T he regional anesthesia program currently takes a multi-modal approach, whether using nerve stimulation, ultrasound guidance, or both, depending on the circumstances of the surgery and what is best for the patient, says Scott J. Mellender, MD, assistant professor of anesthesiology, and clinical director of the New Jersey Pain Institute at Robert Wood Johnson University Hospital. tion are available to help patients avoid that issue and doze through the surgery, he adds, without having the potential drawbacks of general anesthesia. Advances in the field also have brought additional benefits. “Drugs, technology, and techniques have evolved,” Dr. Kiss says. Much of the evolution in the area of regional anesthesia can be attributed in part to the shifting emphasis on reducing hospital lengths of stay, says Dr. Mellender, a fellowshiptrained interventional pain medicine specialist who completed residency training in anesthesiology, as well as general surgery, at Robert Wood Johnson Medical School. The use of regional anesthesia techniques has helped turn what in some cases used to be a five-day hospital stay into a two-hour outpatient surgery, he says. As medication and technologies continue to improve, more surgical procedures are involving the use of regional anesthesia, says Dr. Kiss. As a result, there is a much greater need and request for anesthesiologists who are skilled in these 10 Robert Wood Johnson I MEDICINE techniques. At Robert Wood Johnson Medical School, a dedicated regional anesthesia rotation has been in place since 2008. The medical school’s anesthesiologists and residents have been encouraged to learn new techniques and even push the envelope, Dr. Kiss says. For example, Shaul Cohen, MD, professor of anesthesia and a specialist in regional anesthesia, has been a pioneer in developing some of the techniques of obstetric anesthesia. For the past year, members of the acute pain and regional anesthesia team also have been working more with placement of specific blocks and the use of balanced anesthesia (employing a combination of smaller doses of different medications, to minimize side effects and still yield the desired effect) for surgeries such as total knee replacement, to allow for pain relief to the area while enabling some muscle control. The department also has been working extensively with ultrasound-guided regional anesthesia to help determine the best location for the injection, according to Dr. Fratzola. Certain blocks, such as the supraclavicular block, are done using ultrasound guidance because of the proximity of the lungs and the precision needed for safe, effective delivery of anesthesia. Use of ultrasound guidance can help improve the speed of the block, as well as provide enhanced opportunities for teaching purposes, says Dr. Kiss. The regional anesthesia program currently takes a multimodal approach, whether using nerve stimulation, ultrasound guidance, or both, depending on the circumstances of the surgery and what is best for the patient, Dr. Mellender says. Expanding Options “W e give patients choices a lot of places can’t,” says Dr. Kiss. These options not only enhance care, but also help patients feel more empowered, he says. “As surgeons are realizing that patients are having good expe-