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AnesthesiaExam Podcast

David Rosenblum, MD, creator of AnesthesiaExam.com and ABAstagedExam.com discusses anesthesiology board prep and issues relevant to anesthesiologists.
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Mar 13, 2024
Dr. Rosenbum discusses Interventional Psychiatry, the role of Stellate Ganglion Blocks in PTSD, Ketamine Infusions for Depression, and the role of Magnesium as a co-factor in ketamine infusions.  Other Announcements from NRAP Academy:
 
Live Workshop Calendar
 
Ultrasound Interventional Pain Course Registration 
 
 
For Anesthesia Board Prep Click Here!
References
 
References
 
Górska N, Cubała WJ, Słupski J, Wiglusz MS, Gałuszko-Węgielnik M, Kawka M, Grzegorzewska A. Magnesium in Ketamine Administration in Treatment-Resistant Depression. Pharmaceuticals (Basel). 2021 May 3;14(5):430. doi: 10.3390/ph14050430. PMID: 34063604; PMCID: PMC8147622.
 
 
 
Hanling SRHickey ALesnik I, et al
Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder: A Randomized, Double-Blind, Controlled Trial
 
Feb 28, 2024

Dr. Rosenblum interviews West Viriginia Society of Interventional Pain Physician's President Rudy Malayil, MD and discusses the upcoming WVSIPP meeting in April 2024 as well as Dr. Rosenblum's upcoming ultrasound course. 

Rudy Mathew Malayil, M.D., completed his internship in General Surgery at New York Presbyterian/Cornell Hospital in New York City, followed by residency training in Physical Medicine and Rehabilitation at New York University Medical School. Dr. Malayil further completed a Pain Medicine Fellowship at the Albert Einstein School of Medicine at the Beth Israel Medical Center Campus in New York City. 

After training he went settled in West Virginia and eventually became the president of West Virginia Society of Interventional Pain Physicians and started private practice Pain Management 360.

 
Ultrasound Interventional Pain Course Registration 
 
 
For Anesthesia Board Prep Click Here!
References
https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1293358/full
Feb 8, 2024

In this episode, Garden City (long island) based Pain Physician, Dr. David Rosenblum explores Peripheral Nerve Stimulation, Biologics and Ablations for hip pain.

He reviews a case report of a 67-year-old female with a history of a mechanical fall causing injury to her lumbar spine and pelvis resulting in hip and pelvic pain is presented. The patient had hypertrophic non-union of the right iliac wing fracture and displacement of the pubic symphysis and right sacroiliac joint. Medications were not effectively managing her pain, so she sought treatment at a pain management clinic.

The patient underwent diagnostic obturator and femoral articular nerve branch injections, as well as a middle cluneal nerve steroid injection, all guided by fluoroscopy and ultrasound. She experienced improvement in her pain following these procedures. Subsequently, she had a peripheral nerve stimulator (PNS) trial and underwent implantation of leads targeting the right middle cluneal nerve and right obturator and femoral articular nerve branches.

The patient reported significant relief in both the posterior and anterior distribution of her pain. Her activities of daily living improved, and she was able to sleep without pain after the PNS implantation. The successful use of combined fluoroscopy and ultrasound in targeting the specific nerves and replicating the patient's pain distribution before permanent PNS implantation is highlighted in this case.

Additionally, the show notes mention an events calendar located at this link: https://www.nrappain.org/pages/ultrasound-course-calendar.

Upcoming Course schedule for NRAP Academy includes the following events:

  1. Ultrasound Guided Pain & Regional Anesthesia Course in New York City on February 10, 2024. This course will cover nerve blocks, joint injections, and more. Attendees will have the opportunity to scan live models after the didactic session.

  2. MSK Pain & Regional Anesthesia Course in Miami, Florida on February 18, 2024. This course will focus on ultrasound-guided nerve blocks and MSK (musculoskeletal) pain management.

  3. Ultrasound Guided Pain Course in Key West, Florida on February 23, 2024. This 4 CME (Continuing Medical Education) course will cover ultrasound-guided nerve blocks, MSK, PRP (platelet-rich plasma), BMAC (bone marrow aspirate concentrate) targets, and regional anesthesia.

  4. Regional Anesthesia and US Guided Pain Management Course in New York City on March 9, 2024. This course will provide training in ultrasound-guided interventional pain management and regional anesthesia.

  5. Ultrasound Guided IPM (Interventional Pain Management) Course in West Virginia on April 14, 2024. This course is part of the Appalachian Regional Spine and Pain Meeting and will be conducted by NRAP Academy. It will focus on interventional pain management using ultrasound guidance.

  6. Regenerative Pain Medicine Course in New York City on May 4, 2024. This course will cover PRP (platelet-rich plasma) and other regenerative pain medicine techniques.

