Anesthesia E-ssential Oct. 30, 2013

Anesthesia E-ssential

Oct. 30, 2013


Vital Signs

Don’t Miss These Professional Development Opportunities
There is still time to register for the Business of Anesthesia workshop in Pittsburgh on Saturday, Nov. 2. In today’s healthcare environment you need to provide more than great clinical service. You need the tools necessary to create a strong foundation to manage your nurse anesthesia practice. The Business of Anesthesia workshop is designed to help CRNAs understand how the changing healthcare environment may impact choices. Register on site at the Renaissance Pittsburgh Hotel.

The AANA Fall Leadership Academy, Nov. 8-10, 2013, is in sun-drenched Miami Beach, Fla. This three-day event features your choice of educational tracks designed to inspire you with creative ideas and empower you with essential nuts-and-bolts information to advance the practice of nurse anesthesia. The keynote presenter is Sarah Sladek, a noted author and generational expert who will share her observations on Generations X, Y, and Z as well as leadership. Note: Online Registration for the FLA is now closed. Onsite Registration will be available at the Ocean Tower II Foyer at the Eden Roc during the following hours:
  • Friday, Nov. 8: 6:30 a.m. - 4:30 p.m.
  • Saturday, Nov. 9: 7 a.m. - 5 p.m.
  • Sunday, Nov. 1: 7 a.m. - 2 p.m.
Save the Date! The Assembly of School Faculty is Feb. 18-20, 2014, in San Diego, Calif. While we will have a pattern change for this year only, with the meeting running mid-week Tuesday through Thursday, the agenda will continue to tackle the issues and needs faced by nurse anesthesia program administrators, anesthesia program faculty, and SRNAs. Virginia Trotter Betts, RN, JD, MSN, FAAN, will address the Impact of Healthcare Policy Changes on Advanced Practice Nursing Education as the 2014 John F. Garde Memorial lecturer. Register today.


The Pulse

  • National Nurse Anesthetists Week 2014
  • October Marks 10-Year Anniversary of North Dakota and Washington Opting Out of Federal Supervision Requirement
  • International Nursing Review Seeks Associate Editors
  • Sponsor a Student for 2014
  • Support the FY2014 Annual Giving Campaign
Professional Practice
  • AANA Continues Work on Pain Management Guidelines
  • Single Dose or Multi Dose? Know the Difference
  • The Joint Commission Releases Guidance on Infection Prevention and Control Standards


PR, Publications, and eCommunications 
  • Annual Meeting Highlights Available Online!


News from COA
  • Update on Drafts of Practice Doctorate Standards and Post-Graduate Fellowship Standards

  • Colorado Supreme Court to Review Lower Court Opt-Out Decision
  • AANA SGA Division Participates in State Health Policy Conference
Federal Government Affairs
  • Uncle Sam Reopens for Business and More Budget Work on a 90-Day Deadline
  • AANA Issues Second Edition of Reimbursement Primer for CRNAs
  • Noridian Publishes Final LCD on Nerve Block Reimbursement, Effective Early November
  • Affordable Care Act Updates: Online Rollout Hits Snags, and Proposed Rule Issued on Basic Health Plans
  • Register Now for “Havana Nights” CRNA-PAC Fundraiser at Fall Leadership Academy
  • Amendments

Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Inside the Association
National Nurse Anesthetists Week 2014
Jan. 19, 2014, marks the beginning of the 15th annual National Nurse Anesthetists Week celebration. Promotional material for this year’s theme, “Our Priority, Our Passion, Our Patients,” will be available through the AANA bookstore Nov. 1 and online at To help spread the word, AANA is taking to Twitter with its hashtag #nnaw. Follow the tag to stay current with AANA-sponsored contests. Join in by incorporating the tag in your Twitter posts.
October Marks 10-Year Anniversary of North Dakota, Washington, and Alaska Opting Out of Federal Supervision Requirement
Ten years ago this month, North Dakota, Washington, and Alaska became the eighth, ninth, and tenth states, respectively, to opt out of the federal physician supervision requirement for Certified Registered Nurse Anesthetists (CRNAs). In October 2003, less than two years after the Centers for Medicare & Medicaid Services (CMS) published its anesthesia care rule granting state governors the ability to opt out of the supervision requirement, Governors Gary Locke (North Dakota), John Hoeven (Washington), and Frank Murkowski (Alaska) sent letters to CMS informing the agency that it was in the best interest of their respective states’ citizens to exercise this exemption. 

