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Epidural Anaesthesia. Images, problems and solutionsC. CollierHodder Arnold, 2012 ISBN 978-1-444-15604-1, 152 pp., Price £49.99

It is apparent from as early as the foreword that this book represents the author’s lifetime’s work and passion. It builds on his 1998 publication on epidurography, a specialist field limited to few other investigators; the paucity of other such available imaging is indeed what makes this book unique. It incorporates images taken over 30 years, from 178 (mostly obstetric) cases, and aims to demonstrate why epidurals sometimes fail. This aim, I believe, it successfully achieves, and it has certainly proved a fascinating eye-opener. Where the book fails to deliver, however, is the declaration that it “will enable you to refine your technique and avoid adverse outcomes in practice”.

Most of the 10 chapters follow a similar layout with an introduction, a selection of labelled epidurograms with corresponding case histories and clinical information, a brief conclusion and references. The early chapters deal with the rationale for investigating epidural blocks, the technique of epidurography and the typical epidurogram. The remaining chapters are devoted to complicated and failed blocks, looking at a myriad of operator, equipment and patient factors. Chapter 5 is perhaps the most illuminating, as it incorporates not only a variety of striking epidurograms, but also detailed discussion and evidence on the anatomy of the sub- and intradural spaces, complete with clear illustrations, scanning electron microscopy (SEM) and 3D images.

The style of writing is easy to follow; however, duplicate descriptions of the images occur frequently in the main text and the captions. Terminology that may be unfamiliar to the reader is explained well and the intricacies and idiosyncrasies of epidural anaesthesia are truly brought home. The case histories are very detailed and not always fully pertinent, yet they help to make the dry subject matter more digestible. Also, certain local anaesthetics and concentrations described are no longer routinely used, reducing current relevance.

The epidurograms, photographs, diagrams and SEM images, many in colour, are generally of good quality and well labelled, though numbering the thoracic and lumbar vertebrae would have helped. Unfortunately, the images and corresponding text are often on different pages, though this is somewhat offset by having clear captions. Also available to the reader are supporting free web resources (http://www.hodderplus.com/epiduralanaesthesia), although the downloadable image library was not yet active. The video bank, however, containing fluoroscopic examples taken from Chapters 3-8, was easily accessible from the sidebar under ‘additional resources’. Although a few images were of poor quality, the collection remains impressive, particularly to the unfamiliar eye, and cements descriptions in the book.

The author has targeted this book at both specialist and trainee anaesthetists; however, I believe it will mostly appeal to senior trainees and consultants, who will in turn glean the most from its insightful offerings. I am not convinced epidurography should be a routine modality or that it makes mothers safer, or that this book provides solutions to circumvent future block problems, but I do agree that this is an informative and enlightening read for those anaesthetists who remain fascinated by the weird and wonderful outcomes sometimes achieved after epidural anaesthesia.