In addition to the live training, attendees will receive bonus material including access to the On Demand Ultrasound Guided MSK Interventional Pain Management Course, a course workbook and certificate, post-course guidance and discounts, and the opportunity to join the mailing list for calendar updates.

Please note that these course details are subject to change, so it's recommended to visit the NRAP Academy website for the most up-to-date information.

Reference

Fu E, Elsharkawy H
#35977 Peripheral nerve stimulation implant for chronic post-traumatic hip and pelvic pain
Jan 24, 2024

Painexam Podcast Show Notes: Journal Club on "Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves"

Special Thanks to Robert Stall, MD

Introduction:

  • Welcome to another episode of the Painexam Podcast! In today's journal club edition, we delve into a fascinating study by Dr. Joel E. Pessa on cerebrospinal fluid (CSF) circulation in human nerves.

Background:

  • The study addresses the growing evidence of CSF circulation in human nerves and its implications in various conditions encountered by plastic surgeons.
  • Conditions such as nerve transection, stretch injuries, and peripheral neuropathy may be related to dysregulation of the CSF system.

Methods:

  • Dr. Pessa and his team developed the ventricular infusion technique using buffered saline in 2017.
  • The technique was applied to eight fresh cadavers before dissecting the median nerve.
  • Fluorescent imaging and nanoprobe injections were combined with ventricular infusion in selected specimens.

Results:

  • The eight cadaver specimens (six female, two male) aged 46–97 underwent successful ventricular infusion.
  • Ventricular cannulation was performed successfully using specific coordinates.
  • Results suggest that CSF flows in neural sheaths, including pia meninges, epineurial channels, perineurium, and myelin sheaths (neurolemma).

Conclusions:

  • Ventricular infusion and nanoprobes effectively identify CSF flow in neural sheaths of human nerves.
  • CSF flow in nerves is described as an open circulatory system occurring via channels, intracellular flow, and cell-to-cell transport associated with glial cells.
  • Neural sheaths, including neurolemma, may play a role in glucose and solute transport to axons.
  • The techniques showcased in this study can be utilized in anatomic dissection and live animal models and have been extended to the central nervous system to identify direct ventricle-to-pia meninges CSF pathways.

Significance:

  • This study opens new avenues for understanding the intricate mechanisms of CSF circulation in neural tissues.
  • Plastic surgeons and researchers can benefit from these techniques in studying and addressing conditions related to CSF dysregulation in nerves.
  • The findings have implications not only for nerve-related conditions but also for broader applications in the central nervous system.

Closing:

  • Thank you for joining us on this insightful journey through Dr. Joel E. Pessa's study. Stay tuned for more engaging discussions on pain management and neurology in future Painexam Podcast episodes!

Reference

Pessa JE. Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves. Plast Reconstr Surg Glob Open. 2022 Feb 17;10(2):e4126. doi: 10.1097/GOX.0000000000004126. PMID: 35198353; PMCID: PMC8856590.

Nov 27, 2023

 

Dr. Rosenblum reviews the anatomy of the ilioinguinal nerve and entrapment syndromes related to the nerve and its relationship to the iliohypogastric nerve.
He describes cases in which patients have a tender spot (tinel’s) over the lateral iliac crest.

Live Regenerative Medicine and Ultrasound Workshops

For  up to date Calendar, Click Here!

#painboards #painfellowship #abpm #aspn #abipp #Asipp

#nans #painexam #painexampodcast #regionalanesthesia #regemed #regenerativepainmedicine #jointinjections #prppain #bmac #painqbank #uspaininjections #Usjointinjections #interventionalpain

 

References

https://assets.cureus.com/uploads/review_article/pdf/94743/20220610-32009-17da8fm.pdf
https://www.bizwan.com/en/index.php?view=article&id=82:proximal-entrapments-of-the-lower-extremity&catid=86&start=1
Oct 12, 2023

Dr. Rosenblum reviews information he found regarding the various types of peptides that private practices are useing for healht and wellness. 

Upcoming Pain Management Conferences

 

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ISPN-save-the-date-2023-v3.png

 

 

Upcoming Workshops and Events

 

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, October 28, 2023 8:00 AM

 

Charleston, SC  Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Sunday, October 29, 2023 9:00 AM

 

NRAP Academy:  Regenerative Pain Medicine Course NYC

Saturday, November 11, 2023 8:00 AM

 

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, December 16, 2023 7:30 AM

 

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, January 6, 2024 7:30 AM

  

For  up to date Calendar, Click Here!

 

Sep 28, 2023

Dr. Rosenblum discusses his concerns over:

 RFA of the Genicular Nerves being a non reimbursed service when the patient already had them in the past with excellent relief.

Plus a discussion on CMS policy toward Peripheral Nerve Block reimbursement limitations and documentation!