“This was a great decision for the residents of Washington 10 years ago and continues to be today,” said Christian Schmalz, CRNA, president of the Washington Association of Nurse Anesthetists. “In Washington, CRNAs have long provided safe anesthesia care to patients of all ages, for all types of procedures, and in every setting in which anesthesia care is delivered.”

Two studies confirm that opting out of the physician supervision requirement benefits patients and healthcare access. The study, titled “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians,” conducted by RTI International and published in the August 2010 issue of Health Affairs, examined nearly 500,000 individual cases involving anesthesia and confirmed what previous studies have shown—CRNAs provide safe, high-quality care that is the same with or without physician supervision.

The other study, titled “Cost Effectiveness Analysis of Anesthesia Providers,” was conducted by Virginia-based The Lewin Group and published in the May/June 2010 issue of the Journal of Nursing Economic$. This study considered the different anesthesia delivery models in use in the United States today, and it showed that CRNAs acting as the sole anesthesia provider cost 25 percent less than the second lowest-cost model. On the other end of the cost scale, the model in which one anesthesiologist supervises one CRNA is the least cost-efficient model. The researchers also confirmed there is no research to indicate that CRNAs and physician anesthesiologists aren’t equally safe providers.

The results of the Lewin study were particularly compelling for people living in rural and other areas of the United States where anesthesiologists often choose not to practice for economic reasons. The safe, cost-effective anesthesia care provided by nurse anesthetists has been a mainstay in these areas for more than 100 years, ensuring millions of patients access to surgical, obstetrical, trauma stabilization, and diagnostic procedures. 

Since 2001, 17 states have opted out of the federal physician supervision requirement for nurse anesthetists. They include: Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, Minnesota, North Dakota, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, and Colorado.
International Nursing Review Seeks Associate Editors
International Nursing Review (INR), the official journal of the International Council of Nurses, is seeking applications for two Associate Editor positions, starting in January 2014. The deadline for submittal is Nov. 30, 2013. A quarterly, peer-reviewed publication, INR focuses on original articles that help to forward the ICN’s mission worldwide by representing nursing, advancing the profession, and shaping health policy. Detailed information about the journal is available at
New Member Spotlight Story Added
Kent Taylor, CRNA, is profiled in the latest Member Spotlight story. Spurred by his own experiences with prostate cancer, he organized a golf outing to raise awareness and funds for prostate cancer research. Seventy-two men participated in the Sept. 12 event at A.L. Gustin Golf Course, Columbia, Mo., raising more than $12,000 for the Prostate Cancer Foundation. In addition, Safeway, Inc., matched the amount for another $12,000 donation. Taylor said the day also achieved its goal of getting men to speak more openly about prostate cancer. He plans to make it an annual event. To read the entire story, click here.

Sponsor a Student for 2014 - Deadline Date – January 1, 2014
In 2013, the AANA Foundation’s Student Scholarship Program awarded 54 scholarships totaling $112,000. Thank you to all those who sponsored a student!

We are once again seeking sponsors to support nurse anesthesia students through their nurse anesthesia program. The deadline date for sponsoring a student scholarship for 2014 is Jan. 1, 2014.

If you wish to be part of this important program, click here to visit our website and access the Fellowship and Scholarship Sponsorship Application.

Complete the application and email it to or mail with your tax-deductible donation to the AANA Foundation, Scholarship Sponsor, 222 S. Prospect Ave., Park Ridge, IL 60068. Please note that the minimum donation to sponsor a student is $3,000 per scholarship.

Thank you in advance for impacting the life of a future nurse anesthetist.
Support the FY14 Annual Giving Campaign
Please make your FY14 donation to the AANA Foundation today! Your support is critical to advancing the nurse anesthesia profession through education and research that validates quality and cost-effective anesthesia care. 
  • Visit to make an online donation, or
  • Mail your donation to AANA Foundation, 222 S. Prospect Avenue, Park Ridge, IL 60068
All donations of $100 or more will be recognized in print and on the website. AANA members who make donations of $250 or more to both the AANA Foundation and CRNA-PAC will be recognized as Triple Crown members.

Thank you in advance for your support. It is greatly appreciated.



