Book Review

Pain Relief and Anesthesia in Obstetrics

N Engl J Med 1996; 335:1930December 19, 1996

Article

Pain Relief and Anesthesia in Obstetrics
Edited by André Van Zundert and Gerard W. Ostheimer. 1062 pp., illustrated. New York, Churchill Livingstone, 1996. $120. ISBN: 0-443-04474-0

This book is a collection of papers dealing with obstetrical anesthesia. It will appeal primarily to anesthesiologists. The material is heavily weighted toward the management of labor pain with regional anesthesia and the management of cesarean section. Practitioners may find the sections dealing with spinal and epidural administration of opioids particularly helpful. Other chapters discuss the anatomy and physiology of pain associated with childbirth, the pharmacology of opioids and local anesthetic agents, techniques and complications of regional anesthesia, and anesthetic management in high-risk obstetrical patients. The book also contains sections on the organization and administration of an obstetrical anesthesia service and common ethical problems. There is little or no information, however, on techniques of pain management suitable for use by obstetricians — for example, local anesthesia for cesarean section, nerve blocks suitable for vaginal delivery, and parenteral narcotics for labor. Also, there is little discussion of psychological methods of pain control: childbirth-education classes, techniques of natural childbirth, and the role of birth partners, or doulas, as they are sometimes called. For many patients, these methods are important. Anesthesiologists should understand them, as should obstetricians and nurses.

The quality of the chapters varies. Some are excellent; others are skimpy or out of date. Some chapters have almost one full page of references for every two pages of text; other chapters have very few references. There is considerable repetition. Despite a long introductory chapter on the history of obstetrical anesthesia, for example, individual sections contain similar material. Discussions of maternal physiology, placental transfer, and fetal monitoring appear in several places. Other important subjects are virtually ignored. Material on fetal blood gases is sparse, despite the medical and legal impact of these measurements on practice.

I was often puzzled by the organization of the book. Why are spinal headaches discussed in the section on alternatives to epidural anesthesia? Why are caudal blocks considered separately from other epidural techniques? In several sections, the editors include a “USA View” along with a view from some other country, presumably to provide diverse perspectives. I am not confident, however, that the writers' views represent the practice in their respective countries. Moreover, the authors often do not discuss the same issues, even though they are addressing the same topic.

This book contains useful material, but it is hard to find. Had the book been better planned and organized, it would have been considerably smaller, less expensive, and easier to use.

Donald Caton, M.D.
University of Florida, Gainesville, FL 32610