Faculty Bibliography

Pain management in the setting of acute and subacute orthopedic trauma can be challenging. Due to the recent focus on the rising opioid epidemic, as well as the adverse side of effects of opioid pain medication, multimodal pain control has become the standard of care for management of orthopedic trauma, particularly during operative fixation. The purpose of this paper is to report on the use of regional anesthesia for surgical intervention of extremity fractures in patients who present following traumatic injury as part of a multimodal pain management protocol. Types of, indications for, and outcomes of both upper and lower extremity peripheral nerve blocks will be reviewed.
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The COVID-19 pandemic has rapidly changed the way that health care providers interact with patients, particularly through the widespread implementation of telemedicine. Previous studies in other medical specialties have examined the role of telemedicine and physician satisfaction with the modality [1], but no such studies have been reported in the field of anesthesiology. The purpose of the study was to evaluate the scope of use and satisfaction with telemedicine among anesthesiologists who were ASA and ESAIC members. We developed a survey that was sent out to anesthesia providers through the European Society of Anaesthesiology and Intensive Care (ESAIC) and the American Society of Anesthesiology (ASA). The survey was open for the duration of 30 days, after which it was closed and no new responses could be generated. The survey comprised three major sections and examined, (1) the characteristics of the anesthesia providers, (2) the settings within which they were using telemedicine, and (3) their satisfaction with the experience. We performed analyses to determine if there was a significant difference in satisfaction for those who used telemedicine prior to COVID-19 compared to those who started using it during the pandemic. There were a total of 708 responses from various provider demographics. Satisfaction with developing patient rapport was higher than satisfaction with airway and physical exam. Providers who were using telemedicine before the pandemic had consistently higher rates of satisfaction across all the subcategories. Familiarity with the software could have played a role in this result. Overall, satisfaction among users was high and the majority of practitioners, 86.3%, plan to continue using telemedicine in their practice.
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BACKGROUND:While it is assumed that neuraxial analgesia and pain management may beneficially influence perioperative hemodynamics, few studies provided data quantifying such effects and none have assessed the potential contribution of the addition of a nerve block. QUESTIONS/PURPOSES/OBJECTIVE:This clinical trial compared the visual analog scale (VAS) scores and measurement of arterial tone using augmentation index of patients who received combined spinal-epidural (CSE) only to patients who received both CSE and lumbar plexus block. METHODS:After obtaining written consent, 92 patients undergoing total hip arthroplasty were randomized to receive either CSE or CSE with lumbar plexus block (LPB). Perioperative pain and arterial tone were measured using VAS scores and augmentation index (AI) respectively, at baseline and at various times postoperatively. RESULTS:After the exclusion of 2 patients, 44 patients received CSE alone and 46 patients received CSE and LPB. Patient demographics and perioperative characteristics were similar in both groups. AI continuously decreased after placement of a CSE with or without LBP, beyond full resolution of neuraxial and peripheral blockade. Although the LPB group demonstrated a statistically significant reduction of VAS pain scores in the postanesthesia care unit (PACU; P < 0.05), overall, the addition of a LPB did not significantly reduce the AI when compared to the control group. CONCLUSION/CONCLUSIONS:The addition of a LPB provided better pain control in the PACU but did not reduce the AI, compared to the control group. We conclude that the addition of a LPB may have limited ability to affect arterial tone in the presence of a continuous infusion of epidural analgesics. In summary, the addition of a LPB in patients undergoing total hip arthroplasty is clinically effective and provided better pain control, especially in the immediate postoperative period. The continuous decrease on the AI in both groups beyond the full resolution of the neuroaxial and LPB will require further studies.