Pain Management, Anesthesiology, PMR Board Review

Upcoming Workshops and Events

 

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, October 28, 2023 8:00 AM

 

Charleston, SC  Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Sunday, October 29, 2023 9:00 AM

 

NRAP Academy:  Regenerative Pain Medicine Course NYC

Saturday, November 11, 2023 8:00 AM

 

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, December 16, 2023 7:30 AM

 

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, January 6, 2024 7:30 AM

 

For  up to date Calendar, Click Here!

Reference

 

Sep 11, 2023

 

Drawing from her own experience of transformation from being a burnout physician to regaining, designing, and retaining control of her physician life, Dr. Myrdalis Diaz-Ramirez created the maxAllure Mastermind. It is now her passion to help physicians who feel overwhelmed and lost in medicine to find a new path and control their lives through entrepreneurship.
She is a born and self-made entrepreneur with experience in owning different clinics which she successfully sold in the past. She has also owned other businesses, including an entertainment company. Dr. Myrdalis Díaz-Ramírez is a dual Board-Certified Anesthesiologist and Interventional Pain Management Physician. She is also a Medical Expert,
Professor, Author, Speaker, Podcaster, Entrepreneur, and Mastermind Facilitator. Through her Mastermind, physicians can transform their personal and professional lives. They have been able to define, plan, and execute a designed vision for their life and business that was once only a dream!

 

Aug 24, 2023

Dr. Rosenblum discusses posterior hip pain/buttock pain near scar after Total Hip Arthroplasty. Included in this episode:

  • Patient Testimonial re: SPRINT PNS (superior gluteal and superior cluneal nerve)
  • Superior Gluteal Nerve Anatomy
  • Hip Innervation
  • Upcoming Private and Group Ultrasound Training

Upcoming Pain Management Conferences

Course Calendar

2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

Oct. 28 Regional Anesthesia and Interventional Pain Medicine NYC

Nov.11 Regenerative Pain Medicine Course: NYC  

Dec. 16th Regional Anesthesia and Interventional Pain Ultrasound Training NYC

2024

Jan. 6 Regional Anesthesia and Interventional Pain Ultrasound Training NYC

For  up to date Calendar, Click Here!

Board Review

References

Pierre Laumonerie and others, Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature, Pain Medicine, Volume 22, Issue 5, May 2021, Pages 1149–1157, https://doi.org/10.1093/pm/pnab061

Pinho, A.R.; Leite, M.J.; Lixa, J.; Silva, M.R.; Vieira, P.; Nery-Monterroso, J.; Bezerra, M.C.; Alves, H.; Madeira, M.D.; Pereira, P.A. Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region. Diagnostics 2023, 13, 2314. https://doi.org/10.3390/diagnostics13142314

Lung K, Lui F. Anatomy, Abdomen and Pelvis: Superior Gluteal Nerve. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535408/

Aug 12, 2023

David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses: a case of paresthesia in the upper neck realted to C3 and C4 stenosis and considers a selective nerve root block while wondering if a deep cervical plexus block would suffice.  

Rational :

  • Desire to avoid epidural due to proximity to spinal cord
  • Ultrasound approach of cervial plexus may anesthetize C3 and C4 roots and may be sufficient to do with ultrasound alone
  • Unfortunately, no data found to support this particular situation, however, it may be safe and effective if performed properly.   

Claim CME

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/lubWXJ

Also discussed on this podcast:

The Superficial Cervical Plexus and applications for headache, neck pain, and clavicular fractures. 

Caution: Phrenic Nerve

Anatomy

The cervical plexus is a complex network of nerves located in the neck region, originating from the anterior rami (branches) of the cervical spinal nerves, specifically those stemming from the upper cervical segments (C1 to C4). This intricate network serves to provide sensory and motor innervation to various structures within the neck and surrounding areas.

The cervical plexus is positioned within a groove between the longus capitis and the middle scalene muscles in the neck. It is organized into different nerve loops and branches that radiate outwards to supply various regions. The cervical plexus can be divided into deep and superficial components, each with distinct functions and innervation patterns.

Cervical Plexus: The plexus involves nerve loops and branches that provide both sensory and motor functions. The superficial sensory branches originating from adjacent anterior spinal nerves (C2 to C4) are responsible for providing sensation to specific areas of the skin, particularly in the head, neck, and shoulder regions. These sensory branches include the lesser occipital nerve (C2, C3), great auricular nerve (C2, C3), transverse cervical nerve (C2, C3), and supraclavicular nerves (C3, C4). These nerves typically run posteriorly and then penetrate the prevertebral fascia before reaching the skin and superficial structures.

For Pain Management and Anesethesiology Board Review, go to

For the Virtual Pain Fellowship Experience, Go to:

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Ultrasound Workshops and Courses

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

Regenerative Pain Medicine Course NYC- November 11, 2023

For  up to date Calendar, Click Here!

Refereces

Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol. 2018 Aug;71(4):274-288. doi: 10.4097/kja.d.18.00143. Epub 2018 Jul 4. PMID: 29969890; PMCID: PMC6078883. Read more!

