Department of Anesthesiology Faculty Papers

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Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital
(International Journal of Critical Illness and Injury Science | Published by Wolters Kluwer - Medknow, 2016-09) Lollo, Loreto; Grabinsky, Andreas
Background: Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. Methods: Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted. Results: One hundred twenty‑four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty‑one percent were male. Motorized vehicles caused 51% of injuries in males. Forty‑one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty‑seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long‑term follow‑up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work. Conclusion: Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.
Regional Anesthesia in TraumaMedicine
(Hindawi Publishing Corporation, 2011) Wu, Janice J.; Lollo, Loreto; Grabinsky, Andreas
Regional anesthesia is an established method to provide analgesia for patients in the operating room and during the postoperative phase. While regional anesthesia offers unique advantages, as shown by the recent military experience, it is not commonly utilized in the prehospital or emergency department setting. Most often, regional anesthesia techniques for traumatized patients are first utilized in the operating room for procedural anesthesia or for postoperative pain control. While infiltration or single nerve block procedures are often used by surgeons or emergency medicine physicians in the preoperative phase, more advanced techniques such as plexus block procedures or regional catheter placements are more commonly performed by anesthesiologists for surgery or postoperative pain control. These regional techniques offer advantages over intravenous anesthesia, not just in the perioperative phase but also in the acute phase of traumatized patients and during the initial transport of injured patients. Anesthesiologists have extensive experience with regional techniques and are able to introduce regional anesthesia into settings outside the operating room and in the early treatment phases of trauma patients.
Inferior Hypogastric Plexus Block Affects Sacral Nerves and the Superior Hypogastric Plexus
(2012) Stogicza, A; Trescot, A. M.; Racz, E.; Magyar, L.; Keller, E.
Background. The inferior hypogastric plexus mediates pain sensation through the sympathetic chain for the lower abdominal and pelvic viscera and is thought to be a major structure involved in numerous pelvic and perineal pain syndromes and conditions. Objectives. The objective of this study was to demonstrate the structures affected by an inferior hypogastric plexus blockade utilizing the transsacral approach. Study Design. This is an observational study of fresh cadaver subjects. Setting. The cadaver injections and dissections were performed at the Department of Forensic Sciences and Insurance Medicine, Semmelweis University, Budapest, Hungary after obtaining institutional review board approval. Methods. 5 fresh cadavers underwent inferior hypogastric plexus blockade with radiographic contrast and methylene blue dye injection by the transsacral fluoroscopic technique described by Schultz followed by dissection of the pelvic and perineal structures to localize distribution of the indicator dye. Radiographs demonstrating correct needle localization by contrast spread in the specific tissue plane and photographs of the dye distribution after cadaver dissection were recorded for each subject. Results. In all cadavers the dye spread to the posterior surface of the rectum and the superior hypogastric plexus. The dye also demonstrated distribution to the anterior sacral nerve roots of S1, 2, and 3 with bilateral spread in 3 cadavers and ipsilateral spread in 2 of them. Limitations. The small number of cadaver specimens in this study limits the results and generalization of their clinical significance. Conclusions. Inferior hypogastric plexus blockade by a transsacral approach results in distribution of dye to the anterior sacral nerve roots and superior hypogastric plexus as demonstrated by dye spread in freshly dissected cadavers and not by local anesthetic spread to other pelvic and perineal viscera.
Propofol infusion syndrome in a super morbidly obese patient (BMI = 75)
(Medknow Publications, 2011) Ramaiah, Ramesh; Lollo, Loreto; Brannan, Douglas; Bhananker, Sanjay M
Propofol infusion syndrome (PRIS) is a rare but often fatal complication as a result of large doses of propofol infusion (4–5 mg/kg/hr) for a prolonged period (>48 h). It has been reported in both children and adults. Besides large doses of propofol infusion, the risk factors include young age, acute neurological injury, low carbohydrate and high fat intake, exogenous administration of corticosteroid and catecholamine, critical illness, and inborn errors of mitochondrial fatty acid oxidation. PRIS manifestation include presence of metabolic acidosis with a base deficit of more than 10 mmol/l at least on one occasion, rhabdomyolysis or myoglobinuria, acute renal failure, sudden onset of bradycardia resistant to treatment, myocardial failure, and lipemic plasma. The pathophysiology of PRIS may be either direct mitochondrial respiratory chain inhibition or impaired mitochondrial fatty acid metabolism mediated by propofol. We report a case of supermorbidly obese patient who received propofol infusion by total body weight instead of actual body weight and developed PRIS.
