Book Reviews Neural Blockade in Clinical Anesthesia and Management of Pain, 2nd Edition, edited by MI. Cousins and P.O. Bridenbaugh, Lippincott, Philadelphia, PA, 1987, 1145 pp., Price U.S. $120.00, ISBN 0-397-50562-O.
This excellently produced and edited book is a major advance on the first edition published in 1980. There are 24 new contributors in the total of 41 authors of the 36 chapters. In part 1 on the pharmacology and physiology of neural blockade every chapter has been substantially rewritten because there have been marked advances. In addition, there is a new and striking chapter by Kehlet on the ‘Modification of responses to surgery by neural blockade: clinical implications,’ which examines the long-term advantages of neural blockade over general anesthesia in relation to metabolic and endocrine consequences of surgery and of tissue damage. In part 2, on techniques of neural blockade each of the 17 chapters has been revised. They discuss the various forms and locations of blockade and of neurolytic techniques. Part 3 on neural blockade in the management of pain, contains the most extensive change since this is the area which is most rapidly expanding. There are 11 new chapters and even the one from the first edition has been enlarged. Part 3 discusses not only the treatment of acute but also of chronic pain and the use of blocks for diagnosis. The mechanisms by which they act are discussed by Yaksh and the psychology by Melzack. Beyond local anaesthetics the use of neurolytic agents, steroids and narcotics are covered in detail. A chapter by Tasker reasonably also discusses stimulation which, although not strictly a blockade, uses the same skills and techniques which have been developed for block. In such an outstanding book characterised by careful scholarly writing, excellent tables and quite remarkable illustrations, it is difficult for a citric 0304-3959/89/$03.50
0 1989 Elsevier Science Publishers
to be critical. Perhaps the only comment I can make relates more to the subject of pain rather than to this book. Throughout the many chapters, pain is treated as the consequence of a single mechanism. The simple fact that an analgesic dose of morphine does not produce pin-prick analgesia nor does it influence chronic pain after nerve or root damage, immediately tells one that there are at least 3 mechanisms. The fact that nerves communicate both by way of nerve impulses and by way of chemical transport is not mentioned, nor is it discussed that the common local anaesthetics block transport as well as nerve impulses. The nature of the sequential appearance of different pain mechanisms is only now appearing in basic studies and in a reinterpretation of clinical studies. Part of the future undoubtedly depends on a recognition and exploitation of these newer views on the plasticity of the nervous system which offer not only fundamentally new ways of treating pain but opens up the possibility of prevention. This means happily that there will eventually have to be a third and subsequent editions but in the meantime the authors and editors can be very proud of their splendid book.
Dept. of Anatomy
Patrick D. Wall and Developmental Biology, University College London, London WClE 6BT (U.K.)
Handbook of Cancer Pain Management, edited by D.E. Weissman et al., Wisconsin Cancer Pain Initiative, 1300 University Ave., Madison, WI 53706, 1988, 38 pp., Price U.S. $3.50. This excellent little booklet will fit easily into any pocket, takes half an hour to read from cover to cover, and should have widespread influence in the management of cancer pain outside specialist
units. The booklet emanates from the Wisconsin Cancer Pain Initiative and it describes the principles of effective pain control in cancer. The style is necessarily didactic and the recommendations are clear, practical and generally sound and are based on the WHO 3-step ‘analgesic ladder.’ This is a cookbook approach but exactly what is required by inexperienced house officers, general practitioners and nurses and indeed by more experienced non-specialist practitioners. It is small and cheap enough to be widely disseminated and I would give it away to every graduating physician. The handbook is orientated to the U.S.A. market, but with some minor modifications would be very widely applicable around the world. Abbreviations such as ‘D5W’ and ‘sq’ are unintelligible to non-Americans; tradenames such as Percoet (p. 16) must also be changed or defined. I would have one or two suggestions for the next edition. The paragraph on respiratory depression (p. 11) gives too much emphasis to a problem that does not occur except in exceptional circumstances. Controlled release morphine could be given more emphasis early on (p. 6); nausea (p. 10) is not invariable: 30-508 of patients taking oral morphine will never experience this side effect; sedation (p. 10) is a common problem as an initiation side-effect but invariably gets better within a few days; radiotherapy schedules (p. 4) particularly for palliation of bone pain are generally much shorter (e.g., one fraction) than the 5-15 days described. It would be also helpful to include a paragraph on changing from oral to parenteral analgesia emphasising the appropriate dose adjustment since this is a manoeuvre which frequently causes problems. Continuous subcutaneous infusions (frequently used in practice) would be better discussed separately from continuous i.v. infusion (rarely indicated) in Appendix 3. This was a very good idea and has been very well executed. I hope the handbook becomes as widely used as it deserves. G.W. Hanks The Royal Marsden Hospital, London S W3 6JJ (U.K.)
The Encyclopedia of Sports Medicine. Volume 1. The Olympic Book of Sports Medicine, edited by A. Dirix, H.G. Knuttgen and K. Tittel, Blackwell Scientific Publications, Oxford, 1988, Price E39.50.
This large (690 pages) and lavishly produced book, from the International Olympic Committee, is aimed at those involved in all aspects of sports and exercise. The stated purpose is to provide a general reference work which is apparently to be followed by a series of more specialised volumes. The international composition of the IOC is reflected by the nationality of the authors who originate from virtually every continent, the majority coming from Europe - both east and west. The scope of this book is very extensive and includes basic physiology and physiological measurements. The role of exercise in both health and disease is an obvious inclusion; in the former group there are separate chapters discussing exercise and training with respect to children, women and the aging individual. The treatment and prevention of exercise-related injuries occupies about half the total volume. It is perhaps inevitable that a book which aims to cover such a wide subject area cannot deal with each in any depth. Having said that, there is great variation in the depth, and also the quantity of references cited, between the chapters. This variation seems to be of a rather haphazard nature rather than reflecting the importance of the subject matter, e.g., anthropometry is given 30 pages while the effects and control of heat and cold stress are given less than 6 pages each. Readers of this journal, in particular, will be surprised to learn that the subject of pain receives virtually no attention. In view of the high incidence of pain both during and after sporting events, this seems a strange omission. Virtually the only mention of pain management comes under the heading ‘narcotics analgesia’ in the section on doping. The overall impression is that this publication