Aug 3, 2023

ISPN Dubai 2023

David Rosenblum, MD interviews Reda Tolba, MD on the PainExam Podcast

In this episode, we delve into the realm of Pain Management in the US and the Middle East. Our international pain experts discuss the upcoming ISPN (International Society for Pain and Neuroscience) meeting in Dubai this december.

ISPN Pain Dubai Conference

 

Subscribe to the PainExam Newsletter to Receive Free Content, Discounts and Course Updates!

 

Dr. Reda Tolba, MD, chairs the Pain Management Department at Cleveland Clinic Abu Dhabi. He's internationally recognized for his contributions to Pain Medicine, boasting a wealth of experience from institutions like Wake Forest University Medical Center and Ochsner Health System.

Dr. David Rosenblum, MD, is the Director of Pain Management at Maimonides Medical Center and a driving force behind pain education platforms like PainExam.com and NRAP Academy. He's a pioneer in ultrasound-guided pain procedures, having trained thousands of physicians online and in person.

PainExam Pain Management Board Review

Tune in to hear Dr. Tolba's journey to being named Chair of Pain at Cleveland Clinic, Abu Dhabi, and his impressive academic and clinical achievements.Dr. Rosenblum, on the other hand, is known through his contributions to safe pain management protocols, and his mission to spread knowledge through podcasts and educational events.

AABP Integrative Pain Care's Dr. David Rosenblum in Garden City and LI

Patients, interested he's scheduling an appointment with Dr. Rosenblum at his Long Island or Brooklyn Locations can go to AABPpain.com or call 718 436 7246 or 516 482 7246

To learn more about their work and educational initiatives, explore NRAPpain.org and PainExam.com/events. Join us in this episode to uncover insights from these leading figures in Pain Management.

Ultrasound Training

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For  up to date Calendar, Click Here!

Jul 11, 2023

On this episode, Dr. Rosenblum has a chat with Premier Heritage's Greg Alerte.

Greg has over 15 years of experience helping families and small business to achieve their financial goals. As co-owner and Certified Financial Planner at Premier Heritage, he focuses on helping people to preserve and grow their wealth, and to leave a legacy for future generations to build on. Greg’s research and professional opinions, have been quoted in several financial publications, including Wall Street Journal, NerdWallet, Financial Planning magazine, and the Huffington Post. Greg’s favorite quote is by the late Mia Angelou “when you learn teach, when you get give”

For more information, Email: galerte@premier-heritage.com

David Rosenblum, MD

David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses:

Attend and NRAP Course!

NRAP Academy's Regional Anesthesia Course

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For  up to date Calendar, Click Here!

 

Jun 21, 2023

David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses:

  • Genicular Nerve Ablation with Phenol
  • The history of phenol
  • The mechanism of action
  • Indications
  • Complications
  • Clinical concerns when considering neurolysis with phenol
 
Claim CME Credit
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/9GkVWu
References
D'Souza RS, Warner NS. Phenol Nerve Block. [Updated 2023 Jan 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 
 
 Risso CR e tal.Chemical Ablation of Genicular Nerve with Phenol for Pain Relief in Patients with Knee Osteoarthritis: A Prospective StudyVolume21Issue4April 2021Pages 438-444
Jun 14, 2023
 
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/ATmqM6
 
 
David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses Ketamine infusions, optimal infusion protocols and the evidence or lack of to support them. 
 
Ketamine infusions have been used for chronic neuropathic pain, CRPS and depression. Dr. Rosenblum is accepting new patients and consultations could be scheduled by visiting www.AABPPain.com or calling 718 436 7246 or 516 482 7246.
 
Pain Management Board Prep
Anesthesiology Board Prep 
 

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For  up to date Calendar, Click Here!

References 
Maher, Dermot P MD, MS; Chen, Lucy MD; Mao, Jianren MD, PhD. Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization. Anesthesia & Analgesia 124(2):p 661-674, February 2017. | DOI: 10.1213/ANE.0000000000001787 
Jun 8, 2023

In this episode of the AnesthesiaExam podcast, New York Anesthesiologist, David Rosenblum, MD  delves into the topic of maternal physiological changes during pregnancy and the associated concerns for anesthesia providers. The episode emphasizes the importance of understanding these changes to ensure safe and effective anesthesia management for pregnant patients.

Dr. Rosenblum discusses the significant physiological changes that occur during pregnancy, particularly in the cardiovascular, respiratory, and hormonal systems. These changes impact drug distribution, elimination, ventilation, and the risk of aspiration.

Throughout the discussion, the host and guest highlight the need for anesthesia providers to stay updated on the latest evidence-based practices and guidelines for managing pregnant patients. They stress the importance of appropriate dosing, ventilation strategies, and addressing the increased risk of aspiration to maintain the well-being of both the mother and the fetus.

