The Anesthesiologist of Tomorrow

Regional anesthesia is increasingly demonstrating improved clinical outcomes, speedier discharge, enhanced patient satisfaction and significant cost savings. EHM asked B. Braun’s SVP of Marketing, Tim Richards, how healthcare providers can realize the tremendous benefits of regional anesthesia.

EHM. Within the past five years, what significant developments have occurred within delivery of regional anesthesia?
TR. The most significant developments over the past five years have been in the areas of upper and lower extremity PNBs (Peripheral Nerve Blocks), peripheral nerve stimulation, post-op ambulatory infusion pumps, stimulating catheters and the advanced training clinicians are receiving with these new techniques and products. All of these developments have helped fuel the growth of outpatient surgery, providing more effective surgical and post-op blocks and shorter recovery room stays. In an era of cost containment and the continual goal of better patient care, regional anesthesia has become one of the fastest growing anesthesia sub-specialties. New PNB devices, coupled with the introduction of long-acting local anesthetics and ultrasound techniques, is continuing to expand the utility of regional anesthesia.

In all five of these areas, B. Braun, the market share leader in regional anesthesia products, has developed new products and educational materials to support this industry growth. In January, we launched the simple-to-use Contiplex stimulating catheter, and in April the launch of our new HNS 12 nerve stimulator with SENSe (Sequential Electrical Nerve Stimulation) will help make nerve blocks easier to perform. We are also working on product improvements to our leading Perifix epidural catheter line, our complete Pencan spinal needle portfolio and our Espocan combined spinal/epidural line.

EHM. Why choose local or regional anesthesia over general anesthesia?
TR. Regional anesthesia eliminates the unwanted side effects of general anesthesia, including PONV (Post-Op Nausea and/or Vomiting), sore throat and cognitive dysfunction. Most importantly, regional anesthesia can reduce the administration of opiods. This can have huge implications for speedier discharge and increased patient satisfaction.

EHM. Can you explain the theory that enables pain control through continuous regional blocks?
TR. It was only five years ago that patients undergoing open rotator cuff and complex ACL repairs required such a high narcotic load that they frequently had to stay overnight in the hospital. But today, thanks to continuous infusion regional blocks that control pain at its source for 72 hours or longer, the surgical stay is shorter and the patient satisfaction is greater. When general anesthesia is used for shoulder surgery, for example, severe post-op pain can result, and if opioids are ineffective or ‘patchy’, as they sometimes are, physiotherapy stops and the patient may develop adhesive capsulitis, requiring reoperation or more manipulation. A continuous catheter is placed pre-operatively by the anesthesiologist and is usually then connected to a small, transportable pump for post-op pain control.

B. Braun is also a leader in infusion therapy pumps, both ambulatory and pole-mounted, and we are constantly developing new safety features to increase the efficacy of patient infusions throughout the continuum of care.

EHM. How has ultrasound affected the way in which a regional anesthetic is being delivered?
TR. Ultrasound provides real-time anatomic information so clinicians can insert the nerve block needle in the correct location near the nerve, while the motor response to peripheral nerve stimulation verifies that the correct nerve is being targeted. Ultrasound is particularly useful when the nerve the clinician is seeking is close to structures best avoided, such as during a supraclavicular block where the nerves of the brachial plexus are very close to the subclavian artery and lung. By watching the needle approach the plexus under ultrasound, there is increased confidence that these structures will be avoided.

After confirming the correct location with nerve stimulation, the ultrasound picture can help confirm a good spread of anesthetic around the nerve. This dual technique of nerve stimulation and ultrasound is being adopted by anesthesiologists worldwide.

EHM. What does the future hold for the anesthesiologist of tomorrow?
TR. As technology continues to advance, especially in the area of nerve stimulation software, improved ultrasound probes, echogenic needles and advanced catheter and infusion pump safety features, the anesthesiologist will have even better tools to provide safer and more effective anesthesia and analgesia. These new tools will likely result in a wider use and demand for regional anesthesia by surgeons and their patients, requiring greater partnership between clinicians, industry and healthcare consumers throughout the continuum of care.