Duke Anesthesiology’s Regional Division will be well-represented at the 41st Annual American Society of Regional Anesthesia and Pain Medicine Meeting (ASRA) in New Orleans this week as 14 members of their team will present 11 abstracts, host two lectures and lead four hands-on workshops (see table below). This is the largest subspecialty medical society in anesthesiology and Dr. Jeff Gadsden says he’s particularly proud of the team this year as they have pushed the boundaries on several different fronts.
“We’re systematically looking at a variety of outcomes with a view to how we can improve patient postoperative recovery and their experiences at hospitals,” says Dr. Gadsden, associate professor of Duke Anesthesiology. “The Orthopaedics, Plastics and Regional Anesthesiology Division at Duke continues to be a leader in the specialty through innovative technology and our approach to expanding the field, and I hope that conference delegates come away with an impression of Duke Regional as a trail-blazer.”
Dr. Gadsden will be co-presenting an abstract that he’s particularly excited about, titled “Anesthetic technique and hypotension during hip fracture repair: a retrospective study of 2,916 patients.” He and six of his colleagues will present research that looked at different types of anesthetics used for hip fracture surgery, a very common operation. Their findings reveal an association between general anesthesia and the incidence of hypotension during surgery.
“We have galvanized one another this year, specifically because we just really get along and like each other,” says Dr. Alicia Warlick, assistant professor of Duke Anesthesiology. “We love to teach and help patients and we all love regional. And, I think that shows in the efforts we’re putting forth in research, patient care, clinical duties and education.”
Among the team’s 11 upcoming conference presentations, there is one that is sure to get ASRA colleagues talking this year. Dr. Warlick and Dr. Michael Shaughnessy are co-authors of the presentation, “Implementation and evaluation of the medical proficiency training at Duke University Medical Center: the Anesthesiology and Regional Anesthesia rotation with 18 Delta medics.” This rotation takes medics through a curriculum Dr. Warlick developed including airway management, pharmacology (specifically medicine that is used and carried by these medics in the field) and their specific area of regional analgesia and maintenance to provide medical care in the field for prolonged extraction times.
When Dr. Warlick arrived to Duke five years ago, she says she didn’t see any military affiliation present at Duke University Hospital and immediately thought this would be a great place for medics to gain some knowledge. As the wife of a deployed husband, and coming from a military family herself, she felt driven to find a way to give back to the community and change the way soldiers are cared for in the battlefield. “North Carolina is home to the third largest military population in the nation. I knew there were these special medics here and I felt like it was a missed opportunity and I could do something about it,” says Dr. Warlick. “I don’t think people have any idea that these medics are so specialized and provide so much care in the field.”
So, she reached out to her military connections and created an official medics training program in which she has continued to develop with Dr. Mark Shapiro from Duke’s Division of Surgery. According to Dr. Warlick, the anesthesia part of this program is the first of its kind in the nation.
“I want to shed some light on what it takes to keep these medics up to date. The U.S. Army is now dealing with a new problem where injured soldiers do not get evacuated as promptly as they did in previous conflicts,” says Dr. Warlick. “The evacuation times are now delayed, usually up to days, so the medics have to maintain their patients in different ways, and this is a new way to provide analgesia in the field for prolonged times.”
Overall, the introduction of regional anesthesia is one of the most impactful advancements for the entire specialty. Duke Anesthesiology was among the first anesthesiology departments in the nation to adopt regional anesthesia techniques such as continuous perineural catheters and ambulatory pain pumps. As Duke’s regional team heads to this year’s ASRA meeting, which kicks off on March 31, Dr. Gadsden expects conversations to turn to America’s opioid epidemic and how regional anesthesia experts are making a difference in the lives of patients.
According to Dr. Gadsden, his team of 13 faculty members is seeing a significant reduction in the amount of opioids they need to give to their patients – not an unsubstantial accomplishment in an era where there is an epidemic of opioid use and abuse within communities across the nation.
“Tens of thousands of surgical patients at high risk for opioid-related adverse events receive prescriptions for opioids both in hospitals and at home, many of which are completely unnecessary given our ability to eliminate postop pain with targeted long-lasting blocks. If I can get a patient through their entire perioperative stay with an advanced regional technique as their primary pain modality, that has potential for huge improvements in outcomes,” says Gadsden. “We are proving here at Duke to be one of the leaders in perioperative and acute pain medicine by demonstrating these benefits. If I were looking ahead in the next five years for what would be the next best thing, I wouldn’t be surprised if it came from Duke.”