Professional Practice

AANA Continues Work on Pain Management Guidelines
On Sept. 4, 2012, the AANA, COA, and NBCRNA sent a joint letter to the Centers for Medicare & Medicaid Services (CMS) to demonstrate the continued commitment of the nurse anesthesia profession to promoting high-quality and safe delivery of chronic pain services. In this letter, each organization identified its contribution to this overall goal. As part of the commitment made to CMS, the AANA is developing evidence-based pain management guidelines. For project status updates, view the project webpage at (member login required).
Single Dose or Multi Dose? Know the Difference
Dozens of recent outbreaks have been associated with the reuse of single-dose vials and misuse of multiple-dose vials. As a result of these incidents, patients have suffered significant harms, including death. CDC and the One & Only Campaign urge healthcare providers to recognize the differences between single-dose and multiple-dose vials and to understand appropriate use of each container type.  Review this dynamic infographic to learn more and test your knowledge:
The Joint Commission Releases Guidance on Infection Prevention and Control Standards
The Joint Commission has released updated guidance on how to clean, disinfect, and store laryngoscopes blades and handles for:
The Joint Commission has released new guidance on how to clean, disinfect, and store endotracheal tubes for:


PR, Publications, and eCommunications

Annual Meeting Highlights Available Online!
You will find Annual Meeting photos, speeches, news, and more in the special Annual Meeting Highlights section of the AANA website. Visit (AANA member login and password required.)


News from COA

Update on Drafts of Practice Doctorate Standards and Post-Graduate Fellowship Standards
The third drafts of the Practice Doctorate Standards for Nurse Anesthesia Programs and the Standards for Post-Graduate Fellowships were approved at the October 2013 COA meeting. A hearing and a focus session will be held Friday, Nov. 8, 2013, at the AANA Fall Leadership Academy in Miami Beach, Fla., to obtain comments from the community of interest.

In addition, a general call for comments was distributed to the community of interest Oct. 17, 2013. The deadline to submit comments is Wednesday, Nov. 6, 2013. The Standards Revision Task Force and the COA will be reviewing the comments. The draft Standards are scheduled for review and adoption at the January 2014 COA meeting. The COA encourages comments from the community of interest. Please use the following link to submit comments:

Please direct any questions regarding the major revisions of the Standards to the COA to or (847) 655-1160.

Return to Headlines


Colorado Supreme Court to Review Lower Court Opt-Out Decision
The Colorado Supreme Court has announced that it will review the Court of Appeals decision on the state’s opt-out. The Court of Appeals previously upheld the lower court ruling in favor of the Colorado governor and the Colorado Association of Nurse Anesthetists (CoANA). The Supreme Court will review the issue of whether a Certified Registered Nurse Anesthetist can administer anesthesia without physician supervision. Nurse anesthetists provide anesthesia services to 99 percent of the communities with surgical services throughout Colorado. This appeal is particularly important for rural communities, as CRNAs are the sole provider of anesthesia services in more than 70 percent of hospitals.
AANA SGA Division Participates in State Health Policy Conference
The AANA State Government Affairs (SGA) Division attended the 26th annual State Health Policy Conference put on by the National Academy for State Health Policy. The conference, held Oct. 9-11, brought together hundreds of state health policy leaders, administrators, and experts to discuss and be educated about health system improvement, Affordable Care Act implementation, delivery system reforms, options for population health improvements, and more. Speakers at the conference included state representatives, health policy advisors, and state agency directors. The AANA SGA believes that the information and insight gained at this conference will contribute to its ability to successfully navigate the changing world of state healthcare policy, especially in light of the rapid change currently underway as a result of the state-level implementation of the Affordable Care Act. 


