Chris Prabhakar

Happy Holidays from one of the incredible sonographers who created this masterpiece

☃️❄️🌲🎄

An oil painting of Elizabeth Garrett Anderson in the 1860s

Elizabeth Garrett Anderson (1836-1917), 1st female dean of a British med school, and 1st female mayor in Britain, pretended to be rich during med school (in Paris, 1870) so admin would think she'd be able to sue if they suddenly said women couldn't be doctors 1/10

Here’s one of my essentials for a Femoral Triangle Block…and it never gets stolen by anyone else !!!

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Time for another #POCUS pitfalls thread: the infamous IVC 🤩

I have MANY thoughts on the IVC 💭

When I first started teaching POCUS, I actually disliked the IVC because it was often poorly done or incorrectly interpreted ❌

I have now come to love the IVC, BUT you have to do it right!

#emimcc

Interesting, Jon! If I read this correctly, ESP is no better than control. SAPB has the unenviable position of being likely worse than the control group!

ICBs, PVBs, and TEAs for the win!

The authors seem to go silent in the discussion and conclusions re: ESP, not sure why.

VATS procedures:

TEA, PVB, ESP, and SAPB ⬇️ CPSP at 2-3 and 6 months vs control
No differences TEA, PVB, and ESP but SAPB less reduction of CPSP

pubmed.ncbi.nlm.nih.gov/39240480/

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This is a heatmap of topics identified in 6 research prioritisation studies relevant to regional anaesthesia.

Important themes were on the role of RA in:
• ⬇️ chronic postsurgical pain
• improving postop recovery
• benefit in specific patient groups

#RASky #AnSky #MedSky

https://buff.ly/49zVeBD

When I teach Axillary Brachial plexus blocks I often talk about the relatively common variation where the musculocutaneous nerve has “Late take off”.

Here is a post-block example where you see median, ulnar, radial, MCN & MABCN

#RAsky #AnSky #POCUSky

Anaesthetists: Is it just me or does everyone think is a little strange that anaesthetists have to take significant amount of time snapping open glass ampoules, needling vials etc and drawing up the contents, risk/time/tasks. Maybe more drugs should be readily available in prefilled syringes??

In this new randomized trial of 126 patients having laparoscopic cholecystectomy, intravenous lidocaine provided a non-inferior quality of recovery compared to erector spinae plane block. Either approach was superior to placebo.

#RegionalAnesthesia #AnSky

🔗 doi.org/10.1016/j.jclinane.2024.111528

The effect of anterior quadratus lumborum block on morphine consumption in minimally invasive colorectal surgery: a multicentre, double-blind, prospective randomised placebo-controlled trial - PubMed We investigated the efficacy and safety of a bilateral anterior quadratus lumborum block in patients undergoing minimally invasive colorectal surgery. This was a two-centre, double-blind, prospective,...

No blocks yet over here. Steve Coppens' study on anterior QL for laparoscopic colorectal surgery showed no benefit over placebo, despite sensory blockade.

pubmed.ncbi.nlm.nih.gov/37970976/

For Laparoscopic Abdominal surgery- are you performing blocks? If so which?

This study in RAPM compared TAP to Lateral QLB and noted a difference in dermatomal loss of sensation, but not analgesia.

I’d love to see an arm with Anterior QLB.

Thoughts?
#RAsky #AnSky

rapm.bmj.com/content/rapm...

Delighted that Ben Dallyn from @RUHBath won the 1st prize for oral presentation @dasairway

He presented A MANIKIN STUDY OF STYLETS & BOUGIES (static & dynamic)…..

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YouTube video by Regional Anesthesiology and Acute Pain Medicine Ultrasound Guided Genicular Blocks (2024 update!)

Finally a case I can talk about in detail... my own!

I got a ACL reconstruction with patellar bone-tendon-bone graft, microfractures, and intraarticular hydrogel.

Single shot adductor and superolateral geniculate blocks.
Worked great and lasted 16 hours!

www.youtube.com/watch?v=DGv0...

