British Journal of Anaesthesia 113 (4): 723–5 (2014)
BOOK REVIEWS
Pain in Women, 1st Edn. M. L. Chin, R. B. Fillingim and T. J. Ness
(editors). Published by Oxford University Press. Pp. 335;
indexed; illustrated. Price $89.00. ISBN 978-0-19-979641-0.
Poorly managed pain can cause distress and disability, with
chronic pain affecting a greater proportion of women than
men, particularly so in some specific chronic pain conditions.
This book is aimed at any healthcare professional involved in
the management of female patients with acute or chronic pain.
A range of topics are covered in the book, with an inter-
national authorship, including many of the experts in this
field, from diverse disciplines, giving a comprehensive over-
view. The style of the book is consistent throughout, despite
the large number of authors, making it easy to follow and to
access.
The book is divided into four main sections, with from three
to eight chapters per section. While not having copious illustra-
tions, the figures and tables are clear and well laid out. Each
chapter is comprehensively referenced, with a detailed index
at the back of the book, aiding with finding relevant
information.
The first section explores the evidence for sex differences in
pain—in terms of epidemiology, pain perception, and response
to medication. While there is not a detailed analysis of some
of the underlying neurobiological differences in pain and
nociceptive processing, the chapter on neuroimaging explores
anatomical and functional differences at a cortical level and
discusses how neuroimaging techniques may be used to
improve our understanding of sex differences in pain
perception.
The second section explores the bi-psychosocial aspects of
pain perception and how these are impacted by sex differ-
ences. Several fascinating topics are covered including the
role of genetics; how hormonal differences may impact on
pain and response to analgesics; and the importance of
psychosocial factors, where the need for further good quality
studies of differences in response to non-pharmacological
interventions is highlighted.
The third section of the book is longer, with each chapter
focusing on pain syndromes or conditions that only affect
women. These include pregnancy-related issues such as pain
in labour, pain in pregnancy, and also more specifically in
women who have pre-existing tolerance to opioids. Other
areas that are addressed include pelvic pain and vulvodynia,
an area where there is a need for a specialized approach to
improve management. Treatment of cancer-related pain
from breast and gynaecological malignancy is also covered,
again an area where pain control can be challenging.
The final section of the book is dedicated to chronic pain
syndromes that are not exclusive to women, but where there
is a high prevalence in women. These include conditions
such as fibromyalgia and complex regional pain syndrome,
& The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
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including a section on mechanisms and potential treatment
approaches.
In summary, this new publication will provide a valuable
reference source for specialists, non-specialists, and trainees.
It covers many of the topics in some depth, but its clear
layout and style contribute to a book that is very accessible,
even for non-specialists. It will be straightforward to use as a
reference source for particular topics, with a detailed index
making it easy to find the relevant information when required.
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This is an area of importance, where there are not a large
number of textbooks, and this book should prove a welcome
addition to the current literature.
L. A. Colvin
Edinburgh, UK
E-mail: lesley.colvin@ed.ac.uk
doi:10.1093/bja/aeu328
The Anaesthetic Crisis Manual. D. C. Borshoff (editor). Published
by Cambridge University Press. Pp. 60. Price $59.00. ISBN-
13 978-0521279864.
It was probably more than 30 yr ago, after the manuscript by
J. B. Cooper on Preventable Anesthesia Mishaps was published,
that a new perspective on training in anaesthesia to minimize
human error started. In 1994, the book Crisis Management in
Anesthesiology by D. M. Gaba and colleagues marked another
milestone in this new approach to teaching and learning in an-
aesthesiology that has extended to almost all clinical training
in medicine. Since then several publications on crisis manage-
ment, the use of simulation in residency programmes or the
introduction of cognitive aids and other tools have changed
the way our speciality is taught.
The Anaesthetic Crisis Manual by D. C. Borshoff is the latest
incorporation to this line and it comes intended to be a real
aid in the everyday work of anaesthesiologists. The general
perspective of the book, as stated in the prologue, is that ‘it has
been designed to be used as a cognitive aid but not a substitute
for clinical acumen’ with a full clinically oriented approach.
The manual reviews a total of 22 critical events. They are
grouped in four sections: cardiovascular, respiratory, obstetric,
and miscellaneous. Examples of events are ‘Haemolytic Trans-
fusion Reaction’, ‘Can’t intubate Can’t ventilate’, ‘Post-Partum
Haemorraghe’, or ‘Malignant Hyperthermia’ to cite just a
representative of each section.
In facing critical events, there is not much time for discus-
sion but rather they require immediate action. The format in
which the book has been published agrees with this view. It is
ready to hang from the anaesthesia workstation, handy, easy
to open, colour coded (each section has its own colour to be dif-
ferentiated and easy located), and with big font size to allow for
BJA
easy reading and understanding. Around 10 steps to go are
presented for every critical event. The steps will guide the
clinician when diagnosis is already done.
