Publications
APS Bulletin • Volume 10, Number 4, July/August 2000
Resource Reviews
John D. Loeser, MD, Department Editor
Pain Management and Regional Anesthesia in Trauma
Reviewed by W. Thomas Edwards, PhD MD
A.D. Rosenberg, C.M. Grande, & R.L. Bernstein, Eds. Saunders, London, 2000, 436 pages, $120 (hardcover), ISBN 0-7020-2285-3
Occasionally a book comes along that the need for has been sensed but unfulfilled for a long time. Many of us who practice pain management for trauma patients have longed for a collection of current information and clinical wisdom in one reference to which we could refer trainees. This book fills that need admirably.
The book’s strongest feature is its organization into four sections: Basics: Interface of Trauma and Pain, Location-Based Pain Management: Concepts and Considerations, Perioperative Pain Management in Trauma: Techniques and Applications, and Pain Management for Specific Trauma Patient Populations and Injured Organ Systems.
Although this organization leads to considerable repetition of material by the multiple authors, it allows complex clinical problems to be considered in a unified way through different perspectives. These perspectives are frequently illustrated with case examples, making this an interesting and useful teaching aid. So, for instance, it is possible to reference information on the use of ketamine in the prehospital (field) setting, and to encounter it again with a different point of view in the section on treatment of procedural pain in burn patients. Although this kind of duplication of information takes place throughout the book, it allows each distinct clinical problem to be considered individually and relatively completely without having to plow through the entire book.
Several excellent points stand out. The general introduction contains the most concise summary of injury scoring systems I have seen in one place. The summary table on treatment approaches applicable to the emergency department (Table 7-3) is concise and extremely useful for residents. The material on the use of bispectral analysis (BIS) monitoring in the intensive care unit is well presented for what it teaches and for what the authors admit we do not understand about BIS in this setting. The chapters on orthopedic injuries and thoracic/abdominal injuries are particularly well written. The case studies are excellent.
The book is not without flaws. It is a presentation of the International Anesthesia and Critical Care Society, but only 10 of the 53 authors are not from the United States. Several of the authors continue to use the term narcotics rather than opioids. The issue of how important is the platelet count in determining suitability for regional analgesic techniques following trauma is not addressed anywhere, perhaps a reflection of the failure of experts to agree on this subject.
This is a book that approaches a set of difficult clinical problems and, on the whole, handles them well. The editors are to be congratulated for an innovative organization that contributes admirably to the teaching value of this book. I am glad to add this text to my library, where I am sure it will see much use.
W. Thomas Edwards is associate professor of anesthesiology at the University of Washington in Seattle.