IV lidocaine given intraop and for 6-12h postop failed to influence gut motility, analgesia, quality of recovery, or time to discharge following laparoscopic colectomy.

Appropriate Duration of Perioperative Intravenous... : Anesthesia & Analgesia tion of lidocaine infusion in patients undergoing colorectal surgery. METHODS: We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify articles published before D...

Duration may be a factor. 24 hr minimum for IV lidocaine, at least for colorectal surgery.

journals.lww.com/anesthesia-a....

If only mine always unzippered like that! For me, it's more like expanding the deeper muscle, then the superficial one, then losing the plane entirely in various pockets of local!

That feeling when you see “unzippering” like this!

#SIFI #IYKYK
#RAsky #AnSky

with patient consent

a close up of a man 's face with a jacket that says ' a ' on it ALT: a close up of a man 's face with a jacket that says ' a ' on it

t’s interesting how people define anaesthesia

I ask every new resident what anaesthesia is.
When they offer me a triad of

-Unconsciousness
-Muscle relaxation
-Analgesia

I give them 1 out of 3

Why is that?
Am I right?

I thought anesthesia was simply the induction of a state of insensibility (to surgical stimulus). This would fit for all forms of anesthesia. While Wendell Holmes, in his letter to Morton, was describing ether general anesthesia, it fits nicely for local-regional as well.

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I love love LOVE scanning the heart 😍, but when it comes to bang for your buck for ultrasound novices, lung ultrasound is such a winner 🏆

It's time for another #POCUS basics #skeetorial 🧵

Let's talk about common pitfalls in #LungUltrasound and how to correct these ✔️

#emimcc

Engage and learn from the top-tier faculty at the #ASRASpring25 #ASRA50! 🌟 Here’s a glimpse of who you can expect: @emarianomd.bsky.social @dr-rajgupta.bsky.social @son-of-caine.bsky.social @maggieholtzmd.bsky.social @drstugrant.bsky.social @siva6face.bsky.social @chrisprabhakar.bsky.social & more..

There are two microG analogues:
- Underwater
- Parabolic flight

Each have challenges…

🧵 1/5

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Save the date 🗓️- largest #regionalanesthesia meeting #ASRASPRING25 #ASRA50 #RAsky #Ansky
⭐️ Lectures
⭐️ Workshops #POCUS
⭐️ Networking
@emarianomd.bsky.social @ropivacaine.bsky.social @dr-rajgupta.bsky.social @jeffgadsden.bsky.social @dr-amit-pawa.bsky.social @rosiehogg.bsky.social

Introducing the Jane Philpott Primary Care Fund They say all endings are really new beginnings. As the Queen’s community prepares to say farewell to Jane Philpott, she is leaving a parting gift that will have a lasting impact long after her time at...

Tomorrow is my last day as dean Queen's Health Sciences & CEO SEAMO. As a parting gift, I'm donating honoraria I've received this year & using the seed funds to launch the Jane Philpott Primary Care Fund to support research & innovation in primary health care. healthsci.queensu.ca/stories/feat...

I would agree. In fact, I think it may be more important for training colleagues or other practicing MDs who might not have as close supervision for as long, compared to our residents.

Interesting survey, Jon! Do you think RA simulation should be mandated in the curriculum?

We used this meat model in our simulated microgravity study!

Summary:
Nerve blocks can feasibly be performed while floating in microgravity!

doi.org/10.1016/j.bj...

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Simulation-based ultrasound-guided regional anesthesia education: a national survey of Canadian anesthesiology residency training programs - Canadian Journal of Anesthesia/Journal canadien d'anesthési... Purpose Simulation-based education in ultrasound-guided regional anesthesia (UGRA) improves knowledge, skills, and patient outcomes. Nevertheless, it is not known how simulation-based UGRA education i...

Only 5 programs (33%) mandated simulation-based UGRA in their curriculum in Canada.

Inconsistent inclusion and modalities of simulation for UGRA in general.

doi.org/10.1007/s126...

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