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At the conclusion of this activity, learners will be able to: define optimal ultrasound transducer position for cross-sectional imaging of nerves; apply surface anatomic landmark identification in ultrasound transducer application; identify sonoanatomy of common peripheral nerves and surrounding structure; and discuss tips and tricks to improve ultrasound images and ultrasound-guided nerve block techniques.

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There are currently few options to extend the duration of regional analgesia at home beyond the one day expected from most single-injection nerve blocks. Continuous peripheral nerve block (CPNB) with a plain local anesthetic perineural infusion is the most established way to provide days of postoperative pain control and allows titration, but training in insertion techniques and a system to manage ambulatory CPNB patients are necessary. Adjuvants or depot formulations of local anesthetics may offer potential options for limited extension of block duration, but further studies regarding efficacy and safety for regional anesthesia as well as comparative-effectiveness versus CPNB are necessary. At the conclusion of this activity, learners will be able to: discuss the indications for continuous peripheral nerve blocks; identify obstacles to implementing a continuous peripheral nerve block system; examine various techniques and equipment for continuous peripheral nerve block performance; and discuss the application of ultrasound guidance for perineural catheter insertion.

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How do we as anesthesiologists address the need for acute pain medicine physicians and have a positive impact on the patient experience? We can take the lead in developing multimodal perioperative pain management protocols. Anesthesiologists can also add value through cost savings for the hospital. More effective pain management can prevent inadvertent admissions or readmissions due to pain. In addition, an effective multimodal analgesic protocol can directly or indirectly prevent hospital-acquired conditions (HACs). HACs are considered by CMS to be “never events” and supposedly preventable (4); hospitals reporting HACs as secondary diagnoses are not entitled to Medicare or Medicaid payments for related care.

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Inferring community structure in healthcare forums. An empirical study by Chomutare T, Arsand E, Fernandez-Luque L, Lauritzen J, Hartvigsen G. Methods Inf Med. 2013;52(2):160-7. https://www.ncbi.nlm.nih.gov/pubmed/23392282 Abstract BACKGROUND: Detecting community structures in complex networks is a problem interesting to several domains. In healthcare, discovering communities may enhance the quality of web offerings for people with chronic diseases. Understanding the social dynamics and community attachments is key to predicting and influencing interaction and information flow to the right patients. OBJECTIVES: The goal of the study is to empirically assess the extent to which we can infer meaningful community structures from implicit networks of peer interaction in online healthcare forums. METHODS: We used datasets from five online diabetes forums to design networks based on peer-interactions. A quality function based on user interaction similarity was used to assess the quality of the discovered communities to complement existing homophily measures. RESULTS: Results show that we can infer meaningful communities by observing forum interactions. Closely similar users tended to co-appear in the top communities, suggesting the discovered communities are intuitive. The number of years since diagnosis was a significant factor for cohesiveness in some diabetes communities. CONCLUSION: Network analysis is a tool that can be useful in studying implicit networks that form in healthcare forums. Current analysis informs further work on predicting and influencing interaction, information flow and user interests that could be useful for personalizing medical social media.

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The medical specialty of anesthesiology is founded on patient experience and patient safety. Having major surgery would be a very different experience without anesthesia. Before the advent of safe anesthesia techniques, the world of surgery was basically limited to amputations and other attempts at life-saving maneuvers. Dr. Bigelow’s publication describing the safe administration of ether changed everything, and the New England Journal of Medicine called this the most important article in its history. With this article, the science and clinical practice of anesthesiology, as well as the modern era of surgery, were born. Understanding and appreciating the rich history of anesthesiology will help guide the future direction of this specialty. Physician anesthesiologists have the skills necessary to take the quality of perioperative medicine to the next level, combat the opioid epidemic, and redesign the surgical experience,

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The internet has transformed our lives, particularly in the way we access information and communicate with each other. Today academic physicians have more tools than ever in the form of social networking and other online resources to disseminate their scholarly work worldwide. Some of these sites even provide analytics that can help academic physicians measure and report their reach, and these metrics may be useful when filing for promotion.

