The 48th annual Regional Anesthesiology and Acute Pain Conference celebrated the 100th anniversary of the American Society of Regional Anesthesia with learning discussions, hands-on workshops and research presentations on April 20-22.
Rafael Lombardi, MD, a fellow with the UNMC Department of Anesthesiology regional anesthesia and acute pain services team, presented five moderated abstracts at the 48th annual Regional Anesthesiology and Acute Pain conference, three of which had been accepted for publication. Dr. Lombardi said that each of the meta-analyses facilitated decision-making in daily practice by clarifying important points in regional anesthesia.
One abstract, titled “Thoracic epidural anesthesia after TAP block with liposomal bupivacaine on a patient with chronic opioid use” (Rafael Lombardi, MD, Nicholas Heiser, MD, Kyle Ringenberg, MD), described a procedure using thoracic epidural anesthesia with bupivacaine only a day after a transabdominal plane block with liposomal bupivacaine for colectomy in a patient with chronic opioid use.
TAP blocks are typically administered before surgery or at the end of the procedure to aid post-operative pain management and reduce the need for opioids. However, the bupivacaine manufacturer recommends not using local anesthetics within 96 hours of its first use. Dr. Lombardi described the decision-making process of the acute pain service team and the case outcome at the annual meeting, adding that further studies are necessary to evaluate patient safety.
“Our case is the second report of epidural after liposomal bupivacaine,” Dr. Lombardi said. “This case helped us to decide which patients would benefit most from it and with which patients we should avoid using it.”
The other meta-analyses covered the analgesic potential of differing techniques along with efficacy and safety. They included:
• “General anesthesia versus regional anesthesia for hip fracture surgery in elderly patients: systematic review and meta-analysis.” Authors: Isadora Salomao, MD, Rafael Ferreira, MD, Sara Amaral, MD, Matheus de Deus, MD, Vanessa Carvalho, MD, Isabela Marques, MD, Rafael Lombardi, MD
• “Pericapsular nerve group block versus fascia iliaca compartment block for hip surgery: systematic review and meta-analysis of RCTs” Authors: Priscila Andrade, MD, Rafael Lombardi, MD, Isabela Marques, MD, Ana Carla Braga, MD, Beatrice Isaias, MD, Nicholas Heiser, MD
• “Proximal vs distal adductor canal catheters for total knee arthroplasty: a systematic review and meta-analysis of RCTs” Authors: Rafael Lombardi, MD, Isabela Marques, MD, Jasmeen Kaur, MD, Ashish Sakharpe, MD, Nicholas Heiser, MD
• “Infraclavicular versus costoclavicular approaches to ultrasound-guided brachial plexus block: review and meta-analysis” Authors: Sara Amaral, MD, Rafael Lombardi, MD, Natalia Drabovski, MD, Jeffrey Gadsden, MD
“I was very happy to have the opportunity to present at the greatest meeting of regional anesthesia in the world and to represent UNMC along with Dr. Heiser,” Dr. Lombardi said. “My daring long-term goal is to make our department world-renowned. I want people to think about UNMC when they think about regional anesthesia.”
Dr. Lombardi continues his momentum with several projects in the works, including four submissions to the upcoming American Society of Anesthesiology annual meeting in October 2023. He also invites any residents interested in research, meeting presentations and publication are welcome to reach out.
Nicholas Heiser, MD, director of the fellowship program in regional anesthesiology and acute pain medicine praised Dr. Lombardi on his presentations and dedication to research in acute pain. “I was very impressed by what he accomplished at the conference, along with many others in attendance,” Dr. Heiser said.