Spinal Interventions in Pain Management

British Journal of Anaesthesia 109 (4): 652–4 (2012) BOOK REVIEWS Hadzic’s Peripheral Nerve Blocks and Anatomy for UltrasoundGuided Regional Anaesthesia, 2nd Edn. A. Hadzic (editor). Published by McGraw Hill Medical, New York, USA. Pp. 704; indexed; illustrated. Price £116.99. ISBN 007-1-54961-7/ 978-0-07154961-5. S. Munirama Dundee, UK E-mail: [email protected] doi:10.1093/bja/aes316 Spinal Interventions in Pain Management. K. Simpson, G. Baranidharan and S. Gupta (editors). Published by Oxford University Press, Oxford, UK. Pp. 269; indexed; illustrated. Price £37.99. ISBN 978-0-19-958691-2. This is part of the Oxford Specialist Handbook series and is indeed a handbook and is compact. It has a water-resistant cover and two bookmarks. The book contains descriptions of spinal interventions. The editors have outlined their remit clearly in the preface. They assume a level of understanding and education in the readers and, as they say, it is not a book about theory or evidence for different interventions, but merely a description of techniques. It is designed to be a practical handbook about applied anatomy, selection of patients, and performance of procedures. It runs to 270 pages in 14 compact chapters. Each chapter has multiple authors, a total of 29 in all, there is a variety of content and style, but nonetheless, there has been a firm editorial hand. Throughout the book are ‘clinical pearls of wisdom’, which are the distilled wisdom of the contributors and adds a personal touch to the book. Some of the contributors to the book are established authorities, while others are trainees writing under supervision. The book makes an effort to provide guidance on clinical decision-making and the authors rely on guidance from a variety of authoritative bodies. & The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected] Downloaded from https://academic.oup.com/bja/article/109/4/652/237758 by guest on 15 September 2022 This is the second edition of a text first published in 2004 by Admir Hadzic, well known as the inspiration behind the New York School of Regional Anesthesia. The book is divided into eight sections. Section 1—the foundations of peripheral nerve blocks— comprehensively covering the basic principles of regional anaesthesia in 10 chapters. Of note, separate chapters are dedicated not only to the pharmacological principles underlying the regional anaesthesia but also to the fundamentals of everyday aspects of modern clinical practice. For example, inclusion of a separate chapter (Chapter 4) describing the neurophysiology of electrical nerve stimulation is welcome. It recognizes that nerve stimulation still has a role within regional anaesthesia, as not all nerves are visible and access to ultrasound technology may be limited. Monitoring and documentation (Chapter 5) brings all modalities together, including pressure monitoring, as a helpful flow chart designed to help prevent intraneural injection. Chapter 8 is a short but informative chapter providing a summary of the guidelines on anticoagulants and neuraxial blocks. Table 8-1 is particularly helpful in rationalizing the use of commonly used anticoagulants and the new Xa inhibitors (fondaparinux and rivaroxaban) and thrombin inhibitors (desirudin and dabigatran). Section 2 describes all the common upper and lower limb blocks traditionally performed without ultrasound guidance. In each chapter, several photographs are provided to guide the reader and are supplemented by photographs of cadaver dissection. The strength of these chapters is the setting out of goals and the inclusion of several key tips which aid the reader in achieving these goals. Decisionmaking algorithms in each chapter are particularly helpful. Only once the reader is familiar with the fundamentals, are they introduced to ultrasound-guided regional anaesthesia. Section 4, Foundations of ultrasound-guided nerve blocks, has two chapters describing the physics of ultrasound and a short, but important, chapter on how to optimize the ultrasound image. The description of ultrasound-guided regional blocks, Section 5, uses photographs showing the placement of an ultrasound probe over a cross-sectional anatomical specimen. These photographs are particularly useful as the anatomical relationship between nerves, blood vessels, muscle, and ultrasound probe can be readily seen. Ultrasound scans are clear. The authors have endeavoured to match B-mode images with cross-sectional images. Ultrasound of neuraxial and perineuraxial structures may be exacting, even to the expert regional anaesthetist. Section 6 presents several B-mode images of the spine matched to reconstructed CT slices. However, more directly applicable to real-time regional anaesthesia is paravertebral block (Chapter 45). The increasing attention being given to the association between plasma levels of local anaesthetic and longer remission of cancer gives added importance to the teaching of this very effective but vastly underutilized block. Section 7—an atlas of ultrasound-guided anatomy—is particularly good. For each block, a photograph of transducer position, an unlabelled B-mode image, a labelled B-mode image, and an anatomical cross-section is provided. The new edition builds on the success of the first edition. It does so, not by providing an atlas of ultrasound-guided regional block, but by emphasizing the fundamental principles on which regional anaesthesia is based. Ultrasound can only be applied once these fundamentals are known and practiced, and the overall tone of the book reflects that. The author states that where best practice was not known, anatomy was emphasized, rather than recommend a block. We wholeheartedly recommend this book. BJA Book Reviews S. Dolin Chichester, UK E-mail: [email protected] doi:10.1093/bja/aes317 Best Practices in Infection Prevention and Control: An International Perspective, 2nd Edn. B. M. Soule, Z. A. Memish and P. N. Malani (editors). Published by Joint