NYSORA - The New York School of Regional Anesthesia: May 2014 - Newsletter

May 2014 - Newsletter
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admin on 28/05/2014 20:57:00


In this issue:
*A letter from the Editor 	*Upcoming: 13th Annual NYSORA September Symposium
	*Interview with Harold Minkowitz, MD on EXPAREL 	*Featured Educational Video -
Ultrasound-Guided Popliteal Block
The 12th Annual NYSORA Symposium at the Marriott Marquis in Times Square
A Letter from Your Editor
Dear NYSORA Newsletter Reader,
It has been a busy spring at NYSORA with several international programs , such
as Nepal, Kuala Lumpur and the first NYSORA Latin America. Meanwhile, much has
been going on at NYSORA headquarters in New York City. For one, our NYSORA
Boutique Workshops have been a huge hit. These workshops are designed to help
jump start the practice of ultrasound guided peripheral nerve blocks and are
filling up quickly. We are working on releasing new dates so be sure to check
our website periodically for updates.
In this month's newsletter, we feature an interview with Harold Minkowitz, MD,
who discusses how EXPAREL plays a part in postoperative pain management at his
practice, Memorial Hermann Memorial City Medical Center in Houston, Texas. An
increasing number of surgeons are using EXPAREL to control postoperative pain
through soft tissue infiltration.
We cannot hide our excitement about the upcoming 13th Annual NYSORA Symposium,
September 20-21st in New York City. It is shaping up to be one of the grandest
NYSORA NYC Symposia yet. Therefore we dedicate a full feature article piece in
this month's newsletter about it. There are still a few available positions for
workshop instructors at 13th Annual NYSORA Symposium. To apply, please send your
CV to stacy@nysora.com
NYSORA is happy to share some great news: NYSORA application with the
Accreditation Council for Continuing Medical Education (ACCME) has been ongoing
for approximately 2 years now and we just broke champagne to celebrate the news
that the application has been approved.
ACCME certificate for NYSORA
Sincerely,
Matt Becker
NYSORA Newsletter Editor
UPCOMING: 13th Annual NYSORA September Symposium
All are excited about the upcoming 13th Annual NYSORA Symposium in September at
the Marriott Marquis Hotel located in the heart of Times Square in New York
City. The NYSORA Think Tank sessions (TNT) introduced at last year's NYSORA
Annual Symposium, which consist of 20-minute presentations, and 10-minute
rapid-fire question and answer sessions, proved to be a huge hit and garnered
lots of positive feedback. A unique aspect of the TNT structure is that the
delegates are allowed to ask questions, limited to 15 seconds whereas the
speaker has 60 seconds to reply. The NYSORA signature TNT lectures allows a
larger number of delegates to ask questions and receive answers without the
delegates and/or speaker getting entangled in overly lengthy considerations and
rebuttals. Additional Symposium highlights will be featured in future
newsletters leading up to the symposium.
TNT discussions from the 12th NYSORA Symposium
Liposomic Bupivacaine – EXPAREL: What is new and what it means to your
practice:
It is no secret that the liposome-encapsulated bupivacaine, EXPAREL, has become
the “talk of the town”. An increasing number of surgeons are using EXPAREL
in their practice, where applicable. Infiltration after total knee replacement
with large doses of EXPAREL and local anesthetic mixed together has also become
commonplace across United States. Therefore, for this year's NYSORA September
Symposium, we invited an orthopedic surgeon who utilizes EXPAREL in his daily
practice for total knee replacement to discuss any advantages or disadvantages.
The delegates will have a chance to challenge the orthopedic surgeon on this
practice as well as discuss their own observations. While EXPAREL has not been
approved for use in peripheral nerve blocks, it is not a secret that some
experts in local and regional anesthesia are starting to use EXPAREL for studies
and indications where continuous catheters may be contraindicated. At the 13th
Annual NYSORA Symposium there will be several experts sharing their expert
opinions on this topic.
EXPAREL
Pec 1, Pec 2, Pec 3, Pec 4, Pec 5 and Serratus blocks
The widespread use of ultrasound knowledge and sonographic anatomy has resulted
in an ever-increasing number of ultrasound guided nerve blocks and various
tissue plane blocks for postoperative analgesia. Among the new techniques, PEC1
and PEC2 blocks and serratus anterior blocks promoted by Dr. Rafael Blanco are
perhaps the most intriguing and most talked about. In September, Dr. Rafael
Blanco will share his experiences on these techniques, and will discuss
techniques and pharmacology ingredients necessary for their successful use. A
discussion on their analgesic potency will take place in the NYSORA TNT format.