A Rare Complication of Tracheal Intubation: Tongue Perforation
(Hindawi Publishing Corporation, 7/4/1905) Lollo, Loreto; Meyer, Tanya K.; Grabinsky, Andreas
Aim. To describe the subsequent treatment of airway trauma sustained during laryngoscopy and endotracheal intubation. Methods. A rare injury occurring during laryngoscopy and endotracheal intubation that resulted in perforation of the tongue by an endotracheal tube and the subsequent management of this unusual complication are discussed. A 65-year-old female with intraparenchymal brain hemorrhage with rapidly progressive neurologic deterioration had the airway secured prior to arrival at the referral institution. The endotracheal tube (ETT) was noted to have pierced through the base of the tongue and entered the trachea, and the patient underwent operative laryngoscopy to inspect the injury and the ETT was replaced by tracheostomy. Results. Laryngoscopy demonstrated the ETT to perforate the base of the tongue. The airway was secured with tracheostomy and the ETT was removed. Conclusions. A wide variety of complications resulting from direct and video-assisted laryngoscopy and tracheal intubation have been reported. Direct perforation of the tongue with an ETT and ability to ventilate and oxygenate subsequently is a rare injury.
Post-Operative Pain Scores and Level of Regional Anesthesia Expertise: Using Clinical Outcomes to Assess Procedural Proficiency
(Austin Publishing Group, 12/3/2014) Lollo, L; Stogicza, A
Background and Objectives: Peripheral nerve blockade requires regional anesthesia skills that trainees learn in several formats. Technical proficiency has shifted from a quota to comprehensive procedural evaluation. Successful nerve blockade is the clinical endpoint validating proficiency but patient, technical and procedural factors influence this result. The purpose of this study was to determine if procedural expertise for sciatic nerve blockade influenced postoperative pain scores and opioid requirements and if patient factors, technique and repetition influenced this outcome. Method: Sciatic nerve blockade by nerve stimulation and ultrasound guidance and training level of the resident performing the procedure were recorded. Patient obesity, trauma, chronic pain, opioid use and preoperative pain scores were compared to post-procedure pain scores and opioid analgesic requirements. Results: 102 patients received sciatic nerve blockade from 47 trainees over a 36 month interval. A significant relation between training level and improved pain scores was not demonstrated but transition from nerve stimulation to ultrasound guidance lowered scores in all groups. Nerve blockade failure was frequent with chronic opioid use and trauma. Conclusion: Analgesic outcomes should be an integral part of assessment of proficiency in regional anesthesia techniques. Evaluating outcomes of procedures throughout training will longitudinally assess technical expertise.
Prolonged Duration of Sciatic Nerve Blockade in the Elderly after Foot and Ankle Surgery
(the Science Fair Open Library, 9/24/2014) Lollo, L; Stogicza, A
1.1 Background and Objectives: Perioperative morbidity related to anesthesia renders elderly patients vulnerable because age related factors affect medication effects, clearance and metabolism. Regional anesthesia within a multimodal regimen reduces opioid adverse effects in the elderly and improves immediate analgesia but not long term recovery and prolonged nerve blockade has been reported. The purpose of this study was to assess analgesic effects of sciatic nerve blockade in the elderly. 1.2 Methods: Postoperative sciatic nerve blockade was administered for foot and ankle surgery to patients over age 18 years. Preoperative, post-anesthesia unit and 24 hour postoperative pain scores and opioid doses for these same intervals were recorded. 1.3 Results: 47 patients enrolled and 12 (25.5%) were over age 70. Preoperative, immediate and 24 post-operative pain scores and total intraoperative and immediate postoperative opioid doses were lower in the elderly. The total 24 hour postoperative opioid doses in the elderly were lower compared to the younger group. 1.4 Conclusions: Total 24 hour postoperative cumulative opioid doses after sciatic nerve blockade in patients over 70 are lower than in younger patients. Further observations in greater numbers of patients and improved ultrasound to assess sciatic nerve structure in the elderly are warranted to study this effect.