Federal Government Affairs

Uncle Sam Reopens for Business and More Budget Work on a 90-Day Deadline
The federal government reopened for business Oct. 17 after Congress enacted and the president signed into law legislation (HR 2775) funding Uncle Sam through Jan. 15, 2014, directing lawmakers to work out an overall 2014 budget agreement by Dec. 13, 2013, and raising federal statutory borrowing limits through Feb. 7, 2014.
For CRNAs, Medicare claims and federal payrolls will continue being paid on time, and federal services affected by furloughs—notably a major Food and Drug Administration (FDA) community meeting originally slated for Oct. 23—will be rescheduled for later dates. Lower, post-sequestration spending levels continue, meaning nurse workforce development and health research budgets continue at rates 8 percent or so below previous years’ funding. Medicare rules for 2014 CRNA and physician payment, and for hospital outpatient and ASC payment, are delayed from their usual Nov. 1 release date to sometime “on or before” Nov. 27, according to Medicare. They will still be effective Jan. 1, 2014, though.
Looking just a little further down the road, both the Dec. 13 budget agreement and the Jan. 15 budget deadline impact congressional consideration of legislation to avert 24 percent cuts to Part B CRNA and physician payments permanently or temporarily. A key House committee approved a permanent fix last July (HR 2810) with AANA’s backing. But the bill has not moved further, and its 10-year, $175 billion price tag from the Congressional Budget Office makes it a big pill to swallow in fiscally constrained times–even though annual fixes over the same period would cost as much or more than that.
If Congress and the President do not agree on FY 2014 budget levels by Jan. 15, 2014, Uncle Sam could be back where he started Oct. 1—shut down.
AAANA Issues Second Edition of Reimbursement Primer for CRNAs
The second edition of AANA’s “Issue Briefs on Reimbursement and Nurse Anesthesia” is now available online for AANA members.
Of interest to all CRNAs, especially those who are self-employed or serve in an AANA state leadership position (including State Reimbursement Specialists), this 40-page primer provides basic information about policies and issues shaping CRNA reimbursement. The primer reviews essentials about Medicare, other benefit plans and commercial health plans, and health reform implementation.
Download a copy for yourself at (Requires AANA member login and password.) Your feedback is welcome! Please submit comments to with “Reimbursement Primer” in the subject line.
Noridian Publishes Final LCD on Nerve Block Reimbursement, Effective Early November
Noridian Medicare has published its final local coverage determination (LCD) for covering certain nerve block services that CRNAs and physicians provide to Medicare patients. Effective for services beginning Nov. 11, 2013, in the states that the Noridian Medicare administrative contractor (MAC) covers, the final LCD reflects AANA’s recommendations for covering nerve blocks under Part B, but questions remain about coverage of Part A facility payments.
Under the final LCD covering Part B services, Noridian states, “Reimbursement for the control or management of acute pain in the immediate postoperative period is generally packaged into the payment for the surgical procedure. However, if a need for transfer of pain management is documented and ordered by the surgeon and the accepting provider documents the need for and acceptance of transfer of care, separate reimbursement may be made for the service.” AANA had expressed concern last July, saying that Noridian’s draft was inconsistent with Medicare policy and that, “The draft policy to delay placement of post-operative pain blocks until after discharge from the PACU is inconsistent with the findings from peer-reviewed literature…. We request that the draft LCD be changed to allow anesthesia professionals, including CRNAs, to be paid for placing post-operative pain blocks preoperatively, intraoperatively, and postoperatively.”
However, with respect to Part A hospital and facility payments, Noridian’s final LCD states, “Reimbursement for the control or management of pain in the immediate postoperative period is packaged into the payment for the procedure, surgical or anesthetic, regardless of the method by which the care provider, including the anesthesiologist, decides to manage pain. Following discharge from the post-anesthesia care unit (PACU), the medically reasonable and necessary placement of regional or peripheral pain blocks or initiation of other new pain interventions or ‘top-up’ dosing may be separately reimbursable in the outpatient setting. Providers should not expect separate payment for the establishment of epidural or other pain blocks unless the block is placed following discharge from PACU when documentation supports the intervention.” AANA is investigating whether this more limiting Part A language applies in CRNA cases where a rural facility is participating in the reasonable-cost pass-through program for nurse anesthetist services.
Noridian Medicare administers the Medicare program in Jurisdiction E (CA, HI, NV, and Pacific island territories) and Jurisdiction F (AK, AZ, ID, MT, ND, OR, SD, UT, WA, and WY); this LCD applies only to services provided in those states.
Affordable Care Act Updates: Online Rollout Hits Snags, and Proposed Rule Issued on Basic Health Plans