To further support Anesthesiologists and CRNAs  in their board exam preparation, we are offering the NRAP AnesthesiaExam board review course. The course is designed to provide comprehensive coverage of anesthesia with lectures, videos and question bank to ensure candidates are well-prepared for their exams. Listeners are encouraged to visit https://www.nrappain.org/courses/BasicAnesthesiaExam to access more information and register for the course.

The NRAP Academy is offering the exciting opportunity for anesthesia professionals interested in regional anesthesia ultrasound to train at one of our live ultrasound CME workshops. Dr. Rosenblum mentions regional anesthesia ultrasound courses in NY, the US and abroad.

 

These courses offer valuable hands-on training and insights into the latest techniques. Our course calendar is listed here:

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

 

For more information and to register for the regional anesthesia ultrasound courses,

Click Here!

 

Reference

Ruth Bedson, MBBS FRCA , Anna Riccoboni, MBChB FRCA, Physiology of pregnancy: clinical anaesthetic implications, Continuing Education in Anaesthesia Critical Care & Pain, Volume 14, Issue 2, April 2014, Pages 69–72, https://doi.org/10.1093/bjaceaccp/mkt036

Jun 4, 2023

Neurosurgery and Regional Anesthesia

Claim CME Credit:

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/t3z3kR

In this episode, we will explore the various regional anesthesia techniques used in neurosurgery, specifically focusing on blocks for head, neck, and spinal surgeries.

Segment 1: Blocks used in Head and Neck Surgeries

  1. Scalp Block:
  • The scalp block involves blocking six nerves that provide sensory innervation to the scalp.
  • It is performed by subcutaneous infiltration of local anesthetics (such as bupivacaine, ropivacaine, or levobupivacaine) for each nerve.
  • Ultrasound guidance has improved the precision of block administration.
  • The main indication for a scalp block is awake craniotomy, but it is also used in other procedures like deep brain stimulation and cranioplasty surgery.
  • Scalp block offers advantages such as accurate neurological evaluation, pre-emptive analgesia, and hemodynamic stability during surgery.
  • It also reduces postoperative pain, the need for rescue analgesics, and pain scores in the early postoperative period.
  1. Infraorbital Block (IOB):
  • The infraorbital nerve block targets the infraorbital nerve, which supplies the skin and mucous membrane of the upper lip, lower eyelid, and cheek.
  • The IOB can be performed using the classical landmark technique or ultrasound guidance.
  • Ultrasound guidance provides real-time visualization and accurate needle placement.
  • IOB combined with general anesthesia is beneficial for postoperative pain relief in procedures like endoscopic trans-nasal trans-sphenoidal (TNTS) approach for pituitary tumor excision.
  • Other regional techniques like sphenopalatine ganglion block and maxillary nerve blocks have also been attempted for transsphenoidal surgeries.
  1. Trigeminal Nerve Block:
  • Trigeminal nerve block is used for patients unresponsive to medical management of trigeminal neuralgia.
  • Traditionally performed using the paresthesia technique, ultrasound guidance allows real-time visualization and confirmation of local anesthetic spread.
  • Ultrasound guidance helps locate the Gasserian ganglion and visualize the trigeminal ganglion, providing a safe and radiation-free procedure for pain relief.

Segment 2: Blocks used for Spinal Surgeries

  1. Cervical Plexus Block (CPB):
  • CPB is commonly used in carotid endarterectomy (CEA) and cervical spine surgery.
  • Different levels of CPB can be performed depending on the depth of injection.
  • Superficial CPB involves injecting local anesthetic superficially into the deep cervical fascia.
  • Deep CPB requires depositing local anesthetic deep to the prevertebral fascia.
  • CPB helps in monitoring cerebral blood flow during CEA and provides postoperative pain relief.
  • Ultrasound guidance can be used for superficial CPB, ensuring accurate needle placement and local anesthetic spread.
  1. Erector Spinae Block (ESB):
  • ESB is used for pain control in spinal surgeries.
  • It involves depositing local anesthetic in the plane between the erector spinae muscle and the transverse process.
  • ESB provides effective postoperative analgesia and reduces opioid consumption.

Regional anesthesia techniques play a crucial role in neurosurgery, providing effective pain relief and improving patient outcomes. Blocks like scalp block, infraorbital block, trigeminal nerve block, cervical plexus block, and erector spinae block offer numerous advantages in specific procedures. Ultrasound guidance has enhanced the precision and safety of block administration. These techniques contribute to improved surgical outcomes and patient satisfaction in neurosurgical procedures.

Upcoming Courses and Workshops!

Course Calendar

Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PRNRAP Academy Ultrasound Guided Regional Anesthesia and Pain Management Course

For  up to date Calendar, Click Here!