Ultrasound Guided lateral Infra-trochanteric Sciatic Nerve Blockade for Proximal Tibial Surgery: A Novel Technique
(9/1/2011) Lollo, Loreto; Stogicza, Anges R; Estebe, Jean-Pierre
Sciatic nerve blockade (SNB) can be performed at several point along its anatomic course. Proximal SNB techniques described include the classic Labat, sacral (Mansur), infragluteal (Raj), and anterior approches Distal SNB techniques include the mid-femoral, posterior and lateral popliteal and mid-tibial approaches. The anatomic region of the lower extramity to be anesthetixzed will determine the appropriate SNB technique to use for the operative procedure.
Abstract Title: Ultrasound Guided Trans-sartorial Continuous Saphenous Nerve Blockade - A technique for Relief of Postoperative Medial Incisional Foot and Ankle Pain
(1/1/2009) Lollo, Loreto; Edwards, W. Thomas
The saphenous nerve (SaN) innervates the region from the upper medial thigh to the medial aspect of the foot and ankle. A femoral nerve block (FNB) is effective for blockade of the SaN but this causes quadriceps weekness and reduced patient mobility that is unsuitable in an ambulatory surgical setting.
Postoperative Analgesia Following Sciatic Nerve Blockade Administered by Nurse Anesthetists Supervised by Regional Anesthesia Faculty in an Academic Hospital
(Sciencedemain International, 8/23/2015) Lollo, L; Stogicza, A
Introduction: Assessment of expertise in regional anesthesia techniques is traditionally based upon quota fulfillment of procedures during training. Validation of practitioner proficiency in performing procedures in surgical specialties has moved from simple measurement of technical skills to evaluation of global patient outcomes. Complete absence of pain as a result of nerve blockade is the most important clinical endpoint but patient, technical and procedural factors influence results. The purpose of this study was to measure the postoperative pain scores and associated analgesic medication requirements for patients administered sciatic nerve blockade by nurse anesthetists and determine patient or procedural factors that influenced this outcome. Methods: Either nerve stimulator or ultrasound guided sciatic nerve blockade was administered by nurse anesthetists under the supervision of regional anesthesia faculty. Patient demographic data that was collected included gender, body mass index, surgical procedure, and pre-existing chronic pain with associated opioid use. Patient self-reported pain scores and opioid analgesic dosages in the preoperative, intraoperative, immediate postoperative and 24 hour post procedure intervals were recorded. Results: 22 nurse anesthetists administered sciatic nerve blockade to 48 patients during a 36 month interval. Transition from a nerve stimulator to ultrasound guided sciatic nerve block technique resulted in lower mean pain scores. Patients reporting chronic opioid use were observed to have elevated perioperative opioid analgesic requirements and pain scores compared to opioid naïve patients. Conclusion: Effective analgesia is a prime measure for assessing expertise in regional anesthesia and continuous evaluation of this outcome in everyday practice is proposed.
Differences in analgesia in opioid naïve and tolerant patients with sciatic nerve blockade following elective foot and ankle surgery
(the Science Fair Open Library, 9/24/2014) Lollo, L; Stogicza, A
1.1 Introduction and Purpose: Adequate postoperative analgesia in the opioid tolerant with chronic non-malignant pain is challenging. Multimodal pain relief regimens include regional anesthesia but opioid tolerant patients report increased postoperative pain and opioid consumption. This study compared analgesia in opioid naïve and tolerant patients receiving postoperative sciatic nerve blockade for foot and ankle surgery. 1.2 Method: Preoperative pain scores, trauma, maintenance and intraoperative opioid doses and following postoperative sciatic nerve blockade, patient self-reported pain scores and opioid consumption at discharge from the post-anesthesia unit and 24 hours were recorded. 1.3 Results: 191 patients enrolled. 40.3% were opioid tolerant and 33% had lower extremity trauma. Preoperative, immediate and delayed postoperative pain scores and intraoperative, immediate and 24 hour postoperative consumption of opioids were increased in opioid tolerant patients. Trauma and continuous infusion in opioid naïve and tolerant groups did not result in differences in 24 hour opioid consumption. 1.4 Limitations: Small subgroups and use of the pain score limited the accuracy of results. 1.5 Conclusion: Opioid tolerant patients require greater analgesic doses following sciatic nerve blockade for foot and ankle surgery. 24 hour opioid consumption for opioid naïve and tolerant patients is neither influenced by lower extremity injury nor continuous infusion.
