Welcome to the Electronic Era for Regional Anesthesia

November 2019 Issue

  1. Reena John, DO Resident, Kendall Regional Medical Center Co-author
  2. Priyanka Ghosh, MD Resident, Beth Israel Deaconess Medical Center Co-author


As smartphones are becoming more ubiquitous, so too are the various apps designed for them. Smartphone apps provide an invaluable tool for quickly accessing medical information on medications, diseases, or interventions. Medical apps, particularly those pertaining to regional anesthesia, provide valuable information instantly to providers. However, evaluating the multitude of applications on the market allows us to assess which ones provide the most accurate, reliable, and easily accessible information to help physicians provide the best possible patient care. 


Evaluating the multitude of applications on the market allows us to assess which ones provide the most accurate, reliable, and easily accessible information to help physicians provide the best possible patient care.


ASRA Coags 2.1

Providers can quickly and easily review anticoagulation guidelines for specific medications and procedures in this user-friendly application. It combines information and guidelines from the ASRA publication Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy; American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fourth edition) and the 2018 Interventional Pain guidelines from the publication Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (second edition), as well as guidelines from ASRA, European Society of Regional Anaesthesia and Pain Therapy, American Academy of Pain Medicine, International Neuromodulation Society, North American Neuromodulation Society, and World Institute of Pain.

Pros:

  • Simple, user-friendly interface
  • Selections for medication (brand or generic name) and intervention (neuraxial block, deep plexus or peripheral block, superficial block, anticoagulated parturient neuraxial block)
  • Recommendations for both regional and pain procedures
  • Lists mechanism of action and limited duration or half-life information for each drug
  • Includes a PDF of ASRA’s 2018 pain guidelines
  • Updated to reflect new anticoagulants

Cons:

  • Only minimal information is provided for select medications. In certain cases, recommendations may be limited to “not recommended.”
  • Pharmacology descriptions may be brief.
  • Cost is $3.99, but it can be bundled with ASRA’s Local Anesthesia Systemic Toxicity (LAST) and Timeout applications for $7.99.

ASRA LAST 2.0

Get real-time, step-by-step guidance to assist in the treatment of local anesthetic systemic toxicity. The application also incorporates basic advanced cardiac life support protocols, and provides weight-based calculations for all dosing and timing of lipid emulsions.

Pros:

  • Cyclically timed reminders for pulse recheck, cardiopulmonary resuscitation, drug dosing, and more
  • Quick-reference links to ASRA’s LAST treatment checklist, ASRA.com, and LipidRescue.org
  • Generate a report of the information that was recorded on the application throughout the LAST event.

Cons:

  • Costs $3.99, but it can be bundled with ASRA’s Coags and Timeout applications for $7.99.

Regional Anesthesia and Pain Medicine

This application puts ASRA’s official journal at your fingertips on your smart device. The journal is now published monthly and contains a magnitude of literature involving regional interventions and techniques in multiple fields such as intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications.

Pros:

  • Great educational tool
  • Peer-reviewed information
  • Contains full-text articles
  • Download and save any issues
  • Easily navigate through abstracts
  • Receive push notifications when new issues are available
  • Compatible with iPads

Cons:

  • Not an on-the-go guide
  • Involves more reading than other apps
  • $59.99 for nonmembers

Block Buddy

Created by Western Reserve Anesthesia Education, Block Buddy is a mobile reference for performing ultrasound-guided peripheral nerve blocks. The nerve blocks section covers 21 blocks encompassing the entire body. Each includes a photo and description of the block distribution and indications, anatomy with ultrasound images and anatomical images, block technique guidance, a block video, clinical pearls, and current procedural terminology code. In addition, the application offers a nerve block video library; block IQ, including sonoanatomy-based quiz questions; nerve innervation information for the entire body; LAST guidelines; information on local anesthetics, including maximum dosages; information on all non-opioid medications; and an area for personal notes on each block.

Pros:

  • Available in Google and Apple app stores
  • User-friendly interface with clearly labeled sections
  • Covers many blocks and is comprehensive
  • Extensive video selection
  • Has supplemental information, including medication details, local anesthetic maximum dosages, and LAST treatment, which most regional anesthesia apps do not include

Cons

  • Costs $14.99
  • Some content is geared more toward residents and students (eg, sonoanatomy quizzes).
  • Comprehensive information may be too much for someone who is looking for a quick reference.
  • Lacks photos of cadaver anatomy, which would be useful for visual learner

AnSo

AnSo is a comprehensive sonoanatomy resource application divided into sections for upper limb nerves; lower limb nerves; head, neck, and trunk nerves; vascular access; airway; basic transthoracic echo; and lumbar spine. Each section is further broken down into common sonoanatomy areas (eg, brachial plexus, interscalene sonoanatomy). Those subsections contain two or three ultrasound views with labeled structures, a video version of the ultrasound view, a sketch of the anatomy with labeled structures, and probe position shown on human surface anatomy.