References
Kaushal A, Haldar R. Regional Anesthesia in Neuroanesthesia Practice. Discoveries (Craiova). 2020 Jun 29;8(2):e111. doi: 10.15190/d.2020.8. PMID: 32637571; PMCID: PMC7332314.
May 17, 2023

Introduction: Providing anesthesia for pediatric orthopedic patients poses unique challenges for anesthesiologists. The approach must consider the psychological development of the child and the prevalence of respiratory infections. Pain management, management of concomitant diseases, and risk reduction for adverse events are crucial aspects of anesthetic care. This blog post will review the perioperative concerns specific to pediatric orthopedic procedures, discuss pain control methods used, and highlight anesthetic considerations for certain surgeries.

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Select Pediatric Perioperative Concerns:

  1. Upper Respiratory Tract Infections (URI): Pediatric patients presenting for orthopedic surgery with current or recent URIs pose a challenge for anesthesiologists and surgeons. Children commonly experience URIs with symptoms like a runny nose, cough, and fever. While the viral infection may reside in the nasopharynx, the lower respiratory tract remains sensitive for up to 6 weeks after URI symptoms have resolved. This increased sensitivity puts patients at risk for perioperative complications like laryngospasm, bronchospasm, and oxygen desaturation. Delaying surgery for 6 weeks after URI resolution is often impractical, as another URI is likely to occur. For elective surgery, severe symptoms and complications warrant postponing surgery, but clear nasal discharge in an otherwise healthy patient may proceed with elective surgery. Clinical decision-making becomes challenging for cases falling between these extremes. Factors such as patient age, comorbidities, prior cancellations, surgery complexity, and urgency are considered when deciding whether to postpone surgery. If elective surgery is delayed, most clinicians would wait 2 to 4 weeks after URI symptom resolution.
  2. Anxiety in the Pediatric Patient: Pediatric patients undergoing orthopedic surgery often experience varying levels of anxiety and distress. Preoperative stressors can include unfamiliar environments, procedures, hunger, fear of pain, and separation from parents. Certain risk factors contribute to preoperative anxiety, such as ages 1 to 5 years, shy temperament, prior negative medical experiences, high cognitive levels, and parental anxiety. Unaddressed anxiety can lead to postoperative behavioral changes, including generalized anxiety, separation anxiety, aggression, and nighttime crying. It can also result in higher pain scores and increased pain medication requirements after surgery. Strategies to mitigate preoperative anxiety include presurgical preparation programs involving site visits, videos, books, and child-life interventions. Allowing parental presence during anesthesia induction can help alleviate separation anxiety. Pharmacologic interventions like oral midazolam can improve compliance and reduce negative behavioral changes in the short term.
  3.  

Anesthetic Management for Orthopedic Procedures:

  1. Anesthetic Considerations for Select Pediatric Orthopedic Surgeries: Scoliosis Surgery: Anesthetic concerns during scoliosis surgery include optimizing neuromonitoring signals, managing blood loss, preventing positioning-related injuries, and minimizing the risk of postoperative visual loss.

  2. Pain Management: Pain control for pediatric orthopedic patients involves a multimodal pharmacologic approach to minimize opioid requirements. This approach includes non-opioid analgesics, local anesthetics, and regional anesthesia techniques. Regional anesthesia, such as peripheral nerve blocks and caudal anesthesia, is particularly valuable for postoperative pain control. Recent studies have confirmed the safety of regional anesthesia in the pediatric population.

Pediatric orthopedic surgeries present unique challenges for anesthesiologists. Effective management of preoperative anxiety, careful consideration of upper respiratory tract infections, and appropriate pain control strategies are essential for successful outcomes. Anesthesiologists must tailor their approach to the specific needs of pediatric patients undergoing orthopedic procedures to ensure their safety and well-being.

Reference

 Wu JP. Pediatric Anesthesia Concerns and Management for Orthopedic Procedures. Pediatr Clin North Am. 2020 Feb;67(1):71-84. doi: 10.1016/j.pcl.2019.09.006. PMID: 31779838; PMCID: PMC7172179.

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Ultrasound Block Course applicable in  Pediatric Anesthesia for Orthopedic Procedures includes:

  • Certificate of Completion
  • Ultrasound Guided Interventional Pain Atlas
  • Continuing Medical Education Credit
  • Online access to Webinar (additional CME Credit)

Regional Anesthesia:

 

Lower Extremity Nerve Blocks for 

 

Upper Extremity Anesthesia for Fractures and Reductions

 

Truncal and Fascial Plane Blockade

and much more!

Caudal Epidural and Spine demonstrations available as well.

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Or Email DRosenblum@rmcpain.com to arrange a private workshop with your Department.

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Apr 27, 2023

Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Join digital health leader and Upside Health CEO Rachel Trobman and PainExam.com founder Dr. David Rosenblum in a conversation about the impact of the end of the public health emergency in May could have on your pain management practice. We'll specifically discuss the changes to telehealth and remote patient monitoring. The webinar will close with one of Upside Health's clients outlining the launch and successes of RTM in their practice and be available for Q&A.

Course Calendar

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For  up to date Calendar, Click Here!