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This is the slide deck I used for my invited lecture at the 2018 European Society of Regional Anaesthesia and Pain Therapy annual meeting in Dublin, Ireland. After participating in this educational activity, participants should be able to: 1) Identify available online tools that can be used for lifelong learning and continuing professional development; 2) Discuss ways social media platforms can be used to enhance the scientific conference experience; and 3) Apply practical and free Twitter tools available to any new user.

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I gave this presentation as part of a panel called "The Modern Learner" at the 2019 spring annual meeting of the American Society of Regional Anesthesia and Pain Medicine. After participating in this educational activity, participants should be able to: 1. Identify available online tools that can be used for lifelong learning and continuing professional development; 2. Discuss ways that free platforms like PubMed and Google Scholar can be used to improve the efficient and timely delivery of new research.

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This was part of a debate held at #ANES20 (recording available from ASA) between me and Dr. Jeff Gadsden from Duke University School of Medicine. Dr. Gadsden and I clashed on the same topic last year at #ANES19 during which I promoted thoracic epidural analgesia, and Dr. Gadsden made the case for interfascial plane blocks. This year we switched sides! Link to my slides from #ANES19: https://www.slideshare.net/EdwardRMariano/thoracic-epidural-analgesia-is-the-gold-standard-for-major-abdominal-surgery The objectives of this session were as follows: 1. Discuss multimodal pain management strategies in the context of enhanced recovery programs; 2. Discuss advantages and disadvantages of thoracic epidural analgesia for major abdominal surgery in the context of enhanced recovery programs; 3. Discuss advantages and disadvantages of truncal somatic blocks in the context of enhanced recovery programs; and 4. Discuss developing safe and effective procedure specific pain management strategies for major abdominal surgery.

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At the 2019 Society for Education in Anesthesia fall meeting, I was invited to present ways to modernize the traditional curriculum vitae (CV) by creating a digital portfolio. By the end of this talk, learners will be able to: 1) digitize their CVs and update them into living documents; 2) utilize free online platforms for creation of a digital portfolio; and 3) augment the CV with an educator portfolio for academic faculty members primarily engaged in clinical teaching.

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Physicians need to be active on social media and other communication platforms to offset the noise of the anti-science movement. I am speaking at the New Zealand Anaesthesia Annual Scientific Meeting in Queenstown this week [August 21-24, 2019] on the role of social media and medicine. There has been a growing anti-science movement, and physicians have a moral imperative to stand up for science and evidence-based treatments. “Surveys show that physicians are one of the most trusted professions in the eyes of the public. Yet most people in the world today get their information, including health information, from the internet. We have to be there to offset the noise. We can’t ignore where our patients get their information, and we can join the conversation.” Social media also offers a way for doctors to keep up-to-date with the latest research and new treatments. One example is the exponential growth of regional anaesthesia. Regional anaesthesia allows procedures to be done without the patient being unconscious and can provide targeted pain relief. “We have more tools at our disposal. New blocks are being performed and described every month and it’s hard to keep up with the literature. Social media allows you to be part of a learning community made up of people who have similar interests and it can curate information for you.”

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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.

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I hosted this seminar as part of the Emerging Leaders Development Program at the VA Palo Alto Health Care System. Goal: To familiarize participants with the challenges and best practices of coaching and developing employees. Through discussion and instruction, participants will understand the importance of providing employees with personal guidance that will allow them to acquire new skills, advance professionally, and improve patient and customer outcomes.

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Upon completion of this presentation, participants will be able to: 1. Discuss the challenge of losing identity and apply strategies to establish a brand; 2. Review missed opportunities in adopting new technology and identify potential applications in future operating room models; 3. Understand barriers to change implementation and develop a team approach that redefines challenges as opportunities.

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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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Healthcare around the world is changing. In the United States, healthcare reform has been focused on achieving the “triple aim". This triple aim encompasses 3 goals: improving the patient experience, reducing costs of care, and improving population health. The Perioperative Surgical Home (PSH) is a conceptual model introduced by the American Society of Anesthesiologists that may serve as an integrator to help hospitals achieve the triple aim. PSH is defined as “a patient-centered, physician anesthesiologist-led, multidisciplinary team-based practice model that coordinates surgical patient care throughout the continuum from the decision to pursue surgery through convalescence.” Pain medicine is woven throughout the three main elements of the PSH: preoperative preparation, intraoperative care, and postoperative recovery and rehabilitation.

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