Pros:

  • An excellent sonoanatomy resource that covers more than just regional anesthesia blocks and anatomy
  • Comprehensively labeled structures in different sonoanatomy views
  • Ability to highlight anatomy with labels or choose anatomy with no labels to self-identify structures
  • Ability to access the resource without phone service or internet access once downloaded to your phone

Cons:

  • Costs $3.99
  • Covers only sonoanatomy and doesn’t include techniques
  • Simple application with no extra features
  • Does not show cadaver anatomy

Opioid Manager

This point-of-care tool provides information and expert opinions from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. It addresses four clinical areas: before you write the first script, how to conduct an opioid trial, how to monitor a patient on chronic opioid therapy, and when and how to stop opioids.

Pros:

  • Electronic medical record platform available
  • Also available in French, Portuguese, Spanish, and Farsi
  • Provides an opioid switching form with equivalents

Cons:

  • Registration required
  • Costs $7.99

Acute Pain Medicine Opiate Applications

OpioidCalc and Opioid Calculator are free resources that calculate a patient’s opioid dose into morphine milligram equivalents (MME) to help with acute pain patients already taking chronic opioids.

Pros:

  • Free mobile app for both Android and iOS
  • Identifies patients at risk for overdose by calculating total MME (> 100 results in alert)
  • Based on New York City Department of Health and Mental Hygiene opioid prescribing guidelines

Cons:

  • Lacks information regarding evidence-based content and peer review

Doximity

Doximity is a social professional platform for medical professionals that offers a space where physicians can highlight aspects of their clinical practice. It was founded by Jeff Tangney, cofounder of Epocrates. One out of four U.S. physicians uses Doximity, and a recent American College of Physicians survey[1] listed Doximity as a top five application most used by its members. Physicians are able to earn continuing medical education credits on this platform.[1] The application combines their massive medical network with in-app features that attempt to streamline healthcare professionals’ workflow. However, it cannot be accessed by healthcare professional outside the United States. The ultimate goal of this app is to address two of the biggest issues healthcare workers face: miscommunication and handoff errors.

Pros:

  • Free to use
  • Straightforward user interface
  • Encourages collaboration with colleagues
  • Secure Health Insurance Portability and Accountability Act (HIPAA)-compliant network communication for case discussion
  • Customer support available
  • Ability to set up multiple “clinics” and select which one you want to use with each call
  • Call patients without showing physicians’ personal cell phone number
  • HIPAA-compliant online faxing, email, and text messaging, all from one inbox
  • Does not record or store any recordings of calls made with the app
  • Partners with the Cleveland Clinic to offer continuing medical education
  • Offers customizable medical literature alerts
  • Can personalize published research and get notifications when publications have been cited

Cons:

  • No ability to receive a return phone call directly through the application
  • Must have a Doximity account to use the app
  • Currently available only for verified healthcare professionals in the United States

Anesthesia Toolbox

This learning tool for anesthesia residents and fellows enrolled at contributing institutions offers extensive material for every level and every subject in anesthesia, including resident curricula and study guides in the form of online modules and lectures. In addition, it contains problem-based learning discussions (PBLDs), mini PBLDs, and podcasts. The toolbox also includes quiz banks, wiki cases, clinical questions, and clinical pearls. Anesthesia Toolbox provides excellent resources for any level of anesthesia resident, fellow, or attendee looking for specific learning tools.

Pros:

  • Toolbox uses similar processes to develop curricula and resources for other anesthesia subspecialties
  • Provides a comprehensive anesthesiology curriculum

Cons:

  • Limited number of anesthesiology residency programs involved
  • Limited ability to function as a fast, on-the-go reference/resource

Online Resources    

These websites are not apps, but may be accessed at the point of care or whenever quick access to information is desired.

  • The American Society of Regional Anesthesia and Pain Medicine: www.asra.com
    • Provides the latest news from ASRA
    • Links available to ASRA News, Regional Anesthesia and Pain Medicine, podcasts, blogs, patient Information, upcoming courses, and practice guidelines
  • New York School of Regional Anesthesia: www.nysora.com
    • Provides evidence-based information on foundations of regional anesthesia, techniques and videos, educational tools, and meeting information
    • Newsletter available with subscription
  • Ultrasound for Regional Anesthesia: www.usra.ca
    • Provides practical PDF guides for ultrasound-guided regional blocks as well as videos
  • Military Advanced Regional Anesthesia and Analgesia Handbook: www.dvcipm.org/clinical-resources/dvcipm-maraa-book-project
    • Provides pain assessment screening tools and regional anesthesia techniques broken down into chapters that can be viewed on smart devices and e-readers

Conclusion

Regional anesthesia continues to evolve with the introduction of new techniques, and the emergence of experimental and clinical evidence. Smart devices provide a convenient and all-encompassing platform to store and reference regional anesthesia guidelines. However, most apps and online resources are not peer reviewed and we must therefore remain vigilant in terms of interpretation and application of information.

 

References

  1. Vartabedian B. 12 things about Doximity you probably didn’t know. 33 Charts. https://33charts.com/12-things-about-doximity. Accessed August 5, 2019.