Editorial – in Nabil’s Corner: Back to the Future

Jul 17, 2018, 13:03 PM by Nabil Elkassabany, MD, MSCE

Back to the Future

Did you ever think about what the practice of regional anesthesia and pain medicine will look like in 10 or 20 years? 

I was recently invited as a guest speaker in a class for the graduate student program in the School of Biomedical Engineering. The name of the course was “Applied Biomedical Engineering Innovation in Health Care.” The topic was “regional anesthesia and acute pain medicine: the past, present, and the future.” I am fascinated by the evolution of the practice of regional anesthesiology and pain medicine. We have definitely come a long way, from using paraesthesia, to nerve stimulation, to ultrasound. The software technology of the ultrasound machine is still evolving to allow better visualization and accurate placement of block needles. Some of the other innovations that are currently available include coating of the needles we use with reflective materials, using nanotechnology and different drug delivery systems to deliver the local anesthetic around target nerves, and, most recently, the use of peripheral nerve stimulation as an alternative for local anesthetic to achieve postoperative analgesia. All of these advances are bound to bring the skill set of regional anesthesia into the mainstream practice of anesthesiology. The one thing that is clear in my mind is that we should always look beyond the needle tip. Practice of regional anesthesia in the context of acute pain medicine and not the skill set in and of itself is what will distinguish us as a subspecialty. This concept is fundamental to the ASRA mission statement as it puts innovations in research and education as the centerpiece of the society’s mission.

In this issue, we bring to you a wide variety of very interesting topics. Dr Kristopher Schroeder sits down with Dr Joe Neal, past ASRA president, and asks him about his vision of ASRA and its mission through the years and how he sees the future. I personally enjoyed reading this interview and what Dr Neal has to say, and I am sure you will enjoy it as well. We are planning to continue to present to you the perspective of the eminent leaders in the field as they tell us about their journeys through regional anesthesiology and pain medicine.

We also bring back to you the problem-based learning discussion (PBLD) article. This month, the discussion revolves around use of regional anesthesia in trauma patients with rib fractures in the setting of different clinical scenarios of anticoagulation. We posted the PBLD on Twitter and had more than 500 responses. The stem case was also posted on the ASRA blog when the Twitter poll was live. If you like this type of article, please write to us and let us know: Also let us know if you have a case that you would like us to feature or if you would like to comment on a case scenario and actively participate in the discussion.

Special interest groups (SIGs) are now an integral part of ASRA offerings. In past issues, we highlighted the activity of different SIGs. This issue features the objectives and mission of the Resident and Medical Student Pain Education SIG.

Pediatric pain management is well covered in this issue in two articles. Dr Neil Patel discusses a model for systemic approaches to address coping with pain resulting from intervention during hospitalization of children for different reasons. Dr Floria Chae also writes about the importance of an integrated approach for chronic pain management in the pediatric patient population.

“Practice of regional anesthesia in the context of acute pain medicine and not the skill set in and of itself is what will distinguish us as a subspecialty.”

You can also read how our colleagues at the European Society of Regional Anaesthesia & Pain Therapy worked to spread the practice of regional anesthesia in different countries.

However, this is not everything. You will have to read it all to learn it all!


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