Here are two updates for CRNAs relating to Affordable Care Act implementation: disclosures on implementation, and a new proposed rule governing basic health plans.
The website has had difficulty enrolling people into plans and communicating enrollee information to plans, according to news reports and remarks from President Obama. The U.S. Department of Health and Human Services has promised fixes. Learn more at, and see the president’s remarks at
HHS released a proposed rule establishing the Basic Health Program (BHP), a health benefits coverage program created by the Affordable Care Act for low-income individuals who would otherwise be ineligible to purchase coverage through the state’s health insurance marketplaces or exchanges. This proposed rule sets forth a framework for BHP eligibility and enrollment, benefits, and delivery of healthcare services. Of particular interest to CRNAs is the provision in the rule that the BHP and standard health plans must comply with all applicable non-discrimination statutes and requirements applicable to the marketplace and recipients of federal assistance. AANA staff is currently reviewing the proposed rule for possible comment. Comments are due to Medicare on Nov. 25, 2013. View the proposed rule at,
Register Now for “Havana Nights” CRNA-PAC Fundraiser at Fall Leadership Academy
Attendees of the AANA Fall Leadership Academy in Miami Beach are invited to join the CRNA-PAC for “Havana Nights,” a reception on Saturday, Nov. 9, from 6-8 p.m., to benefit the one PAC that works 24/7 in Washington, D.C., for the interests of CRNAs–your CRNA-PAC.
Latin music like this, a cigar roller, and your AANA member colleague friends will all be on hand to make this a special night for the special cause of keeping your CRNA voice strong in Washington. And for this night only, Havana Nights attendees will enjoy salsa dancing lessons led by leading AANA members!
  • The American Society of Anesthesiologists reported that its lobbying expenditures doubled during the third quarter of 2013, according to public filings with the Clerk of the House of Representatives. Roll Call reported Oct. 10 that ASA showed $300,000 in lobbying expenditures during the period, compared with $160,000 during the second quarter. Such an increase may reflect either additional lobbying activity expenditures or an internal change in the society’s method for calculating its total.
  • AANA’s Fall Leadership Academy Nov. 8-10 will offer an educational track for Federal Political Directors and the first dedicated track for State Reimbursement Specialist (SRS) development. Every participant will leave the FLA educated and energized and well prepared to coordinate grassroots and reimbursement advocacy in their states. To learn more or register online, click
  • The CRNA-PAC unveiled a new video in which AANA members share how their own experiences in advocacy and support of the CRNA-PAC have made a positive difference to their practice and the nurse anesthesia profession. See (AANA member login and password required) and click “WATCH our new CRNA-PAC video.”
  • The people of New Jersey elected Cory Booker (D-NJ) to the U.S. Senate Wed., Oct. 16, defeating Republican nominee Steve Lonegan (R-NJ) by 10.6 percentage points. The CRNA-PAC had made a contribution to the election of Sen. Booker, at the request of the New Jersey Association of Nurse Anesthetists and the approval of the CRNA-PAC Committee. Sen. Booker faces the voters again in 2014 to win a full six-year term.
  • Rep. C.W. Bill Young (R-FL), chairman of the powerful Defense Appropriations Subcommittee and the longest-serving House Republican, died Fri., Oct. 18, at age 82. First elected to the House in 1970, he had earlier this month announced plans to retire from office and not run for reelection in his Tampa-based district. Memorial services were scheduled for Wednesday and Thursday in Tampa. To learn more, see Florida Gov. Rick Scott (R-FL) is responsible for scheduling special primary and general elections for Young’s 13th District seat.
  • The Public Affairs Council has named Kate Fry, AANA’s Associate Director Political Affairs, its 2013 “Volunteer of the Year,” noting in particular her contributions to a major benchmarking report on trade and professional association PACs. Based in Washington, the Public Affairs Council serves as a nonpartisan, nonpolitical association for public affairs professionals and organizations involved in public affairs worldwide. Congratulations Kate! Read more about her honor at
  • Another huge Medicare fraud judgment is in the news. This time, a South Carolina hospital fined $276 million for recruiting physicians specifically to prevent them from taking their cases to ambulatory surgery centers. Following a whistleblower report eight years ago, a jury this fall concluded that hospital’s action violated federal Stark anti-self referral laws and defrauded Medicare. Read the article from Outpatient Surgery here:
About This Document
The AANA Federal Government Affairs Hotline is published for the nurse anesthetist members of AANA Mondays when Congress is in session by the AANA Office of Federal Government Affairs, Washington DC, (202) 484-8400,, Frank Purcell, Senior Director. © 2013 American Association of Nurse Anesthetists. The following is an FEC required legal notification for CRNA-PAC: Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.


