirrored in an impressive textbook that was recently released by Bentham Books and that undoubtedly will be a future landmark for everyone interested in regional anesthesia and pain medicine.

Its 389 pages comprise 23 chapters that were written by the editor and his 8 co-authors. The book starts with a well-written introduction that mirrors the editor’s respect for the groundbreaking work of pioneers and other authors that is omnipresent in the book. The chapters progressively tackle nerves above the clavicle, below the clavicle and the axilla-elbow-wrist, nerves of the anterior thigh, sciatic, ankle, the abdominal wall, the thoracic and the lumbar paravertebral space. Every “nerve” is approached following a fixed strategy where first the macroanatomy (know where the nerve lives!), next the microanatomy (know the membranes and fascia that surround it!) and finally the sonoanatomy are described. Two chapters that describe functional anatomy (know the function of the nerve!) conclude the description of the upper and lower extremity. Finally, there are two chapters on abdominal and pelvic sympathetic ganglia and the anatomy of the head and neck. All chapters are well organized, extremely thorough and well written in a clear and precise way with very few typographical errors. They follow a logical order and offer ample up-to-date references (until 2015) or further reading. Key words and a list of used abbreviations are provided for each chapter. Many chapters will be of real interest even for very experienced practitioners. Throughout the book, there is an important place for the concept of the subcircumneural (subparaneural) space and its importance in understanding secondary block failure. Therepeated introduction to the different macroanatomy sections doesn’t hinder and is necessary for understanding the philosophy of the underlying chapter. Each chapter is generously illustrated with drawings, ultrasound images, microscopic and electron microscopic pictures and anatomical dissections.The illustrations are of exquisite quality and one of the absolute pillars of this book. However, the amount of detail that is squeezed into some illustrations or the use of small font in certain illustrations that are composed of three smaller photos sometimescompel to a bit of puzzling. Other images could use additional landmarks to facilitate orientation for less experienced readers. Included in the book are links to a high number of educational videos on ultrasound imaging, anatomy and interestingly on transcutaneous nerve stimulation that show muscle contractions when specific nerves are stimulated on a painted model. Information on different loco-regional techniques or blocks is beyond the scope of this textbook.

Overall, Prof. Dr. Boezaart and his co-authors have done an exemplary work in creating thismuch-needed book that fills a long-lasting niche and offers an exhaustive and very high-quality overview for every reader of what is the foundation for accomplishing safe and effective regional blocks and acute pain medicine in our patients: anatomy, in all its aspects.

Dr. Peter Van der Putte, M.D.,
Belgium

The Anatomical Foundations of Regional Anesthesia and Acute Pain Medicine

As Dr. Boezaart noted in his preface, there are thousands of anatomy textbooks. However, this new work is unique in both its scope and depth (literally), as it covers the regional anesthesia-related anatomy from gross anatomy to ultrasound and fluoroscopic anatomy down to the electron microscopy level. The chapters are organized into neck, upper extremity and lower extremity sections, as well as neuraxial and paravertebral regions, abdominal and pelvic sympathetic systems, and abdominal wall.

Each chapter is extensively illustrated with elegant drawings, meticulous dissections, microscopic histology images, well-chosen fluoroscopic images, ultrasound images annotated brilliantly with companion drawings, and amazing electron microscope images. In addition, there are multipleillustrationsutilizing thejuxtaposition of ultrasound images, physical anatomy, and dissections to emphasize the regional anatomy.

Particularly intriguing is the liberal use of imbedded links to movies; although this reviewer did not have access to the videos themselves, they are described in the text, such as the Functional Anatomy chapters that had particular muscles and nerves painted on a model, which are used to trace the function and action of the anatomical structures.

Although it was not consistent throughout the book, the grouping of the macroanatomy, microanatomy, sonoanatomy, and functional anatomy chapters for each region (neck, axilla, elbow and wrist, anterior thigh, sciatic nerve, ankle, abdomen and pelvis) was particularly useful, allowing one chapter’s concepts to lead to the next.

I had the pleasure of working briefly with Dr. Boezaart at the University of Florida. He is a passionate teacher, and that passion is well illustrated in the depth and detail, as well as the clarity, of the information presented in this textbook.

This book will be most useful to the serious student of regional anesthesia, and it will provide the basis for future research and modifications of techniques for years to come. As an anesthesiologist trained in the days of landmark-guided injections, it is exciting to me to see the level of scholarship, advancement of techniques, and attention to anatomic detail now availablewithin this book for the improved care of our patients.

Andrea Trescott, M.D.,
USA