Artist rendition of Rafael Blanco on the road from Abu Dhabi to NYC
Interscalene blocks and phrenic paralysis
A recent article on anesthesiology by Dr. Kaufman and colleagues featured 19
patients who sustained severe injury to their phrenic nerve requiring surgical
intervention for treatment. The etiology of this complication remains only
speculative although etiologies ranging from direct injury to the phrenic nerve
to inflammatory changes to the anterior scalene muscle, have all been
postulated. Editorials have gone as far as to suggest abandoning interscalene
blocks because of this risk. To demystify the nature of the lesions and the
severity of the injury we have invited Dr. Matthew Kaufman, the first author of
the article, to share his experiences in the TNT track of the 13th Annual NYSORA
September Symposium.
Click for case report
Scientific abstracts
At last year's 12th Annual NYSORA Symposium a number of scientific abstracts
were presented by delegates from throughout the world. Moving forward however,
NYSORA plans to expand sharing the scientific information with the ever-growing
number of NYSORA delegates. The NYSORA symposium in September will feature an
abstract competition with monetary awards of $750, $550 and $250 for the winners
of the first, second, and third-best scientific abstract.
Abstract presentations from last year's symposium
New to this process of scientific abstract presentation NYSORA will print all
posters to avoid the hassles of poster printing and transporting. All that is
required is one PowerPoint slide following the NYSORA template that will be sent
to the authors. Once the authors input their basic information, the NYSORA staff
will format and print all posters. The posters will be displayed throughout the
meeting without the need for presenters put them up or take them down. Moreover,
all accepted abstracts scoring >5 (on a 0-10 scale) will be printed in a Journal
supplement to Minerva Anaesthesiologica, an indexed peer reviewed Journal.
63% of 12th NYSORA Symposium attendees were from the United States. The pie
chart illustrates the breakdown of last year's international delegates.
The pie chart illustrates the breakdown of last year's United States attendance
Best practice protocols
Total knee replacement and hip arthroplasty are common orthopedic procedures
that present significant challenges in regards to postoperative analgesia.
Various institutions use a number of different protocols and there does not seem
to be a universal agreement on the best protocol or standard of care. At the
13th Annual NYSORA September Symposium we will feature several prominent leaders
in this area who will share their secrets on how they tackle postoperative pain
in patients with major orthopedic surgery.
Dr. Malikah Latmore supervising a resident performing a popliteal sciatic block
in a patient after total knee replacement
Adductor canal blocks
At last year's September annual symposium, we had the pleasure of hosting our
colleague from Denmark (Pia Jaeger, MD) who spearheaded the development and
usage of adductor canal blocks as a replacement for femoral blocks. Clearly, the
task at hand is to provide additional analgesia to the knee while avoiding the
weakness of the quadriceps muscle which could interfere with early mobilization
and rehabilitation. However, based on multiple discussion blogs/sessions on
Anesthesiology Network, some clinicians doubt the analgesic value of the
adductor canal block. It is for this reason that at the upcoming 13th Annual
NYSORA September Symposium we have decided to dissect this issue further and
discuss the pluses and minuses of adductor canal blocks.
NYSORA's new range of illustrations from its new reverse-Ultrasound Anatomy
Project. Shown is subsartorius space of relevance to "adductor canal" block
Networking at NYSORA September
Saying that NYSORA invented "CME Networking" would not be an exaggeration.
Indeed, a number of our delegates are coming for the opportunity to interact
with top opinion leaders, get to know the who's who in regional anesthesia and
integrate into the greater regional anesthesia community. This year would not be
an exception. The networking event - NYSORA's fabled Saturday evening cruise
around Manhattan is back by popular demand. Featuring dancing, socializing and
the gorgeous skyline of New York City, the evening cruise is an event not to be
missed. Be sure to sign up as limited space is available.
NYSORA's fabled Manhattan Hudson River Cruise on Saturday Night
Also, if you are a Speaker or Exhibitor, do not miss the fabled NYSORA Bowling
competition on Friday night taking place at the NYC renowned Lucky Strike Lanes.
This event is for Speakers and Exhibitors only.
Bowling for Exhibitors and Speakers. Be ready to compete.