Patient Variability in Sciatic Nerve Branch Point Distance Using Ultrasound Guided Localization
(Austin Publishing Group, 7/1/2014) Lollo, L; Stogicza, A
Background and Objectives: Improved ultrasound and needle technology make popliteal sciatic nerve blockade a popular anesthetic technique and imaging to localize the branch point of the common peroneal and posterior tibial components is important because successful blockade techniques vary with respect to injection of the common trunk proximally or separate injections distally. Nerve stimulation, ultrasound, cadaveric and magnetic resonance studies demonstrate variability in distance and discordance between imaging and anatomic examination of the branch point. The popliteal crease and imprecise, inaccessible landmarks render measurement of the branch point variable and inaccurate. The purpose of this study was to use the tibial tuberosity, a fixed bony reference, to measure the distance of the branch point. Method: During popliteal sciatic nerve blockade in the supine position the branch point was identified by ultrasound and the block needle was inserted. The vertical distance from the tibial tuberosity prominence and needle insertion point was measured. Results: In 92 patients the branch point is a mean distance of 12.91 cm proximal to the tibial tuberosity and more proximal in male (13.74 cm) than female patients (12.08 cm). Body height is related to the branch point distance and is more proximal in taller patients. Separation into two nerve branches during local anesthetic injection supports notions of more proximal neural anatomic division. Limitations: Imaging of the sciatic nerve division may not equal its true anatomic separation. Conclusion: Refinements in identification and resolution of the anatomic division of the nerve branch point will determine if more accurate localization is of any clinical significance for successful nerve blockade.
Comparison of Analgesic Outcomes Following Sciatic Nerve Blockade Performed by Resident Trainees and Nurse Anesthetists
(MedCrave, 8/6/2015) Lollo, L; Stogicza, A
Background and objectives: Peripheral nerve blockade requires regional anesthesia skills that are taught in several formats and assessing technical proficiency has shifted from fulfillment of quotas to comprehensive procedural evaluation. Complete analgesia is the clinical endpoint validating successful nerve blockade but patient, technical and procedural factors influence this result. The purpose of this study was to determine if physician trainee or nurse anesthetist administered sciatic nerve blockade influence postoperative pain scores and opioid analgesic requirements and if patient factors, technique and repetition influence this outcome. Method: Sciatic nerve blockade by nerve stimulation and ultrasound based techniques were performed by senior anesthesiology resident trainees and nurse anesthetists under the supervision of regional anesthesia faculty. Preoperative patient characteristics including obesity, trauma, chronic pain, opioid use and preoperative pain scores were recorded and compared to the post-procedure pain scores and opioid analgesic requirements upon discharge from the post-anesthesia care unit and 24 hours following sciatic nerve blockade. Results: 93 patients received sciatic nerve blockade from 22 nurse anesthetists and 21 residents during 36 months. A significant relation between training background and improved pain scores was not demonstrated but transition from nerve stimulation to ultrasound guided techniques lowered immediate opioid usage in all groups. Patients with pre-existing chronic opioid use had higher postoperative pain scores and opioid dosages following nerve block. Conclusion: Patient analgesia should be an integral measure of proficiency in regional anesthesia techniques and evaluating this procedure outcome for all practitioners throughout their training and beyond graduation will longitudinally assess technical expertise.
Ultrasound Mapping of Nerve Stimulator Response during Sciatic Nerve Blockade and Relation to Postoperative Pain Scores
(Science Fair Open Library, 9/24/2014) Lollo, L; Stogicza, A
1.1 Background and Purpose: Ultrasound guided sciatic nerve blockade has rapid onset but at 24 hours pain is greater than nerve stimulator techniques. Injection of the nerve branches or trunk and sub-sheath blockade increase success and reduce onset times but risk injury. This study mapped needle coordinates for sciatic nerve blockade with nerve stimulation and its relation to postoperative pain scores. 1.2 Method: Angle and distance of the needle tip and infusion catheter from the popliteal sciatic nerve at which stimulated plantar flexion occurred were measured. Pain scores at postanesthesia unit discharge and 24 hours were recorded. 1.3 Results: 81% of opioid naïve patients reported immediate analgesia and 20.8% at 24 hours. In opioid tolerant patients 56.8% reported immediate analgesia and 9.1% at 24 hours. Plantar flexion was observed with the needle in the posterior medial quadrant near the sciatic nerve. Opioid tolerant patients reported adequate analgesia when the needle was located more medially and proximally to the sciatic nerve. 1.4 Conclusion: Stimulated plantar flexion is isolated to a narrow angular range in the posterior medial quadrant adjacent to the sciatic nerve. Opioid tolerant patients report adequate analgesia if the needle and catheter are more medial and proximal to the nerve surface.
