Greetings from New York City. A BIG thank you to all who attended the September NYSORA Symposium in New York. We were impressed with the attendance and the enthusiasm of the attendees; it was a great conference and we look forward to next year’s event. In this newsletter, we are proud to announce some exciting new changes to the Symposium that will be introduced in 2013, to make an already excellent meeting even better.
Additionally, I must remind all that our annual NYSORA Asia meeting is fast approaching. The official dates for the meeting are February 23-24, 2013, in Manila. You can learn more at http://www.nysoraasia.com.
Best, Clark Jaffe
UNVEILING OF NEW FEATURES TO NYSORA 2013 in NYC We would like to share some exciting changes to our annual NYSORA symposium, which is scheduled to take place at the Marriott Marquis in New York City on September 21-22, 2013.
Based on enormous enthusiasm by the delegates and the faculty about the ongoing innovative changes in the NYSORA annual programs, we have decided to make further changes to the 2013 NYSORA annual symposium. New to 2013, we will introduce the NYSORA Think Tank lecture series (NTT). This lecture series will introduce a completely new format. During each lecture, key opinion leaders on specific subjects will present 20-minute talks based on an in-depth synthesis of their research. As opposed to traditional lectures where speakers are required to stick to the data published in the peer-reviewed journals, the carefully selected NTT lecturers will be given a wide degree of freedom to present their own, unique take on the current status and the future of their topic. In some ways, the NTT NYSORA series will be crafted to resemble the fabled TED lectures. However, in addition to the NTT presentations, the audience will have 10 minutes following the lecture to challenge the lecturer on the presentation, which should generate a lively debate. All NTT presentations will be filmed for podcast video streaming off the NYSORA website. The NYSORA NTT lecturers will be announced in the upcoming weeks and some aspects of their presentations will be hinted at in interviews to be featured in future NYSORA newsletters, so keep your eye on these developments
In its attempt to substantially boost the annual symposium, NYSORA has formed a new scientific committee made up of some of its top international collaborators who will craft and chair specific sessions as well as provide input for future NYSORA programs
Finally, NYSORA social and networking events are well known and unparalleled. The social program at the NYSORA September 2013 annual program will be no exception. Several surprise events are planned and will be kept top secret until revealed on September 21, 2013.
We look forward to seeing you in New York, The NYSORA team
Scenes from the exhibit hall at NYSORA 2012 in New York City.
INTERVIEW WITH DR. MASSIMO ALLEGRI
Massimo Allegri is Associate Professor, Department of Surgical, Clinical, Diagnostic and Pediatric Science of University of Pavia, Italy. He works as consultant and clinical reseacher in Fondazione IRCCS Policlinico San Matteo and at the University of Parma. He is the founder of SIMPAR group (Study in Multidisciplinary Pain Research), which hosts a popular annual meeting, the next one occurring March 2013 in Pavia. Dr. Allegri’s major clinical interests concern pharmacogenomics and pain, opioid therapy, and interventional pain management.
The SIMPAR team. Dr. Allegri is in the back row, center, with red tie.
Tell us about your meeting and its focus.
SIMPAR meeting has reached its fifth edition so far. Since its first edition the purpose of the meeting has been to link bench to bedside in order to give to all attendees an increased understanding of how it is possible to change our clinical practice on acute and chronic pain management on the basis of the newest findings. The purpose of SIMPAR and our research group (www.simpar.it) is to encourage the international sharing of experience and knowledge and create common directions in pain management and research in order to optimize pharmacological and interventional therapies toward an evidence based management of the fifth vital sign. The meeting is divided in two different days. In the first day the attendants can choose between three different workshops fully dedicated to a specific topic:
1- How Regional Anesthesia can improve patient postoperative outcome: during this workshop we will focus our attention about the evidence of different techniques of regional anesthesia in improving patient outcomes and reducing as much as possible the chronic postoperative pain. We will discuss also NONA technique together with paravertebral block, TAP block, intrawound catheter infusion and peripheral nerve blocks. 2- Use of opioids for chronic pain: This workshop intends to deepen the knowledge of these analgesics, with a multidisciplinary approach, involving animal models used to understand their activity, the genetic and gender variability of opioid response, their clinical effects and pharmacokinetics. Finally, peripherally acting opioids and their clinical implication for pain control will be presented. The main purpose is to give to basic scientists new inputs for their research and to provide clinicians a new approach in order to better manage this very important class of drug. 3- Chronic pain management: This workshop will focus on different types of pain (including neuropathic and breakthrough pain) stressing the complex mechanisms triggering them. It will involve a practical overview of interventional pain management techniques and also the safe NSAID use in the elderly. The main purpose is to give clinicians a better understanding of chronic pain both diagnostic and therapeutical.
