October 2014 - Newsletter
Dear NYSORA Newsletter reader,
Admittedly, the NYSORA Team is still humming off of the success of our 2014 NYSORA Symposium! Not surprisingly, we are featuring an interview in this month’s newsletter with Dr Hiroaki Murata who presented 2 abstract posters on uses of Pecs II blocks. We will feature some behind the stage experiences from the NYSORA 2014 Symposium. We will wrap it up with some of the photo highlights of our best-to-date recent NYSORA Boutique session, which was amazing and thoroughly enjoyed by the attendance. If you haven't already, take a look at the Anesthesiology Network and find out what the buzz is all about!
We hope to see you at one of our upcoming educational offerings,
We recently caught up with Dr Hiroaki Murata to discuss his team's work on Pecs II blocks which they presented at the abstract sessions at the 13th NYSORA 2014 Symposium in New York.
From left to right Akiko Sakai, Hiroaki Murata, Admir Hadzic, Natsuki Mochizuki and Shozo Tominaga
What inspired your research?
Although the ultrasound-guided nerve block is becoming popular in Japan, its use depends on the environment at each hospital. I have been enthusiastic about ultrasound-guided nerve blocks for the past five years and have tried to develop a favorable environment for these techniques at our hospital. While gaining my own experiences in the techniques, I have collected data about the analgesic efficacy of ultrasound-guided nerve blocks from patients, sonoanatomical data from healthy volunteers, and gross anatomical data from cadavers with the aid of my colleagues-collaborators.
We introduced the Pecs II block for the perioperative pain management of breast cancer surgery, and presented two reports related to the Pecs II block at the 13th NYSORA symposium in New York this past September. One was a retrospective analysis of the analgesic efficacy of the Pecs II block for breast cancer surgery; the other was the anesthetic management of two elderly patients who underwent breast cancer surgery with the Pecs II block combined with intravenous dexmedetomidine.
I believe that making presentations at medical conferences and publishing articles in academic journals are good ways to affirm and promote the effectiveness of ultrasound-guided nerve blocks to the medical staff at our hospital, especially to those who work in the operating rooms. But my inspiration to make presentations and publish articles is not specific to ultrasound-guided nerve blocks; rather it is my keen desire to leave records of our daily clinical experiences accompanied by objective discussions and evaluations. Sharing our experiences can help other clinicians devise best management protocols for their own practice. The bottom line is that an exchange of ideas among anesthesiologists can improve regional anesthesia techniques and postoperative pain management all over the world because each of our experiences are different in many ways. Attending NYSORA symposia is one of the best ways to achieve this.
The Nagasaki University team standing proudly in front of their poster Natsuki Mochizuki, Shozo Tominaga, Akiko Sakai, and Hiroaki Murata.
What are the take home messages for the practicing physician?
Referring back to our experiences, the Pecs II block appears to be a good analgesic technique in combination with general anesthesia. However, complete block of the surgical stimuli of breast cancer surgery can be difficult to accomplish by the Pecs II block alone. Thus sedative agents or local anesthetic infiltration to the surgical site should be considered as part of the anesthetic plan.
Dr Murata performing a Pecs II block
What else needs to be done on this topic? What other information you would like to communicate to the NYSORA Newsletter readership that you could not fit into the publication?
As the Pecs II block is a newly developed technique, further studies are warranted to bjectively evaluate their value in proper randomized controlled trials. Trials are also needed to establish any effect of the Pecs II block on patient outcome after cancer surgery. As we presented at the NYSORA symposium, elderly Japanese female patients tend to be small in stature and lighter built. The maximum dose and appropriate concentration/volume of local anesthetic for safe and effective Pecs II block need to be evaluated. Also, we need to study the optimum combination of short- and long-acting local anesthetics for anesthesia management of breast cancer surgery with the Pecs II block without general anesthesia.
Dr Murata presenting his abstract poster at NYSORA
What is the status of regional anesthesia in Japan? What are the obstacles and what is being done to overcome them?
In Japan, one of the major topics in regional anesthesia is the ultrasound-guided nerve block, which is becoming very popular. In fact, there are no major obstacles to further development of regional anesthesia in Japan. However, some anesthesiologists no longer perform nerve blocks because ultrasound machines suitable for nerve blocks are not available at their hospitals. This is because it’s difficult to recover the cost of high-quality ultrasound machines for nerve blocks under the current healthcare system in Japan.
To help the development the practice, teaching and research in regional anesthesia, the Japanese Society of Regional Anesthesia (JSRA) was established in 2013. The Board of the JSRA is planning to certify anesthesiologists who are specialized in regional anesthesia. Many regional anesthesia workshops are offered across Japan.
The Nagasaki University team enjoying a Yankees game
Please say a few words about your experience at the 13th NYSORA Symposium this past September.
Even though this was my fourth attendance at the NYSORA symposium in NY, it still retains freshness for me. All of the lectures presented, as always at NYSORA, were by the very top-ranking faculty and were absolutely wonderful. One of the great features of the NYSORA symposium is the networking and ease of interaction with the faculty. This time, two anesthesiology senior residents in our hospital joined the NYSORA symposium. This was their first attendance at an international medical conference, and I believe they felt right at home with the world leaders of regional anesthesia. We are looking forward to the future development of NYSORA, and we hope that "NYSORA Japan" will be held in the near future.
Kohnichiwa from NYSORA in Times Square!
Thorsten Steinfeldt, MD
Yasuyuki Shibata, MD., Ph.D
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