The crisis prevention section includes a 15-point machine
check, adverse parameters checklist, and diagnostic pathways
to help rapid diagnosis on deteriorating events. The diagnostic
pathways are specially helpful when there is a real evidence
that something is not going well, but the source of the
problem has not been clearly identified yet. As a summary,
the ‘10 Tchecklist’ is a help to guide clinicians in orienting diag-
nosis and initially manage the crisis when diagnosis has not
been established.
Crisis prevention is also addressed in a specific chapter and
it is advisable to use routinely to make sure that prevention
checking has been done before starting any anaesthetic pro-
cedure. This section contains the description of 11 events.
Crisis aftermath is also addressed and a way to manage and
take the positive from it is well explained.
The format is great. It has a ring for hanging the book close to
the anaesthesia workstation. Last but not least, a blank page for
notes and a list of the Local and Hospital Emergency Phone
Numbers to be filled by the anaesthesiologist is also available.
The Manual has been endorsed and supported by the
European Society of Anaesthesiology (ESA), supported by the
Australian Society of Anaesthetists (ASA), and highly com-
mended by the BMA Medical Book Awards 2012.
Summarizing, this is not a textbook, not even a book as
we understand it. The Anesthetic Crisis Manual must be consid-
ered an aid, a piece of fast use information that will help us
when anaesthetic crisis shows up, to orient the kind of crisis
and act accordingly for the benefit of the patient. It should
not be kept in our pockets or on bookshelves but rather
hanging very visible and handy in any anaesthesia workstation
in or out of the operating theatre.
P. L. Gambús
Barcelona, Spain
E-mail: plgambus@clinic.ub.es
doi:10.1093/bja/aeu325
Comprehensive Atlas of Ultrasound-Guided Pain Management
Injection Techniques. S. D. Waldman (editor). Published by
Wolters Kluwer. Pp. 1224. Price £160.00. ISBN 9781451186703.
The first impression on looking at the sheer volume of the book
was—could we do so many interventions under ultrasound
guidance (USG)? Being a Pain Consultant, I do a substantial
amount of interventions under image guidance (X-ray). I was
very intrigued to read and understand how some of these
could be done using USG. This will have implications in the
longer term for interventionists as they could reduce the
amount of radiation exposure.
The book is very illustrative with more than 1750 very good
quality pictures. This is aimed at interventions from the head
to foot used by pain interventionists, musculoskeletal/sports
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Book reviews
medicine, and radiologists. It has got exactly the same struc-
ture for each chapter with headings of clinical perspectives,
relevant anatomy, ultrasound-guided technique, complica-
tions, clinical pearls, and suggested further reading.
Dr Waldman has yet again shown that a big, illustrative book
to be used for practical purposes is possible. His initial contribu-
tion on radiological-guided procedures is a bible for most pain
interventionists. He has mentioned the people in his team,
but I would have loved to see the contributing team details in
the book.
The book is divided into the head, neck, shoulder, elbow and
forearm, wrist and hand, chest wall, trunk and abdomen, low
back, hip and pelvis, knee and lower extremity, and ankle and
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foot. Each comes with a very structured approach detailing
the indications, clinical pearls, and a clear description of the
ultrasound-guided technique. There are exactly 1779 pictures
in 170 chapters.
Every single chapter is done very well. Shoulder joint injec-
tions, for example, explain clinical symptoms and findings on
various structural pathologies and an ultrasound-guided tech-
nique to deal with this. The picture of the Neptune’s Trident and
trident sign USG picture next to it is a very good illustration
to non-USG-trained eyes. There are similar illustrations in
the book.
Dr Waldman’s previous contribution has some basics before
the chapters start. I would have loved to see a small section on
the basics of USG, with explanation on the different frequency
probes to be used. The appropriate probes have been described
in each procedure. There is a standard needle of 22 G and 3.5 in
described in chapters, even though the needles in pictures are
different. The clinician should be able to choose the ideal
needle and volume needed. Everyone might not accept a
22 G needle and volumes of 5 ml for injection in the head and
neck. Ideally, small gauge for face to reduce scarring should
be considered and the clinician should always have the skill
to see the needle under USG. The importance of relevant
anatomy and expertise in using USG has been restated in
every single chapter.
Patient selection is key as you notice in the illustrations;
most volunteers are not over-weight. I tend not to see a lot
of these patients in my clinical practice. It is prudent to select
a patient whose body habitus will allow the USG to penetrate
to the target nerve. This is especially crucial in the trunk,
abdomen, and low back procedures.
The use of particulate steroid in the head and neck is at
present controversial because of the increased risk of vascular
complications. Some interventions are very close to major
blood vessels, which supply the brain and can lead to unwanted
consequences if a vascular injection takes place. The operator
should be aware of these and take appropriate steps in choos-
ing the non-particulate steroids to minimize the risk.
Dorsal root block, lumbar sympathetic blocks under USG
should only be performed if you have an appropriate patient.
The USG might not give good indication of major vascular
structures, if the angle of scanning is not well oriented.
Even then intravascular injection will be difficult to recognize.
I will be reluctant to perform dorsal root blocks, as I do see