The second edition of Complications of Regional Anesthesia, originally published nearly a decade ago, has long been an essential title in the library of many practitioners of regional anesthesia. With many recent advances in the field, such as established protocols for local anesthetic systemic toxicity – not to mention the evolution and adoption of the nearly routine use of ultrasonography-guided regional anesthesia in many locations – this classic tome was ready for refurbishment.

In this new, third edition, the title of the textbook has been changed by addition of a subtitle: “Complications of Regional Anesthesia: Principles of Safe Practice in Local and Regional Anesthesia.” Dr. Finucane remains the editor of the text, although Dr. Tsui has been added as a co-editor. The many contributors to the book hail from all parts of the globe, with many from disciplines beyond anesthesiology, allowing the book to benefit from diverse perspectives. The number of chapters has increased from 24 to 35. Although the number of pages in the text has remained nearly the same, a change in the typeset has allowed an approximately 30% increase in its overall content.

The book begins with a brief but beautiful summary of the fascinating history of regional anesthesia and then is divided into seven broad sections. The first section is “General Considerations,” which review regional anesthesia assessment, monitoring, equipment, and systemic toxicity. It also has information on outcome studies, comparing regional with general anesthesia.

The second section is entitled “Special Considerations.” The topics covered here are diverse, ranging from chapters on anti-coagulation to infection to evaluation of neurologic injury. The chapter entitled “Evaluation of Neurologic Injury Following Regional Anesthesia” includes a detailed review of the mechanisms and roles of electrodiagnostic studies with their important diagnostic benefits and limitations. The section also includes an exceptionally good chapter on mechanical nerve injury during peripheral nerve block, which offers a systematic review that leaves no stone unturned and summarizes all of the published evidence. Although exceedingly thorough, the chapter’s authors were also able to put the available knowledge into useful summaries.

The third and fourth sections are related to specific blocks and specific patient populations, respectively. The third section has chapters related to blocks of areas of the body, such as the upper and lower extremities, abdominal wall blocks, and the neuraxis. The fourth section has chapters related to associated special patient populations, including pediatric, elderly, obese, pregnant, and chronic pain patients.

With input from a diverse range of surgeons and physicians from various disciplines, the fifth section has multiple chapters that address regional anesthesia in special environments. Topics addressed include oromaxillofacial and ophthalmological blocks, as well as considerations for safe practice and management of issues in plastic surgery and the emergency department. There is also a chapter dedicated to the practice of periarticular infiltration techniques for major joint replacement in orthopedic surgery.

The sixth section of Complications of Regional Anesthesia: Principles of Safe Practice in Local and Regional Anesthesia - Third Edition brings back a section from the prior edition with an updated review of morbidity studies with contributors from Canada, the United States, Scandinavia, Europe, and Australia. This section gives the textbook a broad international perspective, appealing to practitioners worldwide.

The final section reviews the “Medical Legal Aspects” of regional anesthesia practice. It has chapters that represent both the physician’s and legal perspectives. The chapter that represents the physician’s perspective offers recommendations for both preventing and managing legal issues related to regional anesthesia and are applicable to an international audience. The legal perspectives chapter is thoughtfully written, with representative information from the United States, Common Law countries (Canada, UK, Australia, and New Zealand), and European countries. The chapter also benefits from case-based discussions to illustrate the recommendations in the text.

Winston Churchill said that, “All men make mistakes, but only wise men learn from their mistakes.” We must always endeavour to better understand the ways that our practices, despite our best efforts to help and heal, occasionally cause injury. Complications of Regional Anesthesia: Principles of Safe Practice in Local and Regional Anesthesia - Third Edition, in this continuing series, represents a deep dive into the available knowledge regarding regional anesthesia, how it can occasionally go awry, and how this knowledge can guide our management and prevention of complications. The text is thorough, easy to read, and appropriate for anyone, from residents and fellows to the seasoned regional anesthesia practitioner. It is clearly written with a major focus on anesthesiologists, but it is suitable for practitioners from a diverse range of disciplines. The multinational authorship makes it a relevant text for readers around the world.