Ultrasound Mapping of Stimulated Finger Flexion During Infra-Clavicular Brachial Plexus Nerve Blockade for Elbow Arthroplasty and Its Correlation To Postoperative Analgesia
(SciDoc Publishers, 6/17/2015) Lollo, L; Stogicza, A
Background: Infraclavicular brachial plexus nerve blockade (ICNB) is a very common anesthetic procedure performed for upper extremity surgery at the elbow and distally, however the rate of adequate analgesia is variable among patients. Ultrasound guidance (US) has not been demonstrated to increase the success rate of ICNB when compared to nerve stimulator (NS) guidance. Combined US and NS guided ICNB have not been reported, although there is a call for more trials comparing the two techniques. This study was performed to observe if a specific anatomic region near the axillary artery of the brachial plexus identified by finger flexion with nerve stimulation results in improved postoperative analgesia. Method: Patients undergoing elective elbow arthroplasty received a postoperative ICNB. The angle of the nerve stimulator needle tip and the radial distance from the center of the arterial lumen at which an optimal finger flexion twitch response was observed were measured with ultrasound imaging. Pain scores and postoperative opioid dosages on discharge from the post anesthesia care unit and at 24 hours after surgery were recorded. Results: 11 patients enrolled in this study. Adequate finger flexion response to nerve stimulation that resulted in complete analgesia was more frequently observed when the needle was located in the postero-superior quadrant in relation to the axillary artery. Identifying a specific point near the brachial plexus in relation to the artery that consistently provides superior analgesia is desirable and would lead to improved analgesia and faster onset time of nerve blockade and would reduce the need for other approaches for brachial plexus blockade with their associated disadvantages.
Postoperative sciatic and femoral or saphenous nerve blockade for lower extremity surgery in anesthetized adults
(International Journal of Critical Illness and Injury Science, 2015-12-01) Lollo, Loreto; Bhananker, Sanjay; Stogicza, Agnes
Background: Guidelines warn of increased risks of injury when placing regional nerve blocks in the anesthetized adult but complications occurred in patients that received neither sedation nor local anesthetic. This restriction of nerve block administration places vulnerable categories of patients at risk of severe opioid induced side effects. Patient and operative technical factors can preclude use of preoperative regional anesthesia. The purpose of this study was to assess complications following sciatic popliteal and femoral or saphenous nerve blockade administered to anesthetized adult patients following foot and ankle surgery. Materials and Methods: Postoperative patients administered general anesthesia received popliteal sciatic nerve blockade and either femoral or saphenous nerve blockade if operative procedures included medial incisions. Nerve blocks were placed with nerve stimulator or ultrasound guidance. A continuous nerve catheter was inserted if hospital admission was over 24 hours. Opioid analgesic supplementation was administered for inadequate pain relief. Postoperative pain scores and total analgesic requirements for 24 hours were recorded. Nerve block related complications were monitored for during the hospital admission and at follow up surgical clinic evaluation. Results: 190 anesthetized adult patients were administered 357 nerve blocks. No major nerve injury or deficit was reported. One patient had numbness in the toes not ascribed to a specific nerve of the lower extremity. Perioperative opioid dose differences were noted between male and female and between opioid naïve and tolerant patients
Combined Saphenous-Sciatic Nerve Blockade Superior to Femoral-Sciatic Nerve Blockade for Postoperative Analgesia Following Foot and Ankle Surgery
(Journal of Anesthesia & Critical Care: Open Access, 2015-10-29) Lollo, Loreto; Stogicza, Agnes
Introduction: Femoral nerve blockade combined with sciatic nerve blockade has been reported to be an effective treatment regimen for postoperative analgesia following lower extremity surgery.Saphenous nerve blockade is an alternative to femoral nerve blockade for postoperative analgesia in knee arthroplasty surgeryand the level and quality of analgesia that either technique provides patients have been reported to be equivalent. This study compared the postoperative analgesic properties of combined femoral and sciatic nerve blockade with those of combined saphenous and sciatic nerve blockade in patients that underwent foot and ankle surgery. Method: All patients received general inhalational endotracheal anesthesia and were administered lateral popliteal sciatic nerve blockade by a combined nerve