Editorial – in Nabil’s Corner: What Are They Looking for?

Jul 24, 2018, 11:48 AM by Nabil Elkassabany, MD, MSCE

What Are They Looking For?

I recently had this conversation with one of our senior residents (J) who chose to return for an elective rotation in the ambulatory surgical center to get more exposure to regional anesthesia and to be more acquainted with patients’ flow through an efficient surgery center’s operating rooms.

After we were done with the morning round of first start blocks, I asked him: Did you find a job yet?

J: I interviewed in four places around the area, and I accepted a job at X hospital.

Me: Are you going to be doing all subspecialties there? J: Pretty much, they have diverse surgical volume. Dr E [that is me], do you know what was the one question I was asked in all my four interviews?

Me: What was that?

J: “Are you comfortable with blocks and regional anesthesia?” They did not ask me whether I am comfortable doing big vascular or thoracic cases or whether I am comfortable with line placements or invasive monitors. Regional anesthesia was the one thing that they all asked me about.

Me (with a big smile on my face): Well, we are here to help you learn. Is that next patient ready for a block yet?

The practice of regional anesthesia has expanded over the past decade, and most groups (academic and private practices) value having new partners with this skill set. This conversation made me think about the responsibility we have toward our trainees. We need to help them think about regional anesthesia as a means to an end goal. This goal should always be to add value to our patients’ surgical experience. The only way to do this is to think and act like an acute pain medicine consultant skilled in regional anesthesia and knowledgeable about all other modalities of treatment for acute pain.

The record number of registrants for the ASRA spring meeting in San Francisco and the diversity of the program this year make me look forward to the meeting and all that it will have to offer. It is also a testament to the success of the ASRA programs in supporting education and research.

I would like to thank Dr Melanie Donnelly, the associate editor for regional anesthesia for the ASRA News, for her service as her term ends. Melanie has been instrumental in the development of the ASRA News to its current form. I also would like to welcome Dr Kristopher Schroeder to the ASRA News family as he takes over for Melanie. I am sure he will bring new energy to your ASRA News.

In this issue of the newsletter, Dr Asokumar Buvanendran offers an interesting inaugural presidential message. His very first message focuses on research and education as the main pillars of the ASRA mission. Innovations, defining the impact of our practice on patients’ outcomes, and new discoveries are the end product of research and the way of the future. We also bring to you in this issue snippets of the practice experience from different institutions around the country. You will read how the University of California at Irvine conforms its care for joint arthroplasty patients to adapt to the bundled payment model. You will also learn about the experience of one institution in using stellate ganglion blockade for treatment of posttraumatic stress disorder in United States veterans. On a lighter (but a very scientific) note, Dr Veena Graff explains her effort to apply music therapy in her previous institution (the University of Vermont) and how she plans to do the same at the University of Pennsylvania. From the same institution, Dr Taras Grosh and colleagues describe their regional anesthesia group’s experience with mitigating some of the inherent risks of the sitting position in patients undergoing shoulder arthroscopy by stratifying patients by their comorbidities. As enhanced recovery protocols become more popular for different surgical service lines, the University of Virginia group describes theirits protocol for using intravenous lidocaine as part of their multimodal regimen for postoperative pain management in patients undergoing colorectal surgery.

However, this is not everything we have for you in this issue. You have to read it all to learn it all!

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