December 2014 - Newsletter

Happy Holidays from NYSORA!

A Letter from Your Editor

Matt Becker
NYSORA Newsletter Editor

December Newsletter:

Statistics in Small Doses with Maxine Kuroda, PhD

Max Kuroda, PhD
Epidemiology division, NAICE (North American Institute for Continuous Education)
New York, NY 10025

Most of you are clinicians whose good work helps many patients each year. But when you also do research, your work extends beyond the boundaries of your clinical practice, and impacts the lives of countless individuals all over the world. For 2015, the NYSORA newsletters will include short articles on statistics. Each will describe a basic statistical concept written in lay language with most examples borrowed from the field of regional anesthesiology. It is hoped that the articles will be helpful whether you are interested in applying the literature to your own clinical practice or wish to enrich the literature with your own research.

Mark Twain (1835-1910) once wrote: Figures often beguile me, particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force: "There are three kinds of lies: lies, damned lies, and statistics."¹ Perhaps Mr. Twain would think differently if he had a simple definition of statistics. The father of statistics, Sir Ronald A. Fisher (1890-1962), considered the science of statistics to be mathematics applied to observational data. And, even more simply put, Fisher noted that statistics is really just the study of variability.² There is variability everywhere - from the quality of ultrasound images obtained on the surgical limb of a patient at different times prior to placing a nerve block, to the quality of images obtained on the surgical and contralateral limbs of the same patient, and to those obtained by different residents on the same patient regardless of limb. Statistics examines these sources of variability in order to carve out the chunks of explained variance that can be informative of treatment effect (the good stuff) and the chunks of unexplained variance that represents error (the nuisance stuff). This is, in fact, the basis of the traditional statistical methods, and is probably familiar to those of you who have used analysis of variance (ANOVA) to evaluate the significance of the resulting F statistic (named for Fisher).

Sir Ronald A. Fischer, the father of Statistics

SNEAK PEEK AT THE NEW NYSORA STANDARD PNB TECHNIQUES POSTERS

It is often said that creating anything of value and quality requires time. If this is indeed the case, then we believe that the 2nd generation of NYSORA's Standard Nerve Block Techniques Educational Posters will be an immensely helpful addition to the teaching armamentarium. Over a year in making, the 2nd generation of NYSORA's Standard PNB Techniques Posters are JUST ABOUT ready to hit the road. The first edition of 10,000 NYSORA's Standard PNB Techniques posters were distributed complementarity at NYSORA workshops and symposia, NYSORA's educational missions in Asia and Latin America and via downloads on NYSORA website

SNEAK PREVIEW: NYSORA 2nd Edition of Standard PNB Techniques: Supraclavicular Brachial Plexus Block.

The driving vision behind these posters is to summarize the current evidence and expert recommendations into an easy to read, simple to display and standardized set of PNB instructions as instructional posters for educators, students of regional anesthesia and practitioners alike. WE collectively felt that creating standards was the necessity given the mushrooming publications on peripheral nerve blocks, myriad of modifications of techniques, vast diversity in recommendations on indications and pharmacology, absence of uniform recommendations on number of injections, and absence of any monitoring and documentation principles.

Maria Fernanda Rojas Gomez in her studio putting the finishing touches on the 2^nd Ed of NYSORA Standard PNBs Techniques with International NYSORA team

In the process of creating the 2^nd generation of NYSORA standard PNB techniques posters, we have consulted with over 30 top experts and practitioners and teachers of peripheral nerve blocks worldwide. The journey started during seventh annual NYSORA Asia educational outreach program (ESOP) and ended in Cartagena, Colombia with Dr Maria Fernanda Rojas Gomez, an amazingly talented educator, putting the finishing touches. In this process, the various aspects of the techniques were presented at panels with experienced faculty and every aspect of the recommendations in the poster was discussed, and agreed upon by all members of this international team of collaborators. What transpired is the most authoritative, succinct and unambiguous teaching material to-date. The significance of this endeavor, sponsored by an unrestricted educational grant by PACIRA pharmaceuticals, is unprecedented. The lack of standardization is probably for this reason that ultrasound guidance paradoxically has probably increased the risk of neurologic complications with peripheral nerve blocks. This may be due to the fact that standardized teaching has not been introduced, and the fact that visual guidance by ultrasound is conducive to multiple needle insertions, repositions, and multiple injections. Logically, every needle redirection and consequent injection represents another risk of needle-vessel and nerve-trauma, as well as an intravascular injection. The NYSORA 2nd edition of Standard PNB Techniques particularly focuses on clear guidance on the number of injections necessary to accomplish the nerve block with minimal risk to the patient. The posters also provide the clearest possible guidance on 8 of the most common PNB techniques with regards to the volumes and necessary spread of local anesthetics. The posters also recommend the monitoring techniques associated with enhanced safety.