Interview with Harold Minkowitz, MD
NYSORA reporter Matt Becker had a chance to interview Harold Minkowitz, MD
about the use of EXPAREL in his institution. Dr. Minkowitz was one of the
primary Investigators on the recently completed multi-institutional trial on
EXPAREL for femoral nerve blocks in patients having total knee arthroplasty.
The liposome encapsulated bupivacaine (EXPAREL) has been recently FDA approved
for soft tissue infiltration and it looks like the surgeons are competing
against each other for who is going to use it first in their practice. They also
seem to be coming up with all kinds of cocktails, dosages and their own
injecting techniques. We have even heard of surgeons who have developed their
own secret cocktails. What do you see out there in private practice in Houston?
The environment in which I work is conservative. People are using EXPAREL on
label. The usage is really spreading by word of mouth as physicians are seeing
the effect of the drug on their patients. However, in terms of cocktails and
special uses they are limiting administration to the on label usage at this
time.
What are the most common usages by surgeons that you see in your practice?
Initially the usage was confined to hemorrhoid and bunion surgery. It's use has
now been adopted for abdominal surgeries, such as bariatric surgery and
abdominoplasties, and also breast reconstruction and orthopedics for total-joint
infiltrations. In our institution EXPAREL has been used in almost every surgery
that results in significant postoperative pain.
Do these surgeons mix EXPAREL with other local anesthetics, or do they use it
alone?
Some surgeons administer it following the use of local anesthetics. Others use
it as a sole agent. It depends on the surgeon and their personal preference.
Can you share some dosages or volumes that are used for a few common procedures
that you see being used often?
In small cases such as bunions we are using volumes as low as 10 cc but for the
abdominal and plastic cases 100 to 200 cc are being infiltrated. Obviously the
bigger the surgical area, the more the dilution. For total knee replacement, the
surgeon is infiltrating about 100/120 cc of total volume.
What are the actual maximum doses that are being used?
We don't go above 266mg.
Ok so they pretty much stick to what the packaging says?
Correct. We administer the drug per package insert recommendations.
Have you seen any complications yet?
No. I have not seen any as yet.
In how many patients is EXPAREL used say in a month, or how many have you done
so far in your practice?
We do hundreds of cases a month and I am not sure of the exact number, but we
have a very busy practice.
OK, do you see EXPAREL being used, or experimented with, in peripheral nerve
blocks?
No, we are a totally "by the label" group. My only experience would be from the
multi-institutional femoral nerve block study, which was recently concluded.
Can you tell us a little about that nerve block study? What were you expecting
to find, what did you actually find, and were you either positively or
negatively surprised by the results obtained?
It was a blinded femoral nerve block study in patients undergoing total knee
replacement surgery. Patients either received Exparel or placebo. For rescue
pain control, both groups had access to narcotics. For additional analgesia, a
bupivacaine infusion to the femoral nerve via a femoral catheter was available.
(this had been placed at the time of initial nerve block). Injection was easily
performed and the patients did well. However I was unaware into which group the
patients fell until the results were revealed to me. Despite the sciatic nerve
not being blocked, the patients from the EXPAREL group still did better than the
patients in the placebo group. The study demonstrated that femoral nerve block
with Exparal was safe and efficacious.
Are you itching to use EXPAREL in your own practice after, hopefully, the FDA
approval comes in sometime next year?
There is no question that I am ready to start using it for peripheral nerve
blocks in patients for post-op pain control.
Memorial Hermann Memorial City Medical Center, Houston, TX
Featured Educational Video - Ultrasound-Guided Popliteal Block
NYSORA Symposiums and Workshops
NYSORA Education Program
Location
Date
Registration
1
NYSORA Boutique Workshop
New York City, NY
March 29-30, 2014
Sold-Out
2
NYSORA Boutique Workshop
New York City, NY
May 17-18, 2014
Closed
3
NYSORA Boutique Workshop
New York City, NY
June 28-29, 2014
Closed
4
NYSORA Boutique Workshop
New York City, NY
July 26-27, 2014
Closed
5
NYSORA Symposium
New York City, NY
September 20-21, 2014
Open
6
NYSORA Boutique Workshop
New York City, NY
October 25-26, 2014
Open
7
NYSORA Boutique Workshop
New York City, NY
December 6-7, 2014
Open
8
NYSORA Inspire Seminar
Mont-Tremblant, Quebec
Jan 29 - Feb 01, 2015
Open
9
NYSORA Latin America
Cartagena, Colombia
April 9 - 12, 2015
Open