The clinical practice of regional anesthesia has evolved over time into a true medical subspecialty incorporating acute pain medicine. Advancing the science of regional anesthesiology and acute pain medicine will require identifying research priorities and meaningful outcomes. There are tremendous opportunities to develop new applications of regional anesthesiology and acute pain medicine that may improve patient experience, public health, and healthcare value.
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. Apply strategies to provide consistent high quality pain management for postsurgical patients; and
3. Identify opportunities to improve outcomes that matter to patients.
Udaipur Call Girls 📲 9999965857 Call Girl in Udaipur
How Regional Anesthesia Can Improve Outcomes that Matter
1. @EMARIANOMD
How Regional Anesthesia
Can Improve Outcomes
that Matter
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:
– FDA public workshop on regional anesthesia
– CMS quality and cost measures
– The Joint Commission hospital-based pain
management standards
– ACGME accreditation of regional
anesthesiology and acute pain medicine
– National Academy of Medicine action
collaborative countering the opioid epidemic
29. @EMARIANOMD
Role of Acute Pain Service
Hernandez-Boussard, et al. Ann Surg 2017;266:516
Postoperative pain trajectories identify populations at risk for
30-day readmissions and ED visits
30. @EMARIANOMD
Resource Utilization
>1 million patients
PNB associated with:
– Lower rates of complications
– Decrease length of stay
– Lower rates of transfusion
– Lower rate of ICU admission (THA only)
Memtsoudis SG, et al. Anesth 2013;118:1046
32. @EMARIANOMD
Death?
30-day mortality was lower for neuraxial
and neuraxial/GA vs. GA alone for TKA
Most in-hospital complications were lower
for neuraxial and neuraxial/GA vs. GA alone
Transfusion requirements lowest for
neuraxial
Memtsoudis SG, et al. Anesth 2013;118:1046
35. @EMARIANOMD
Cancer Recurrence?
14 studies met criteria EA±GA vs. GA
(including Cummings study, n=42,151)
Improved overall survival with EA
No difference in cancer recurrence
Chen & Miao. PLOS ONE 2013;8:e56540
Cummings KC, et al. Anesth 2012;116:797
Does the intervention match
the trajectory of recovery?