Orthopedic & Regional Anesthesia
There is perhaps no other sub-specialty of anesthesia requiring a greater variety of anesthetic techniques than orthopedic anesthesia. As an alternative to a general anesthetic, many procedures in orthopedic patients may be better managed with regional anesthesia or with combined regional/general anesthetic techniques.
Orthopedic anesthesia residents routinely care for patients undergoing orthopedic surgery as well as an elderly population suffering from severe co-existing cardiovascular or pulmonary diseases. In addition to requiring familiarity with regional anesthetic procedures, such as spinal, epidural, and major nerve blocks, the orthopedic anesthesiologist must also be familiar with other anesthetic techniques, such as fiberoptic intubation for complex airway problems or patient positioning to avoid intraoperative nerve injury.
Residents on this service learn how to manage induced hypertensive anesthesia, isovolemic hemodilution and cell- saver techniques, all of which serve to reduce perioperative blood loss and decrease the need for perioperative blood transfusion.
Residents dealing with orthopedic surgical procedures have the opportunity to learn regional anesthetic techniques, such as central neuraxial (spinal and epidural) anesthesia, upper extremity blocks (axillary, supraclavicular or interscalene approaches to the brachial plexus), lower extremity blocks (femoral/sciatic, popliteal ankle), and peripheral nerve blocks (median, ulnar, radial, peroneal).
As a complement to their clinical exposure, residents are encouraged to develop their own clinical investigations, or to participate in ongoing clinical or laboratory studies.
Regional anesthesia has experienced significant growth in a variety of surgical areas including: orthopedics, vascular and gynecology. The increased use of periperal nerve blockade is partly due to the development of ultrasound-guided placement techniques, the utilization of indwelling catheters for continuous local anesthetic infiltration, and improved clinical efficacy. The Department of Anesthesiology has a group of dedicated faculty known as the "Regional Anesthesia/Acute Pain Medicine Team" that supervises and educates anesthesiology residents during a formal clinical rotation in regional anesthesia. This rapidly growing service now offers a fellowship program along with multiple opportunities for clinical research.