The Physician-Patient Alliance for Health & Safety (PPAHS) has announced the results of the first national survey of patient-controlled analgesia (PCA) practices. The findings, presented at the Society of Anesthesia and Sleep Medicine 3rd Annual Conference on Oct. 10-11, attribute more than 56,000 adverse events and 700 patient deaths between 2005 and 2009 to PCA-related errors. While the numbers warrant cause for concern over patient safety with PCA—primarily due to a lack of consistency in the safety procedures being followed by hospitals across the country—the study also showed that hospitals that continuously monitor their patients with pulse oximetry and/or capnography are able to prevent adverse events and/or curtail costs and expenses. Most notably, said PPAHS executive director Michael Wong, "Those [facilities] using smart pumps with integrated end tidal monitoring were almost three times more likely to have had a reduction in adverse events or a return on investment when measured against costs and expenses (including litigation costs) that might have been incurred."
From "First National Survey of Patient-Controlled Analgesia Hospital Practices Reveals Patient Safety Concerns and Role of Continuous Electronic Monitoring"
Sacramento Bee (CA) (10/16/13)
When the drug ondansetron is given at the same time as acetaminophen, it may reduce the painkilling effect of the acetaminophen, according to a study of children undergoing tonsillectomies. Children who received both ondansetron and acetaminophen needed more morphine during post-surgical recovery, said Dr. Pierre Beaulieu, associate professor of anesthesiology and pharmacology at the University of Montreal. He noted that this study confirms that acetaminophen and ondansetron both use the same serotonin (5-HT3) receptor, which causes a decrease in pain relief. In the double-blinded parallel group study, 69 children ages two to seven underwent elective tonsillectomy and received acetaminophen for pain relief. The children were randomly assigned to receive either ondansetron or droperidol to prevent nausea, and the researchers assessed their pain and morphine consumption for 48 hours after surgery. There was no difference in postoperative nausea and vomiting between the two groups, and no significant difference in postoperative pain in the first 24 hours after surgery. Children who received ondansetron, however, were much more likely to need morphine for pain relief, and the amount of morphine given to this group was nearly three times that of the droperidol group. Dr. Sergio Bergese, chief of neuroanesthesia at Ohio State University, pointed out that droperidol is a sedative and increases opioid effects, which could lower total opioid consumption.
From "Ondansetron May Inhibit Analgesic Effect of Acetaminophen"
Pain Medicine News (10/01/2013) Vol. 11 Savoie, Keely
The Food and Drug Administration (FDA) has recommended that prescription drugs including the opioid painkiller hydrocodone be more closely regulated. The agency wants such products removed from the Schedule III classification for controlled substances and placed in the Schedule II category, which already includes morphine and oxycodone. The rule change would make it much more difficult to obtain products containing hydrocodone—which opponents say could present a hardship for pain patients, particularly older ones. However, the FDA's Janet Woodcock said the decision was based on the level of opioid abuse—which triggered some 475,000 visits to the emergency room in 2009—as well as the "tremendous amount of public interest" in the problem. The FDA's proposal still must be approved by both the Department of Health and Human Services and the Drug Enforcement Administration.
From "FDA Seeks Tougher Rules on Opioid Painkiller"
Washington Post (10/25/13) P. A2 Clarke, Toni
Lower doses of propofol can be a safe, effective treatment for migraine in children, researchers reported at the American Academy of Pain Management's 24th Annual Clinical Meeting. Lead author Dr. David Sheridan, a pediatric emergency medicine specialist at Oregon Health and Science University and Doernbecher Children's Hospital in Portland, explained how use of propofol for a "very difficult migraine" in a child that did not respond to other treatments "worked beautifully." His research team described cases in which they provided propofol to seven children with migraine headache in the emergency department between January 2010 and July 2011. The investigators compared these patients with a similar number of matched controls who received standard migraine therapy with combined use of a nonsteroidal anti-inflammatory medication, diphenhydramine, and prochlorperazine. Compared with the controls, the children treated with propofol had significantly greater reduction in self-reported pain scores, and they had a shorter length of stay in the emergency department. The doses used, Sheridan said, were about one-quarter to one-half that used for sedation, and patients showed none of the side effects seen in higher doses, such as lower blood pressure or respiratory rate.
From "Propofol Effective for Pediatric Migraine"
Medscape (10/01/13) Lowry, Fran