Meanwhile in the second day, in the plenary session, we will present the most recent discoveries or the most debated challenges in the field of acute and chronic pain in order to discuss all together how we have to change our clinical practice and which are the future directions. Finally, this year we will also obtain to open our meeting with three key lectures about the neurobiological meaning of pain (Prof Cervero – president of IASP), how we can improve our research activity in pain (Prof Huntoon – editor in chief elected of Regional Anesthesia and Pain Medicine) and how Ultrasound could be a real “innovative” and useful device also for interventional chronic pain management (Prof Peng – one of the most important researchers in this field).
Scenes from SIMPAR
What are the newest hot topics in Pain Medicine?
I think that in Pain Medicine we have exponentially improved our knowledge in the last years. In acute pain management the real hot topics are new approaches (such as Regional Anesthesia and NONA technique) that focus their attention not only in reducing pain but also in trying to prevent cancer recurrence and chronic postoperative pain development (two of the most challenging problems of postoperative period). In chronic pain management the hottest topics are both to define the real evidence of new interventional pain management (there are an increasing number of new techniques but there is a lack of evidence about them) and to succeed in using in a more proper and effective way all the drugs that are currently available.
How does practice of Pain Medicine differ in Italy and Europe from that in the USA if at all?
The biggest difference is the use of opioids. In USA you have a lot of concerns about it but in Europe there is still a need to increase their use because (especially in Italy) there is a sort of “opioidofobia”. There is a need for better understanding of predictive factors of their efficacy and/or side effects and I am really convinced that genetics and pharmacokinetics will be useful tools in helping us in optimizing opioid treatments. Finally, it will be important also to deepen the peripheral action of these drugs.
What is the latest HOT technological development(s) in pain medicine?
I think that the real NEW and HOT technological development in Pain Management is and will be nanotechnology applied to pain therapy. We are involved in research about it and I think that in the future this technology could guarantee us to obtain a more effective and safe treatment of acute and chronic pain. In fact with nanotechnology we could choose exactly where, how and when we have to administer pain drugs.
What do you think of a role of pre-emptive multimodal approach to perioperative pain therapy?
Even if there no a clear evidence in its role, I think that pre-emptive multimodal analgesia is a key factor in our acute pain management. In fact it could be helpful in reducing the necessity of postoperative drugs and in reducing the risk of chronic postoperative pain. I think that we have to deepen the role not only of regional anesthesia techniques but also of new drugs such as dexmedetomidine.
Are there any challenges unique to being a pain physician? What about unique rewards to the profession?
A Pain Physician has to be a “multi-dimension” physician. I think that the real challenge in this profession is that a pain physician has to match the huge need and space for research and development with the evidence of years of experience, facing a very frail patient’s population whose expectations are, not only of physical improvement, but of real “comprehensive care.” The possible rewards are really numerous: firstly our patients’ satisfaction but also our personal satisfaction when working in a very stimulating medical and research field, with several possibilities of applying our knowledge and being able to deepen it.
INTERVIEW WITH DR. RAVINDRAN NAIR
Dr. Ravindran Nair is the Director of the Regional Anaesthesia Fellowship Programme at Broomfield Hospital in Chelmsford, England.
What attracted you to regional anesthesia?
I have been attracted to regional anaesthesia from very early on in my training days back in 1986 in India. The fact that with an injection to a part of the body you could have an operation on an awake patient or have a patient completely pain free when they woke up from their General Anaesthesia totally awestruck me. Even still it doesn`t cease to amaze me. It seemed like Magic to me except that this was NO ILLUSION or sleight of the hand.
What are the current trends in regional anesthesia of interest to you?
My area of practice is total knee arthroplasty - hence the current trend toward sensory blocks is what interests me. The other aspect of regional anaesthesia I am really passionate about is its effects on outcomes of cancer metastasis and recurrence. I have been following almost all of the studies very keenly in relation to this aspect.
Dr. Ravindran Nair
What are some of your methods to ensure a safe block?
I check the patient`s consent form with the patient and also check and make sure the side of the operation and site is very clearly marked. I stop and check before I actually make the injection as to it is the correct side as well. I perform almost all my blocks awake and if sedation is required I use it sparingly. In addition I inject the local anaesthetic myself and do not use a 2nd pair of hands for it so as I get a feel for how easy it is to inject. I perform all my blocks under ultrasound guidance.
What do you think of the role of nerve stimulation and injection pressure monitoring?
Nerve stimulation does add to the safety of the block, but as everything else has its down sides. So if you know how to use it appropriately it can be useful. Injection pressure monitoring should be really useful however I haven’t been able to use it in my practice, mainly because of the budgetary pressure in the NHS nowadays.
What do your surgeons think about the potential of RA to decrease the risk of cancer recurrence and how does this impact your practice?
Unfortunately before we speak about the surgeons it is our Anaesthetic peers who need to be educated first and then convinced. I am sure the articles first started to come out around mid-2000 or so in relation to breast cancer. However even in today you will find many of our colleagues who are totally ignorant of this connection. It comes as news to many when I talk about it. As far as surgeons are concerned if we had substantial evidence and many of us practiced it, I am sure they will have no objections. At the moment however it is an uphill task for me. I am unable to provide it for my patients with some surgeons as they see it as something that takes time. They do not see the potential.
