April 21, 2012
Controversies and Fundamentals in Regional Anesthesia - 16th Annual Symposium
Members of the American Society of Regional Anesthesia and Pain Medicine receive a 10% discount on the registration fee for this program. Please mention that you are a member of ASRA when registering by phone. Please indicate "asradiscount" when registering on line.

April 24-28, 2012
III NWAC World Anesthesia Convention

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PRO/CON - The Future of Pain Medicine Fellowship Training.  Dr. Kevin Vorenkamp and Dr. Robert Hurley debate the merits and pitfalls of extending Pain Medicine Fellowship training from 1 year to 2 years as well as the current fellowship training model.

We present the findings on 510 consecutive outpatients who were treated at our institution with CPNB over a three-year period. Between 1/1/08 and 10/31/11 adult patients undergoing foot and ankle surgery were offered a home CPNB analgesic therapy. Following consent, preoperatively the anesthesiology physician placed a popliteal non-stimulating catheter employing a nerve stimulation technique or ultrasound guidance. 30 ml 0.5% ropivacaine was injected followed by catheter insertion. Patients received general anesthesia. In PACU, the block was assessed and a continuous infusion of 0.2% ropivacaine was initiated. At discharge, an anesthesiologist assessed the surgical pain and if adequately controlled initiated the home CPNB (500 ml 0.2% ropivacaine, 5ml/hr with 5 ml/h patient bolus, On-Q Pump, Iflow Corp, Lake Forrest, CA) and discussed in detail the written instructions with the patient. Patients were provided telephone access to an on-call anesthesiologist during the postoperative period. The anesthesiologist contacted each patient daily while the CPNB was in place to assess the efficacy and safety of the block. Of the 510 patients, 40 (7.8%) patients were lost to follow-up. The average duration of catheter infusion of 2.3 days. Beyond the protocol of daily calls by the anesthesiologist, 9 (1.7%) patients additionally accessed the on-call anesthesiologist. Four patients visited their local ER related to pain and/or CPNB malfunction (0.8%). Other complications included symptoms concerning for local anesthetic toxicity (metallic taste) occurred in 3 (0.5%), 1 local site infection (0.2%), and 1 patient reported hives (0.2%). No patients reported falls or difficulty in removing their home PNC. Our series is a unique report of 470 outpatients treated with popliteal CPNB following orthopedic surgery. We observed few CPNB-related complications. Once daily telephone contact with patients was adequate, there was minimal impact on the anesthesiology care team, and patients or caregivers were able to reliably remove their catheters at home.