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Orthopaedic Anesthesia

Our goal is to provide safe and effective pain relief for our community. We are committed to using the latest in ultrasound and imaging technology to achieve this end. Through non-opioid based regional techniques, our primary objectives are to optimize patient satisfaction, minimize morbidity, and improve perioperative efficiency.

Patient Care

There has been tremendous activity over the past two years in our orthopedic and regional anesthesia program. We have expanded our regional anesthesia services to cover the brand new and state of the art ambulatory surgery center and our block volumes have increased to approximately 250 per month.

We currently staff the service with one fellow, two residents, three RNs, and a staff anesthesiologist. We have five fully monitored and equipped procedure bays to facilitate our expanding case numbers. We offer ultrasound-guided pain relieving procedures for a wide variety of orthopedic, plastics, vascular, and general surgical patients. We have aggressively expanded our peripheral nerve block repertoire to include ambulatory perineural catheters, ultrasound guided TAP blocks, and ultrasound-guided paravertebral blocks. Our regional anesthesia fellowship is entering its sixth year with competitive candidates applying from many outstanding institutions in a wide array of countries.

Education

Anesthesiology residents continue to graduate in the 100th percentile for regional anesthesia cases performed. During their rotation on the service, residents have no official operating room responsibilities. Instead, they focus on the science and art of regional anesthesia. As part of the month long rotation, each resident participates in an academic pursuit. These projects have ranged from database analyses to randomized and controlled trials.

Research

Our research activities center on the utilization of ultrasound to facilitate and improve the performance of regional anesthesia. Current areas of active investigation include but are not limited to:

  • The evaluation of ultrasound in facilitating the placement of epidural and spinal anesthesia;
  • The ultrasound identification of safe and effective injection locations for peripheral nerve blocks;
  • Defining the competencies involved in ultrasound guided regional anesthesia;
  • Categorizing ultrasound artifacts associated with regional anesthesia;
  • Novel approaches to the ankle block;
  • Peripheral nerve tumor imaging with high frequency ultrasound;
  • Development of ultrasound transducer stabilizing devices;
  • Development of training software and videos;
  • Development of new intrathecal catheters;
  • Maintenance and evaluation of a prospective regional anesthesia database which currently has over 12,000 patients;
  • Identifying the reasons for nerve block cancellations;
  • Improving the perioperative efficiency of total knee arthroplasty;
  • Identifying quality-compromising behaviors associated with neuraxial anesthesia.

Current areas of excitement include the design and construction of a fluoroscopy based approach to the placement of pre-operative epidurals. We anticipate that continuous neuraxial anesthetic procedures will eventually all be placed under modern imaging modalities. In addition, we are proud to now offer a unique consult service designed to facilitate the efficacy and safety of peripheral nerve surgery. On the request of our nerve surgeons, patients undergoing peripheral nerve surgery have the preoperative placement of an ultrasound guided wire localization of the surgical lesion. This procedure, analogous to a breast lesion wire localization, is performed by our regional block team and is designed to facilitate the intraoperative dissection. Such a unique and innovative service is the result of the creative, collegial, and profession relationship that exists between our surgical colleagues and the anesthesia department.

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