For Board Prep go to www.AnesthesiaExam.com

For more questions Email Rachel Trobman at Rachel@upside.health

Apr 12, 2023
Regenerative Medicine Journal Club
 
Dr. Rosenblum reviews a case report discussing Platelet Rich Plasma Intra-discal Injection using ultrasound and fluoroscopy. The author mentions use of ultrasound to avoid the Internal jugular vein, carotid artery, phrenic nerve, esophagus and neural structures.  The author mentions mixing lidocaine with PRP and Dr. Rosenblum comments on his experience and knowledge of the technique.  Dr. Rosenblum mentions the risk of disci tis.
 
 
Course Calendar
 
Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!
 
 
 
 
 
 
For  up to date Calendar, Click Here!
 
Claim CME Credit
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/wpE4BfThe CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/wpE4Bf
 
References
Mar 29, 2023
The MOTION Study: Minimally Invasive Lumbar Decompression
 
CME Credit
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/W8x3jd
 
Journal Club. Minimally Invasive Lumbar Decompression (mild® Procedure) with Conventional Medical Management vs. Conventional Medical Management Alone.
Descripton of Procedure, Safety, Technique, study outcome, personal experience with this minimally invasive technique that interventional pain physicians are using to treat neurogenic claudication related to ligamentum flavum hypertrophy. 
 
Dr. Rosenblum discusses spinal stenosis pathophysiology and neurogenic claudication. Dr. Rosenblum also mentions upcoming courses and webinars:
 
 
Upcoming Courses and Workshops!
 
Course Calendar
 
Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!
 
 
For  up to date Calendar, Click Here!
 

References

Timothy R Deer, MD, Shrif J Costandi, MD, Edward Washabaugh, MD, Timothy B Chafin, MD, Sayed E Wahezi, MD, Navdeep Jassal, MD, Dawood Sayed, MD, The MOTIONStudy: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild® Procedure: One-Year ResultsPain Medicine, Volume 23, Issue 4, April 2022, Pages 625–634, https://doi.org/10.1093/pm/pnac028
 

 

Mar 21, 2023
Biologics and the Peripheral Nerve.
 
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Dr. Rosenblum discuss his upcoming talk at the Appalachian Region Spine and Pain Meeting:  Incorporating Ultrasound into a Spine and Pain Practice on April 14-16 2023 and the topics he plans to include: Ultrasound Guided Knee therapies, cluneal nerve, caudal, brachial plexus and more!
 
Today’s podcast focuses on the risk and benefits of performing PRP injection onto a nerve.  Dr. Rosenblum discusses:
 
 Possible fibrosis of the ulna nerve after using PRP for partial ulnar collateral ligament tears
 Best Time for PRP Injection after Nerve Regeneration
 Alpha 2-macroglobulin (what is it?)
 PRP for moderate to severe carpal tunnel syndrome
 
Featured Courses!
 
May 25, 2023 Private Pain Group   Ultrasound Course- NYC (Sold out)
 
see the full schedule for our July and August US IPM Courses!
 
References
Robert G. Thompson, Kendall Bradley, Gary M. Lourie,
Ulnar nerve dysfunction at the elbow after platelet-rich plasma treatment for partial ulnar collateral ligament injuries,JSES Reviews, Reports, and Techniques,Volume 1, Issue 1,2021,Pages 41-44,ISSN 2666-6391,
 
Si-Ru Chen, Yu-Ping Shen, Tsung-Yen Ho, Tsung-Ying Li, Yu-Chi Su, Yu-Ching Chou, Liang-Cheng Chen, Yung-Tsan Wu,One-Year Efficacy of Platelet-Rich Plasma for Moderate-to-Severe Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial,Archives of Physical Medicine and RehabilitationVolume 102, Issue 5,2021,
Pages 951-958,ISSN 0003-9993,https://doi.org/10.1016/j.apmr.2020.12.025.
 
Rehman, A.A., Ahsan, H. and Khan, F.H. (2013), Alpha-2-macroglobulin: A physiological guardian. J. Cell. Physiol., 228: 1665-1675. https://doi.org/10.1002/jcp.24266
 
Muhammad Pandunugrahadi, Komang Agung Irianto, Oen Sindrawati, "The Optimal Timing of Platelet-Rich Plasma (PRP) Injection for Nerve Lesion Recovery: A Preliminary Study", International Journal of Biomaterials, vol. 2022, Article ID 9601547, 7 pages, 2022. https://doi.org/10.1155/2022/9601547
Mar 11, 2023
Knee Osteoarthritis and Regenerative Pain Medicine
 
Claim CME
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/TJXGw0
 
 
Dr. Rosenblum reviews the latest evidence comparing Bone Marrow Aspirate and Platelet Rich Plasma for knee pain. He also reviews the latest publication by Di Martino et al’s study which compared Leukocyte-rich PRP vs. Leukocyte-poor PRP in the treatment of knee osteoarthritis. 
 