Commissioning Resources, IL, USA. Pp. 183. Price £67.50; US$ 85.00. ISBN 978-1-55940-619-0. This is the second edition of this book and is a project supported by the Society of Healthcare Epidemiology of America (SHEA) and the Joint Commission international (JCI) and is designed to ‘provide practical strategies for creating a learning and performance environment for health care-associated infection (HAI) prevention that is centred on patient care’. It takes a worldwide perspective with contributions from all continents and includes hospital-acquired infections, epidemics, and pandemics and even bioterrorism. What this book does well is bringing together the institutional processes from various sources which might provide strategy for managing outbreaks and crises. What it is less good at is providing scientific evidence to justify recommendations. Providers of healthcare, whether at an institutional or national level, are understandably very worried about infection. The approach in recent years has therefore been to institute processes and governance structures for the management of HAIs through the development of infection control professionals and teams. These teams are multidisciplinary and although may differ in structure around the world, they may be given great resource and influence. Each time there is an event, locally or nationally, a series of procedures, precautions, and rules are introduced to overcome the problem. When done well, they can be very successful and real reductions in HAIs can be observed. A good example of this has been in the management of central venous catheters where bundles of care have been reproducibly shown to decrease the risk of serious bacteraemia. The difficulty, however, is that it is impossible to tease out of these systems what is important or indeed vital for success and what is superfluous effort and expense. Of course, it can be argued that so long as it works, does understanding what works matter? In these days of austerity, perhaps this will matter more than it did before. Some actions do not need any further justification, for example, hand washing, this was shown to be important so long ago it is difficult to see how anyone can justify not including this is in their routine management of every patient, nevertheless, 100% adherence to hand washing is still to be achieved. Other actions may appear logical and obvious, but may not be so. An illustration of this may be cohorting patients in one part of a ward with, for example, methicillin-resistant Staphylococcus aureus (MRSA). There is in fact very little evidence that this is necessary for MRSA and indeed in my own institution we actually observed a decrease in cross-contamination when we stopped cohorting all patients with MRSA in one part of our intensive care unit. Of course, this is not proof against cohorting patients and indeed for highly infectious diseases, isolation and cohorting may be entirely logical and necessary, but if the literature is reviewed, there is little proof that it is important for some HAIs. Cohorting is often justified but always in the context of an infection control bundle and it has not been tested as a single measure, although this would be difficult to achieve. The book is full of examples where individual measures are included on the assumption that they are proven necessities and infection control teams will insist on them as proven necessities. I had hoped the book would discuss some of the individual measures in detail but it kept to systems and strategies. It 653 Downloaded from https://academic.oup.com/bja/article/109/4/652/237758 by guest on 15 September 2022 The book is well illustrated with X-rays and line drawings. The line drawings have stood the reduction in the size of the book to a handbook very well, but the radiographs and magnetic resonance images have been less successful in terms of the reduction in size. I think in all the authors and editors may be disappointed with the final product simply because the quality of the imaging, especially in terms of radiographs, is often poor. It is often hard to tell what the reduced images are supposed to show. This is a shame because this book is essentially sound and full of useful information, but suffers from the reduction in size to a handbook. There are previous ‘how to do it’ books of clinical procedures and I am afraid the reduction in size here makes this book less successful. In addition, the text does suffer on occasion from efforts to reduce the length of the text. While the editors have stated quite clearly that their intention is to have this as a ‘how to do it’ book and not to talk about evidence, ultimately this is a difficult path to tread and I am not sure if it is successful. That evidence-based medicine has undoubtedly become the cornerstone of modern medical practice is without question and the days of removing evidence of effectiveness altogether from a book on interventional techniques are probably over. There are, however, snippets of evidence within the text, the chapter on vertebroplasty and kyphoplasty, for example, contains specific details of two clinical trials in New England Journal of Medicine in 2009, which are topical, but nonetheless there are other randomized controlled trials which have not been mentioned. Under most procedures covered, there are headings on indications and complications. In my opinion, evidence of effectiveness and complication are two sides of the same coin, as this is what we discuss with patients when we obtain consent, for example. I am not convinced that evidence of effectiveness needed to be excluded simply on the grounds of brevity, and indeed a brief précis of evidence on each technique could have worked well in this setting. I think that this book would be useful to trainees, but would benefit from having more and larger pages to provide better descriptions and certainly better radiographic images of techniques. This topic does not lend itself easily to the handbook style.