ASA Meeting Reviews
By Franklin Chiao MD, LAc
ASA Pediatric Acute Pain Management Workshop
One of this year’s innovative workshops at the American Society of Anesthesiology Annual Meeting was the Pediatric Acute Pain Management workshop. It was directed by Franklin Chiao MD, LAc (New York Presbyterian Hospital-Weill Cornell Medical College). The other faculty consisted of leaders from programs such as Boston Children’s Hospital, the Children’s Hospital of Philadelphia, Texas Children’s Hospital, Lurie Children’s Hospital, Seattle Children’s Hospital, and one faculty from as far as Italy. It started with a presentation describing recent research, new block techniques and a review of block anatomy.
Recent research was presented. The most pediatric pain resources are found in urban or academic centers whereas rural and community hospitals have fewer satisfactory services.1 Most hospitals offer caudal blocks while peripheral nerve blocks are only provided at some hospitals. This gap in patient care provides opportunities and illustrates the need for education and improvement.
New blocks that were discussed included the pudendal block. A review of the anatomy, and both landmark and ultrasound approaches were covered. Common surgeries where this block helps include circumcision, urethroplasty, scrotoplasty, orchiopexy, labiaplasty, and peno-scrotal procedures. Frequently, 0.2% ropivacaine or 0.25% bupivacaine at 0.2ml/ kg were used.
Participants then rotated at various stations covering upper extremity, lower extremity, truncal, neuraxial, paravertebral, erector spinae, and lumbar plexus blocks. Two stations were dedicated to multimodal PBLD discussions and acupuncture techniques. Each station had live block videos and analysis of ultrasound anatomy. New ultrasound devices and equipment for catheter infusions were available for participants to use. Caudal catheter equipment and methods were presented.
The faculty appreciate the support of the ASA and SPA members whose input and time made the workshop a success.
- Chiao FB, Wang A. An Examination of Disparities in Pediatric Pain Management Centered on Socioeconomic Factors and Hospital Characteristics. J Racial Ethn Heal Disparities. February 2017:1-5. doi:10.1007/s40615-017-0343-3.
- Gaudet-Ferrand I, De La Arena P, Bringuier S, Raux O, Hertz L, Kalfa N3, Sola C, Dadure C Ultrasound-guided pudendal nerve block in children: A new technique of ultrasound-guided transperineal approach. Paediatr Anaesth. 2018 Jan;28(1):53-58.
- Tutuncu AC, Kendigelen P, Ashyyeralyeva G, Altintas F, Emre S, Ozcan R, Kaya G. Pudendal Nerve Block Versus Penile Nerve Block in Children Undergoing Circumcision Urol J. 2018 May 3;15(3):109-115.
Opioid-sparing Pediatric Surgery with Regional Anesthesia-When, How, Clinical Pearls
Dr. Franklin Chiao and Dr. Jessica George (Johns Hopkins University School of Medicine) described several opioid-free and opioid-sparing pediatric anesthesia techniques. These surgeries included everything from ENT such as tonsillectomy to colorectal surgeries. Moreover, a number of surgeries are being performed without any opioids including colectomy, inguinal hernia repairs, ureteral reimplantation, and breast reduction. Regional anesthesia techniques discussed included TAP, rectus sheath, supraclavicular, pectoralis blocks, and spinal anesthesia. Opioid-free laparoscopic surgery cases performed by Dr. Chiao and colleagues were highlighted. Dr. Chiao discussed the steps and nerve blocks needed to develop these opioid-free programs with surgeons. He discussed major obstacles including the role of pharmaceutical lobbyists, the convenience of sedative effects of opioids, and their addictive properties. The use of analgesic acupuncture techniques in the perioperative period was also demonstrated.
Several multimodal analgesic techniques were demonstrated by Dr. George. She analyzed how NSAID use can result in similar pain scores for tonsillectomy, and better return to baseline activity. She showed the discordance between opioids prescribed and used post-operatively. The role of dexmedetomidine is significant and growing as an analgesic supplement.