Upcoming Courses

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

References

El-Kadiry, A.EH., Lumbao, C., Salame, N. et al. Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study. BMC Musculoskelet Disord 23, 23 (2022). https://doi.org/10.1186/s12891-021-04910-5

 
Hede, Kris, et al. "Combined bone marrow aspirate and platelet-rich plasma for cartilage repair: two-year clinical results." Cartilage 13.1_suppl (2021): 937S-947S.
 
Anz AW, Plummer HA, Cohen A, Everts PA, Andrews JR, Hackel JG. Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):618-629. doi:10.1177/03635465211072554
 
 
Di Martino A, Boffa A, Andriolo L, et al. Leukocyte-Rich versus Leukocyte-Poor Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):609-617. doi:10.1177/03635465211064303
Feb 25, 2023

Carpal Tunnel Syndrome

Claim CME
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/JiPKnm
 
Diagnosis, Pathophysiology, Clinical Findings and Management of the Carpal Tunnel Syndrome

 In this episode, we will be discussing Carpal Tunnel Syndrome, a common condition that affects millions of people worldwide. But before we dive into the topic, we want to tell you about a great opportunity to advance your medical knowledge through the NRAP Academy CME courses offered on our website.

Discussion on Carpal Tunnel Syndrome:

Carpal Tunnel Syndrome is a condition that occurs when the median nerve, which runs from the forearm to the hand, becomes compressed or squeezed at the wrist. This compression can lead to pain, numbness, and tingling in the hand and arm, which can be debilitating.

There are many causes of Carpal Tunnel Syndrome, including repetitive hand movements, wrist injuries, pregnancy, and medical conditions such as diabetes and thyroid disorders. Treatment options for Carpal Tunnel Syndrome range from non-invasive approaches like rest, ice, and wrist splints to more invasive treatments like surgery.

It's important to diagnose and treat Carpal Tunnel Syndrome early to prevent long-term damage to the median nerve. A proper diagnosis can be made through a physical exam and imaging tests like an electromyography (EMG) or nerve conduction study (NCS).

Don't forget to check out the NRAP Academy CME courses offered on our website, www.painexam.com/events page, to continue your medical education and enhance your patient care.


NRAP Academy Events

Hands on Training for medical professional looking to enhance your knowledge and skills in pain management? Offering courses are designed to help you stay up-to-date with the latest advances in pain management and to help you improve patient outcomes. Visit our website, www.painexam.com/events page, to learn more about the courses available and to sign up today.


References
Sevy JO, Varacallo M. Carpal Tunnel Syndrome. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/
 
Sevy JO, Varacallo M. Carpal Tunnel Syndrome. 2022 Sep 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28846321.
Jan 31, 2023
Claim CME 
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/tn70Yk
 
Dr. Rosenblum discuss a challenging case and reviews the pathology, treatment and evidence for interventional pain in the the treatment of Post Herpetic Neuralgia.
Discussed in this podcast:
Intrathecal injection of methylprednisolone
Dorsal Root Ganglion 
Paraveterbral Nerve Block
Stellate Ganglion Block
Spinal Cord Stimulation
Botulinum Toxin Injection
And more!
 
Course Calendar
 
 
 
 
References

Lin, Chia-Shiang, et al. "Interventional treatments for postherpetic neuralgia: a systematic review." Pain physician22.3 (2019): 209.

https://www.painphysicianjournal.com/current/pdf?article=NjMwMg%3D%3D&journal=120
Jan 10, 2023

David Rosenblum, MD, creator of PainExam.com, AnesthesiaExam.com, PMRExam.com, NRAP Academy and International Pain Academy Co-Founder presents an excerpt from Grand Rounds Given on January 2, 2023 to the Metropolitan Hospital Physical Medicine and Rehabilitation Department.

Reflect on Ultrasound Guided Interventional Spine Procedures and Claim CME Credit

Agenda:

  • Ultrasound Guided Cluneal Nerve Blocks
  • Ultrasound Guided Stellate Ganglion Block 
  • Ultrasound Guided Facet Joint Injection
  • Ultrasound Guided Medial Branch Blocjks
  • Ultrasound Guided Sacroiliac Joint Inejction 
  • Ultrasound Guided Caudal Epidural Injections

Dr. Rosenblum offers live regional anesthesia, regenerative medicine, board review and interventional pain management CME courses in NY and around the world. For more information, go to www.NRAPpain.org or PainExam.com/events

Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Great Neck Office 516 482 7246

 

Upcoming Courses and Workshops!

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022

Regenerative Interventional Pain Course NYC- Jan, 28, 2023

Ultrasound Guided Regional Anesthesia and  Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

NRAP: NYC Regional Anesthesia and Pain Ultrasound CME Workshop Registration, Sat, Dec 3, 2022 at 7:30 AM | Eventbrite

For  up to date Calendar, Click Here!

 

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