What do you feel is the educational significance/role of NYSORA.com worldwide and UK more specifically?
I think NYSORA has a really huge educational significance and role. The ease of access to all aspects of regional anaesthesia at a click of a button is fantastic. I have been using the NYSORA website for my references and I ask my trainees to use it as well. As far as their conferences go it is absolutely fantastic. What is really amazing is they take it to various countries in the world too. I remember back in 2009 I think when I attended the very first NYSORA meeting outside New York here in London. So I think NYSORA is playing a really fantastic educational role for regional anaesthesia.
SPOTLIGHT ON A NEW EDUCATIONAL RESOURCE FOR ULTRASOUND-GUIDED REGIONAL ANESTHESIA
Fundamentals of Ultrasound-Guided Regional Anesthesia: An Interactive Guide is a recently released ebook by Glenn Woodworth, Eric Roessler, and Jean-Louis Horn. Here, we have asked Dr. Horn (of Oregon Health and Science University) a few questions about the project.
What motivated you to publish this iBook?
The electronic book format is ideally suited to teach ultrasound skills. This format allowed us to include animations, interactive illustrations, and quizzes to illustrate key concepts. In addition, the format allowed us to include multiple ultrasound videoclips. This level of interactivity goes far beyond what is available in current textbooks or websites.
Jean-Louis Horn, MD. Professor and Director of Regional Anesthesia at Oregon Health and Science University in Portland, Oregon
Glenn Woodworth, MD. Director of the Regional Anesthesia Fellowship program at Oregon Health and Science University.
Please tell us more about the book? What are its unique features?
The electronic format for this topic is unique and it was written to take advantage of the multi-touch interactivity and multi-media capability of electronic books. This book is also unique because of its content. We included chapters on ultrasound physics, machine operation and an extensive discussion on tips and strategies related to guiding needles to targets using ultrasound. These topics are often only superficially addressed. We have also focused on anatomy and sonoanatomy to give learners a solid understanding of how to recognize key structures on ultrasound. Most websites portray a single idealized sonographic image that encourages learners to only recognize an image pattern of an ideal nerve. Unfortunately, most patients don’t have idealized anatomy. This book teaches fundamental sonoanatomy and key anatomy relationships to help learners master a strategy for ultrasound scanning and ultrasound guided regional anesthesia procedures.
Who is the intended audience?
This book is intended for those with limited experience with ultrasound guided regional anesthesia; however, even those with more experience have found the book valuable.
Please tell us more about the process of self-publishing an iBook. Was it more or less challenging than you anticipated? How so?
The first step is the significant work it takes to assemble your content including digital assets like video clips, artist drawings and animations. Once these were assembled, we took advantage of Apple authoring software to construct a multi-media book. This authoring software was easy to use and we were able to create a very professional text; however it is for the iPad only. We have not explored if we could also use the software to export to a format that could be published on other e-readers. The next step is publishing. We had to go through a learning curve to obtain a copyright, ISBN number, and other elements required to publish a book. We then executed a distribution contract with Apple, which has some restrictive clauses that have made some authors uneasy. The final proofing and electronic publishing went smoothly. Overall the process was a bit more than we expected, but was well worth the effort.
Sample from the iBook.
To learn more about the ebook, including purchasing information:
The Journal of the American Medical Association had a very favorable review of the new NYSORA textbook in their July 18 issue. Here are a few excerpts. The full review is at http://jama.jamanetwork.com.
“The list of peripheral nerve blocks is substantial and covers upper extremity, lower extremity, and truncal nerve blocks. Although some clinicians will want to skip directly to the section dealing specifically with ultrasound-guided nerve blocks, readers should not overlook the chapters on nerve stimulation and surface landmark techniques; these dynamic chapters cover a significant amount of anatomical pearls relevant to ultrasound-guided techniques. Plenty of “Tips” are located throughout each chapter. A short section discusses ultrasound basics and techniques for optimizing images. Readers new to the use of ultrasound will find these chapters particularly helpful.”
“The final section is a large repository of ultrasound images, with and without labels, paired with prepared human cross-sections. In addition, the images show placement of the ultrasound probe on the skin to help orient the reader. This will be of particular importance for readers looking for a quick review and reminder prior to probe placement.”
“There are an impressive number of regional anesthesia books on the market, and they all have their value. But when it comes to learning regional anesthesia, it's the subtleties of performing blocks that is key. No book comes closer to teaching the art of regional anesthesia than this one does. The previous edition was published in 2004, and a lot has been added to this edition. Apart from dedicating half the book to ultrasound techniques, whole sections are devoted to cadaver and ultrasound images and surface anatomy. In short, this is the only book one needs to learn and become proficient in performing regional anesthesia.”