stimulator and ultrasound guidance technique in the postoperative recovery area. During the first six months of the study femoral nerve blockade was simultaneously administered employing combined nerve stimulation and ultrasound guidance. During the second six month interval saphenous nerve blockade was administered using ultrasound guidance. Continuous nerve block catheters were inserted if patients were admitted over 24 hours. Breakthrough pain was treated with hydro-morphone patient controlled analgesic infusions. Postoperative pain scores, opioid analgesic consumption and lower extremity movement in the immediate recovery period and at 24 hours after nerve blockade were recorded. Results: 167 patients were enrolled. Femoral nerve blockade was administered to 45 patients and 122 received a saphenous nerve blockade. Immediate pain scores were lower for opioid naïve females that were administered saphenous nerve blockade. All groups that received saphenous nerve blockade had lower opioid requirements in the immediate postoperative period. Differences in pain scores and opioid requirements were noted between opioid naïve and tolerant patient groups. Conclusion: Combined popliteal sciatic and saphenous nerve blockade resulted in lower immediate postoperative pain scores in opioid naïve females and reduced immediate postoperative rescue opioid analgesic dosages in all patient groups. Differences in pain scores and analgesic requirements were not present 24 hours postoperatively. Opioid tolerant patients with effective nerve blockade 24 hours postoperatively required elevated rescue opioid analgesic medication dosages.
Two Cases of Lower Extremity Compartment Syndrome after Posterior Urethroplasty
(International Journal of Anesthesiology & Research (IJAR), 2015-09-23) Lollo, Loreto; Ivashkov, Yulia; Grabinsky, Anderas; Ramaiah, Ramesh
Acute lower extremity compartment syndrome following surgery in the lithotomy position is uncommon but is a surgical emergency causing irreversible damage if suspected and requires emergent decompressive fasciotomy. This report describes compartment syndrome following bulbo-urethroplasty. Patient A developed lower extremity pain with absent dorsiflexion 9 hours after surgery and Patient B experienced calf pain immediately after surgery. One year after fasciotomy A had permanent drop foot and B had peroneal nerve distribution numbness. Shared risk factors that placed the patients at risk were obesity and prolonged surgical times. Emerging concepts aimed at improving care for patients with compartment syndrome are discussed.
Low Cost, High Fidelity Ultrasound Phantom Gels for Regional Anesthesia Training Programs
(MedEdPortal, 2012-05-04) Lollo, Loreto; Stogicza, Agnes
This is a regional anesthesia training curriculum using low cost high fidelity phantom gels that can be inexpensively produced and reused. These gels mimic the anatomic structures pertinent to performance of upper and lower extremity peripheral nerve blockade under ultrasound guidance. The process by which the phantoms can be produced and the use of these phantoms in training programs is described. An anatomical and procedural review resource is included for instructors to use with trainees prior to the simulation sessions. - See more at: https://www.mededportal.org/publication/9170#sthash.NU9xiq5B.dpuf
Advanced Pain Life Support (APLS) Simulation Training for Interventional Pain Physicians
(MedEdPortal, 2012-09-25) Trescot, Andrea; Lollo, Loreto; Stogicza, Agnes
Educational interventions including pre- and post-tests, didactic lectures, and simulation/learner feedback increase the interventional pain physician's knowledge, skills, and attitudes related to responding appropriately to emergent complications occurring during procedures. These complications have occurred during neuraxial interventions on the head, neck and spine. All physicians performing these types of specialized procedures would benefit from this training in challenging situations using a team approach, active thinking and timely feedback during simulation of catastrophic scenarios. Improved outcomes compared to historical data would indicate improved patient safety as a result. The premises for this type of training are the ACLS guidelines first published in 1974 that have saved untold numbers of lives and certification in this training is an almost universal requirement for all health care providers. Pre- and post-test data comparisons identify the effectiveness of this training. Introduction and universal adaptation of APLS as a national requirement for both the chronic pain practitioner and facility certification will promote an environment of patient safety and reduce procedure related complications. - See more at: https://www.mededportal.org/publication/9240#sthash.ZLTyjtIA.dpuf

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