By the end of this lecture, learners will be able to:
1. Discuss current problems related to perioperative pain medicine and access to regional anesthesia;
2. Identify ways to personalize pain medicine;
3. Compare currently available methods to extend nerve block duration including adjuncts and continuous peripheral nerve blocks; and
4. Identify opportunities to improve outcomes that matter to patients.
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How Does Regional Anesthesia Stay Relevant in the Future?
1. @EMARIANOMD
How Does Regional
Anesthesia Stay Relevant in
the Future?
Edward R. Mariano, M.D., M.A.S.
Professor of Anesthesiology, Perioperative & Pain Medicine
Stanford University School of Medicine
Chief, Anesthesiology and Perioperative Care
Veterans Affairs Palo Alto Health Care System
2. @EMARIANOMD
Disclosures
None financial.
Other disclosures:
– Consultant to the FDA on the current and
future practice of regional anesthesia
– Clinical subcommittee member, CMS MACRA
episode-based cost measures
– Standards review panel, TJC hospital-based
pain management
– ACGME milestones Chair for regional
anesthesiology and acute pain medicine
19. @EMARIANOMD
What Regional Anesthesia Does
Mitigates maximal pain intensity after
surgery1 and can be titratable
Decreases opioid consumption2 (maybe
less opioid-induced hyperalgesia)
Facilitates early mobility3
Avoids immobility which can produce
hyperalgesia and persistent pain4,5
1. Ilfeld BM. A&A 2011;113(4):904
2. Richman JM, et al. A&A 2006;102:248
3. Ilfeld & Mariano, et al. Pain 2010;150:477
4. Ohmichi Y, et al. Eur J Pain 2012;16:338
5. Guo TZ, et al. J Pain 2014;15:1033
22. @EMARIANOMD
Adjuvant Reliable Block
Duration >24 hrs
Epinephrine
Clonidine
Dexmedetomidine
Opioids except
buprenorphine
Buprenorphine
Dexamethasone
Based on actual studies; inspired by Dr. Patrick Wong, University of Ottawa
33. @EMARIANOMD
3 day infusion of ropivacaine vs. saline
At 12 months:
– 13% pain-induced dysfunction for ropivacaine
vs. 47% for saline (p=0.011)
– Mean BPI 1.6 ± 4.6 for ropivacaine vs. 5.9 ±
11.3 for saline (p=0.007)
Ilfeld BM, et al. Ann Surg Onc 2015;22:2017