This is my sixteenth year as a member of the Orthopedics, Plastics and Regional Division, Duke Department of Anesthesiology. For the past ten years, I have served as the Division Chief, responsible for leading the divisional faculty of thirteen members in the execution of our departmental missions. I am recognized as an expert worldwide in the field of Regional Anesthesia especially in the use of regional ultrasound techniques and often sought out to participate as a lecturer in various teaching/training activities to my colleagues both in the United States and abroad. This led to my past appointment as a member of the American Society of Anesthesiologists (ASA) committee.
As the Division Chief, on a daily basis, I am responsible for the management of thirteen faculty members and up to a maximum of fourteen orthopedic, plastics and trauma operating rooms. Under my leadership, the regional anesthesiologist’s role has rapidly expanded within the hospital and new technology, pharmacological agents and care plans have been introduced. For instance, to better manage patient’s postoperative pain continuous peripheral nerve block techniques have been used replacing the single shot nerve block. In addition, continuous nerve block catheters have been sent home with patients to manage postoperative pain. This program has been extremely successful and adopted by other surgery types across the board. Compassionate to explore even more accurate methods in nerve identification, the use of ultrasound was introduced and adopted over twelve years ago. Duke University Medical Center was one of the first institutions within the United States to adopt this technique and have been on the forefront ever since. Today, over 95% of all blocks performed under ultrasound. This has vastly improved the efficacy and safety of our regional techniques.
With the construction of the new preoperative areas both in Duke University Hospital North and the Duke Medical Pavilion brought more opportunities for improvement. Under my guidance, the regional division developed a perioperative block area to include equipment (wall-mounted ultrasound machines) needed to perform regional anesthesia techniques. At the same time and in collaboration with nurse management, a preoperative nursing program was developed. This allowed nurses to be actively involved in the performance of the block and improved efficiency, safety, surgeon satisfaction and an increased adherence to universal protocol.
As a method to bring uniformity to patient care and alignment with our surgical colleagues, I introduced care plans for all major orthopedic surgeries: hip, knee and ankle replacements. They not only include the use of regional anesthesia techniques and more importantly, nerve block catheters, but multimodal analgesia as well. The most recent addition to these care plans has been the introduction of blood conservation techniques using amicar and tranexamic acid. Recently, I have been involved in and taken Anesthesia’s lead on a multi-disciplinary care plan with our two sister hospitals: Duke Regional and Duke Raleigh, for hip fracture patients after they present to the emergency department. The major role of anesthesia faculty is the early placement of a femoral nerve block catheter in the emergency department to lessen pain and reduce opioid consumption. This plan has successfully been implemented. The uniqueness of this plan at Duke University Medical Center is the use of a nerve catheter instead of a single shot nerve block. We are currently transforming our care plans for our hip and knee replacement surgeries with the aim of better pain management, earlier mobilization and shortened hospital length of stays.
The Regional Division faculty’s expertise and proficiency along with the workplace infrastructure and protocols have led to Duke being a leader in the field of Regional Anesthesia attracting visiting physicians to observe our practices resulting in the development of our on-site continuing medical education course.
Since 2001, I have served as a member on IRB committee reviewing both departmental and institutional human investigational research studies offering recommendations to protocols and consent form submissions.
I have been involved in numerous visiting professorships, grand round lectures and resident grand round lectures both at Duke and other institutions throughout the country. I have participated in many anesthesia workshops and conferences to include but not limited to: the American Society of Anesthesiologists (ASA) annual meetings and the North & South Carolina Anesthesia Society. I have served as the medical director of the successful CME conference, Emerging Technologies in the OR held in Orlando, Florida for the last 6 years and the co-medical director of the successful CME conferences: Ultrasound Guided Regional Anesthesia Preceptorship (now in its eighth year) and the Pre-ASA Regional Anesthesia Ultrasound conference workshop for over 6 years.
As the primary investigator for over 18 industrial trials, I supervised and managed a group of physician and research nurses in several research studies with the major emphasis of work being devoted to liposomal epidural extended morphine. I was the first in our field to research the use of this medication in the management of postoperative pain in joint replacement surgery. I obtained academic recognition in my role in these studies with multiple publications and lectures. As a result of this research, extended release epidural morphine was successfully introduced into our clinical practice at Duke.
Other research areas, which have resulted in over 20 publications and 27 abstracts, include the investigation of oral opioids in the management of pain, blood replacement products, non-invasive cardiac output monitoring and regional anesthesia. I was the lead author in three anesthesiology book chapters of Anesthesiology on the subject of regional anesthesia.
Nominated by the Department Chairman, Mark Newman MD, I participated in and am now a Fellow of the Chancellor’s Clinical Leadership in Academic Medicine Fellowship Program. This is a six-month rigorous course of didactic lectures, workshops and collective teamwork, sponsored by the Chancellor to prepare the health leaders of the future.