Researchers in Denmark have found preliminary evidence that patients who receive a nerve block in addition to general anesthesia during breast cancer surgery run a lower risk of cancer recurrence and metastasis than those who receive general anesthesia only. Patients given the nerve blocks required less opioid pain relief after surgery and were more likely to be alive six years later. The study, a follow-up to an earlier study of the long-term effects of paravertebral blocks in 77 patients who had gone through breast cancer surgery. In reviewing the medical records of the patients in the study six years later, researchers found that only 10 percent of those who received a nerve block had passed away, compared to 32 percent in the group that only received general anesthesia. Cancer recurrences were documented in 13 percent of the nerve block group and 37 percent of the general anesthesia group. The study authors concluded that their research has brought "increased evidence to the hypothesis that paravertebral block through [lessening] of surgical stress and reduced opioid consumption reduces the risk of developing metastases." The findings were presented at the Anesthesiology 2013 annual meeting.
From "Numbing Breast Cancer Numbers"
DailyRx (10/15/13) Stoneham, Laurie
Although it involved just three patients, a pilot study undertaken at the University of California, San Diego suggests that continuous nerve block may offer an effective solution for treating phantom limb pain. All three men were fitted with catheters hooked to a portable electronic infusion pump, which delivered either ropivacaine or normal saline for a period of six days. After four months, two of the three patients received new catheters but were treated with the six-day protocol opposite to their original regimen. The saline solution did little to improve phantom limb pain in the research participants, but both remaining patients reported complete resolution of their symptoms during and immediately following the ropivacaine treatment. The investigators suspect that phantom limb pain is tied to cortical abnormalities in patients who have the condition and that a continuous peripheral nerve block for an extended period of time could deliver permanent relief, perhaps by reorganizing cortical pain mapping. Although the researchers acknowledge the need for a large, randomized trial to confirm their findings, the preliminary results bode well for phantom limb sufferers—only about 1 percent of whom are effectively treated, despite the availability of dozens of treatments.
From "Nerve Blocks May Be Effective in Treating Phantom Limb Pain, Pilot Study Shows"
Pain Medicine News (10/01/2013) Vol. 11 Vlessides, Michael
A study led by Yuna Rapoport, MD, of Vanderbilt Eye Institute, found that patients undergoing cataract surgery reported less pain when they received topical anesthesia than when they received a retrobulbar block (RBB). The researchers reviewed patient records for 110 cataract surgeries performed at the Veterans Affairs medical center in Nashville, looking at the type of anesthesia used and the amount of pain reported by patients. The types of anesthesia used included general anesthesia, RBB, topical anesthesia with tetracaine drops in combination with sedation, and topical anesthesia without sedation. According to researchers, patients given RBB reported more pain compared to those who received a topical regimen. In addition, the researchers found that surgeries where the anesthesiologists administered a topical anesthetic took significantly less time than those surgeries where RBB was administered. Rapoport commented that in light of the findings, the researchers "are in the process of collecting more data prior to changing policies, but are considering the risks and benefits of RBB as compared to other types of anesthesia during cataract surgery." The results of the study were presented at the 2013 meeting of the Association for Research in Vision and Ophthalmology.
From "Topical Anesthetic Better Than Block for Cataract Surgery"
Anesthesiology News (10/01/13) Vol. 39, No. 10 Marcus, Adam
Submicron Diclofenac Reduces Postsurgical Pain
A study presented at PAINWeek 2013 showed that an investigational submicron formula of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, from Iroko Pharmaceuticals LLC, effectively curbed the need for opioid rescue medication in patients suffering from acute postoperative pain following a bunionectomy. The use of submicron technology allows NSAID drug particles to be reduced to at least 10 times smaller than their standard formulations. According to co-author Srinivas R. Nalamachu, MD, co-director of the Pain Management Institute in Overland Park, Kansas, this reduction in size allows the medication to be more easily absorbed. Recommendations from the FDA that physicians should prescribe NSAIDS "at the lowest effective dose for the shortest duration consistent with individual patient treatment goals" helped spur the development of the submicron formulation. Nalamachu said the submicron formulation not only allows a lower dose but provides "efficacy with 30 percent less [...] diclofenac, which translates to a better safety profile" for the drug, which had been associated with a significant increase in cardiovascular risk in its standard formulation. The results of the study were included in Iroko Pharmaceuticals' New Drug Application for submicron diclofenac, which the FDA accepted in February 2013.
From "Submicron Diclofenac Reduces Postsurgical Pain"
Medscape (09/16/13) Melville, Nancy A.
Abstract News © Copyright 2013 Information Inc.