Artwork from Reverse Ultrasound Anatomy Project

This substantially updated second-generation of posters are accompanied by numerous original illustrations which are part of an entirely new NYSORA educational initiative titled Reverse Ultrasound Anatomy Project (RUAP^TM). The purpose of RUAP^TM is to advance the understanding and teaching of tissue planes and their significance to safe and successful peripheral neural blockade. RUAP^TM introduces a new style of precise but easy to understand anatomical illustrations based on natural ultrasound images. Teaching anatomy and ingraining ultgrasonographic patterns is difficult using actual anatomical dissections or cross sections in cadavers as these never mimic the anatomy captured by ultrasound. Instead, NYSORA's RUAPTM project creates accurate and highly didactic illustrations of the actual ultrasonography images for utmost accuracy. NYSORA's 2^nd Edition of Standard PNB Techniques will be released in January 2015 both as hardcopy posters which will be distributed at NYSORA education offerings, as well as available for complimentary download from NYSORA.com. The contributing authors will be listed on the poster; NYSORA would like to thank them immensely for their input and wisdom and vast clinical experience in creating this unique educational value to the regional anesthesia community and beyond. In this issue of the NYSORA Newsletter letter we feature one brief example of the educational approach taken.

Infraclavicular Brachial Plexus Block section from 2^nd Generation Poster

Partial list of contributors: Drs. Anna Lopez (SPA), Daquan Xu (USA), Xavier Capdevila (FRA), John Laur USA), Alvin Chuen (AUS), Catherine Vandepitte (BE), Pablo Helayel (BRA), Carlos Bolini (ARG), Roman Zuercher (SWI), Dimitri Dylst (BE), Ali Nima Shariat USA), Emily Linn USA), Thomas Clark USA), Philippe Gautier (BE), Malikah Latmore USA), Manoj Karmakar (HK), Jeff Gadsden USA), Jason Choi USA), Xavier Sala-Blanch (SPA), Javier Cubillos (COL), Maria Fernanda Rojas Gomez (COL), Yasuyuki Shibata (JAP).

NYSORA LATIN AMERICA SOCIAL PROGRAM

2nd NYSORA
Latin America Symposium on Regional Anesthesia and Perioperative Medicine
April 9 - 12, 2015

SOCIAL PROGRAM - CRUISE AROUND THE BAY
Saturday April 11, 2024
Cost - $125.00 USD per person

After a vigorous two days of learning, we invite you to take some time out to enjoy the beautiful sights of Cartagena with your fellow delegates and the faculty. This one-hour cruise adventure will include transport and entertainment on a Chiva bus to the beautiful Spanish galleon. While on board, partake of the appetizers and open bar while a Vallenato band serenades; take in the sights and enjoy a pirate show. A bus transfer back to hotel will end this fun-filled event.

To register for the event and social program event, please visit www.nysoralatinamerica.com or If you're already registered for the event and would like to add the social program please contact Stacy Atkinson at [email protected] or +1-212-721-9900.

Click here to learn more about NYSORA Latin America!

A VERY SPECIAL EVENING IN FLANDERS

Fabrica, 1500's, Andreas Vesalius

NYSORA Reverse Ultrasound Anatomy Project - An intraneural hematoma and intrafascicular injection

A very special evening in celebration of 500 years of the birth of Andreas Vesalius, the famous Flemish anatomist who started it all. Animated presentation by Dr. Johan Van Robays the author of autobiography book "Andreas" and Dr. Admir Hadzic who will talk about the relevance of anatomy in RAPM 500 years after Vesalius and unveil NYSORA's Reverse Ultrasound Anatomy Project. Moderated by Dr Jan Van Zundert. The program starts with snacks and drinks 18:30 at the Auditorium of Hospital Center Oost-Limburg, Genk, Belgium. Not to be missed.

NYSORA Monthly Poll: VOTE NOW!"

Featured Educational Video: Ultrasound-Guided Femoral Nerve Block

NYSORA Symposiums and Workshops