Reviews of Educational Material  |   November 2003
Radiographic Imaging for Regional Anesthesia and Pain Management.
Author Notes
  • Johns Hopkins University School of Medicine, Baltimore, Maryland.
Article Information
Reviews of Educational Material
Reviews of Educational Material   |   November 2003
Radiographic Imaging for Regional Anesthesia and Pain Management.
Anesthesiology 11 2003, Vol.99, 1247. doi:
Anesthesiology 11 2003, Vol.99, 1247. doi:
Radiographic Imaging for Regional Anesthesia and Pain Management. By P. Prithvi Raj, Leland Lou, Serdar Erdine, Peter S. Staats. Churchill Livingstone, New York, 2002. Pages: 335. ISBN: 0443065969. Price: $90.
Interventional management has achieved widespread popularity for the treatment of chronic pain. However, the majority of techniques used by interventional pain specialists lack rigorous scientific evidence. Principles of evidence based-medicine should be applied to interventional pain management, and the scientific community has started to make significant strides in this direction. Unfortunately, historical textbooks devoted to pain management procedures were largely descriptive in nature and failed to include sections on efficacy, safety, and long-term outcomes. Radiographic Imaging for Regional Anesthesia and Pain Management  is very different in this regard. Each chapter covers important safety concepts and concludes with a section summarizing the efficacy of the majority of procedures just described. This approach is long overdue and, certainly, refreshing.
The textbook begins with a discussion on the basic principles of radiology, radiographic equipment, radiation safety, radiographic drugs, and the physical principles of neuroablative technology. Unfortunately, some of these early chapters lack sufficient clarity, detail, and depth to satisfy the more informed reader. The textbook continues with a series of chapters dedicated to neural blockade of head and neck structures. These chapters sufficiently describe state-of-the-art approaches and are enjoyable to read. The specific chapters devoted to visceral plexus blocks and sympathetic ganglion blocks are also thorough and well written. In addition, this textbook contains chapters specifically devoted to topics that traditionally have been covered superficially in most previous texts. These topics include epiduroscopy, vertebroplasty, intradiscal electrothermy, discography, and decompressive neuroplasty. Finally, the chapters on subjects such as facet blocks, epidural injections, and nerve root blocks should be familiar to most readers and thus are rather satisfying.
As a rule, individual chapters within the text are divided into the following sections: history, anatomy, indications, contraindications, equipment, drugs, patient preparation, procedure, complications, helpful hints, and efficacy. This format allows quick identification of relevant sections for review. In addition, each chapter concludes with a list of relevant Current Procedural Terminology (CPT) codes. This may be useful for office managers, billing personnel, and clinicians who must keep current with procedural codes. Finally, the appendix includes photographs of much of the equipment required to perform the procedural care. These depictions can be useful for both patient and resident education.
The textbook itself is well constructed. The binding is secure and the pages are of appropriate thickness. The illustrations and fluoroscopic images adequately depict important concepts such as patient positioning, anatomic relationships, and needle placement. Each chapter includes several references for the interested reader. In general, these reference sections include peer-reviewed MEDLINE-indexed sources from the English literature. The print is clear and the prose is well edited and reads easily. The organization of chapters, however, is somewhat uncustomary. For example, the chapters follow the cephalad–caudad topography of the body rather than the more customary neuroanatomic organizational scheme. As such, the lumbar region is combined with the abdomen rather than the lower extremities. A navigational map placed immediately after the index illustrates the organization of the textbook.
In general, other textbooks provide much of the material covered in the current text. However, no single textbook covers the scope of information that this text offers with regard to image-guided nerve blocks. In some respect, the current text may be considered an intermediary between other texts. It offers perhaps more detailed and thorough explanations than those that are described traditionally in atlases devoted solely to nerve blocks. However, the current text does not include the excessive prose of larger tomes, such that the reader can move quickly from one topic to the next. Physicians who are familiar with the topics may appreciate the ease in which the book can be used within the usual time constraints of clinical practice. In general, the current text complements existing textbooks of pain medicine and replaces other less comprehensive efforts.
It is generally accepted that the management of pain is a multidisciplinary endeavor. As such, pain management clinicians must apply knowledge synthesized from various medical specialties. In addition, collaborative efforts are essential to elucidate complex and complete understanding. As suggested by the title, the focus of this book is on radiographic imaging for interventional pain management. Accordingly, many readers may be surprised to discover that the textbook lacks authorship from a board-certified radiologist. Finally, many pain specialists have moved away from the strict use of fluoroscopy toward computed tomographic guidance for certain pain management procedures. Radiologists have recognized the advantages of computed tomographic-guided imaging for years, and contemporary pain specialists, regardless of previous training, will need to understand how and when to use computed tomography. Nevertheless, this book will be informative and beneficial for most interventional pain medicine specialists who use fluoroscopic guidance for the majority of their invasive procedures. I would strongly recommend this textbook as a reference source for pain fellows and pain specialists alike.