View Dr. Gadsden’s op ed featured in The Herald-Sun, “Address Overlooked Starting Gate to Opioid Dependence.” And, stay tuned for more details about Dr. Warlick and her medics rotation in the 2016 edition of Duke Anesthesiology’s annual publication, BluePrint.
|1||Wrong sided-nerve block—a close encounter||Suraj Yalamuri, Jeff Gadsden||Thurs 3/31. 1:15 pm (Napoleon Room)|
|2||Failed spinal due to a lumbar seroma: would ultrasound scanning have saved the day?||Amber Franz, Jeff Gadsden||Fri 4/1. 7:40 a.m. (Exhibit Hall, Screen D)|
|3||Incidence of successful paravertebral block using landmark technique in a phantom model.||Irfan Samee, Stuart Grant, Jeff Gadsden||Fri 4/1. 3:30 pm (Napoleon Room)|
|4||Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation For Postoperative Analgesia: A Prospective Feasibility Study||Stuart Grant||Fri 4/1. 3:30 (Napoleon Room)|
|5||Case of acute EKG changes after a fascia iliaca block in an 81 year old female. Was this local anesthetic systemic toxicity?||Alicia Warlick, Siddharth Sata||Sat 4/2. 7:40 a.m. (Exhibit Hall, Screen F)|
|6||Anesthetic technique and hypotension during hip fracture repair: a retrospective study of 2916 patients.||Jeff Gadsden, D. Matt Levine, Malikah Latmore, Isabel Fernandez, Gerardo Fernandez, Daquan Xu, Siddharth Sata||Sat 4/2. 10:05 (Exhibit Hall, Screen A)|
|7||Implementation and evaluation of the medical proficiency training (MPT) at Duke University Medical Center: The Anesthesiology and Regional Anesthesia rotation with 18 Delta medics.||Alicia Warlick, Michael Shaughnessy||Sat 4/2. 10:05 (Exhibit Hall, Screen E)|
|8||Adductor canal displacement rates after total knee arthroplasty||Evan Sutton, Jeff Gadsden||Sat 4/1. 4 pm (Napoleon Room)|
|9||Percutaneous peripheral nerve stimulation for the treatment of perioperative pain during total knee arthroplasty||Stuart Grant, Brian Ilfeld, Gavin Martin, Jeff Gadsden, Michael Bolognesi, Amorn Wongsarnpigoon, Joseph Boggs||TBD|
|10||Oral opioids are superior to PCA IV opioids for ambulation following total knee arthroplasty as a component of a multimodal analgesic pathway||W. Michael Bullock, Stuart Grant, Mitchell Klement, Brian Nickel, Alexander Lampley, Gavin Martin, Thorsten Seyler, Michael Bolognesi||TBD|
|11||Adductor canal catheter improves ambulation following total knee arthroplasty compared to local infiltration analgesia with liposomal bupivacaine||W. Michael Bullock, Stuart Grant, Mitchell Klement, Brian Nickel, Alexander Lampley, Joshua Dooley, Thorsten Seyler, Michael Bolognesi||TBD|
|1||Refresher course: Peripheral nerve anatomy: from roots to peripheral nerves||Jeff Gadsden||Thurs 3/31. 8:00-9:30 (Crescent City Room)|
|2||Simulation in Anesthesia Training: What’s New?||Ankeet Udani, MD||Friday 4/1.
10:15 – 10:35 am
|1||Psoas compartment and proximal sciatic blocks||Jeff Gadsden||Thurs 3/31. 10:15-11:45|
|2||Rescue blocks of the upper extremity||Jeff Gadsden||Fri 4/1. 8:00-9:30|
|3||Psoas compartment and proximal sciatic blocks||Jeff Gadsden||Fri 4/1. 10:15-11:45|
|3||Simulation Workshop (WS-22)
Crisis Management for the Regional Anesthesiologist
High Fidely Simulation Setting
Diagnose and Manage Acute Crisis in the Setting of Regional Anesthesia
(Small Group Hands-On Practice and Discussion)
|Co-faculty: Ankeet Udani, MD||Friday 4/1
1:15 pm – 5:00 pm
|4||Simulation Workshop (WS-26)
Crisis Management for the Regional Anesthesiologist
High Fidelity Simulation Setting
Diagnose and Manage Acute Crisis in the Setting of Regional Anesthesia (Small Group Hands-on Practice and Discussion)
|Co-faculty: Ankeet Udani, MD||Sat. 4/2
8:00 am – 11:45 am