British Journal of Anaesthesia 111 (2): 306–8 (2013)
BOOK REVIEWS
Principles and Practice of Regional Anaesthesia, 4th Edn.
G. A. McLeod, C. J. L. McCartney, J. A. W. Wildsmith (editors).
Published by Oxford University Press. Pp. 277. Price £70.
ISBN 978-0-19-958669-1
An Austrian ophthalmologist used Erythroxylum coca as a local
anaesthetic for the eye about 130 yr ago. Anaesthetic agents
and technical aspects of regional anaesthesia have consistently
evolved since this time, and now are used in patients of all ages.
Regional anaesthesia has become increasingly important in
routine clinical anaesthesia. It is superior to opioid-based anal-
gesia to optimize perioperative pain in a lot of clinical situations.
The fourth edition of Principles and Practice of Regional An-
aesthesia, written by several international authors, provides a
broad overview of regional anaesthesia in 277 pages. Each
chapter is at least six pages in length, corroborated with key
references and numerous journal articles. The book is divided
into two major parts. Part 1 deals with the general principles
of regional anaesthesia. It provides a brief insight into the
history and development of local anaesthesia over the years.
The book recapitulates the basics of pain physiology and the
pharmacokinetics of local anaesthetics. It describes the most
common peripheral nerve location techniques and their corre-
sponding neurological complications. Finally, the management
of patients after the administration of regional anaesthesia is
addressed. Testing the block, dealing with failures, care during
surgery, and postoperative care are described.
Part 2 addresses the core of the matter, including anatomy
and techniques of regional anaesthesia. It consists of 14
comprehensive and clearly arranged chapters that deal
with a wide range of techniques, although some of them
are of decreasing popularity in the clinical setting (e.g. infil-
tration techniques for Caesarean section). Every chapter
starts with a detailed presentation of anatomy, including
the innervation of various dermatomes. These are shown in
illustrations. A list of anatomical variations would have
been useful. Lacking this information, the anaesthetist
might experience failures when performing peripheral
nerve blocks. Most of the chapters provide pictures of the
patient’s position when administering regional anaesthesia.
The favoured anatomical target is marked on the patient’s
skin. This would certainly help the less-experienced
anaesthetist to achieve successful needle alignment and in-
sertion. One of the strengths of the book is that every sub-
chapter addresses early and late complications, such as
accidental puncture of the dural space during epidural an-
aesthesia or toxic reaction after application of local anaes-
thetic drugs. The authors provide useful data about further
management once the complication has been identified.
Peripheral nerve blocks are used in the clinical setting
because they are safe, effective, and associated with few
airway or cardiovascular side-effects. Based on recent advances
& The Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
For Permissions, please email: journals.permissions@oup.com
in ultrasound technology, regional anaesthesia has become
safer. The quantity of injected local anaesthetic has also been
reduced. We believe that 30 ml of local anaesthetic, such as
that used for an interscalene block, is no longer appropriate.
Ultrasound images of anatomical structures have been provided
in every chapter, but just a few of these show the insertion of the
needle and its proper position.
The book covers also neuraxial and obstetric regional anaes-
thesia. These chapters are detailed and also mention important
Downloaded from https://academic.oup.com/bja/article/111/2/306/254723 by guest on 03 November 2023
conditions in obstetric anaesthesia care (such as aorto-caval
occlusion, fluid therapy, or the narrow epidural space in preg-
nant women).
As regional anaesthesia is being used increasingly in the
paediatric setting, the authors provide a good overview of
peripheral and central techniques in this patient population.
They address potential differences in the neurobiology of
pain in children, especially neonates. However, the main path-
ways of pain and principles of local anaesthetic pharmacology
are much the same. The recommended dose of local anaes-
thetic does not take the various additional anaesthetic regi-
mens for children into account (such as general anaesthesia
or just sedation), which may be associated with different quan-
tities or concentrations of local agents. Last but not least, tech-
niques for day-care surgery are mentioned as an upcoming and
challenging field of anaesthesia.
In summary, Principles and Practice of Regional Anaesthesia
provides a broad and well-arranged overview of basic knowl-
edge and different techniques of regional anaesthesia, al-
though anatomical variants of peripheral nerve anatomy in
lacking. It also reflects the styles of the various international
authors, which may differ from country to country. Neverthe-
less, the book is a useful teaching aid for trainees and con-
sultants in any clinical setting.
M. Keplinger*
P. Marhofer
Vienna, Austria
*E-mail: maya.keplinger@meduniwien.ac.at
doi:10.1093/bja/aet241
The Perioperative Medicine Consult Handbook. C. J. Wong,
N. J. Hamlin (editors). Published by Springer, New York, 2013.
Pp. 283. Price £26.00. ISBN 978-1-4614-3219-7.
We really wanted to like this book. If surgery is a disease, a pre-
meditated trauma that challenges the host’s physiological
defence response, then anaesthetists are perioperative phy-
sicians, uniquely placed to use a range of interventions to
improve patient outcomes. Unfortunately, this book does not
touch on that message. It is written largely by American physi-
cians for the benefit of American physicians involved in the