Q&A with Speakers

We Asked - They Answered!

We asked ESRA 2019 speakers to provide us with their lectures learning objectives, and the relevance for today’s practice. Below are their answers.

Dr. Teresa Parras

Session/lecture title: Chest Wall Blocks for Breast Surgery: which, where, how?
Learning Objectives: To describe the relevant sonoanatomy, techniques, and indications.
Lecture connection to a hot topic: The chest wall blocks are a hot topic, like the pecs, serratus plane and erector spinae blocks are recently described.
Importance of topic: I will explain the anatomy behind them, the sonoanatomy and how to perform a successful block.

Session/lecture title: Regional Anaesthesia in Multidisciplinary Fast-track Surgical Care Pathways. Breast Surgery.
Learning Objectives: Explain the perioperative approach aimed at reducing surgical stress and facilitating postoperative recovery after breast surgery.
Lecture connection to a hot topic: The chest wall blocks are a hot topic, among them pecs and serratus plane blocks are indicated for breast surgery.
Importance of topic: Blocks to perform in breast surgery as part of a fast track pathway.

Prof. Lee Sang-Hoon

Session/lecture title: Diagnostic Blocks in Chronic Pain
Learning Objectives: Diagnostic blocks are needed to confirm the pain generators, but no nerve supply one structure. Medial branch block cannot exclude myofascial or ligamentous pain generators of the posterior spinal structures. A very cautious approach is needed.
Lecture connection to a hot topic: There are many articular branch anatomic studies targeting denervation procedures. But, we have to accept that there are also flaws in their studies.
Importance of topic: Denervation procedure will open a new era of interventional pain procedure, but it will bring unexpected complications.

Session/lecture title: Daily Chronic Pain Management in the Search of Answers?
Presentation title: Discography in Chronic Spinal Pain-Update of the Systematic Appraisal of the Accuracy and Utility
Learning Objectives: Typically, discogenic lower pain is reproduced or aggravated with prolonged sitting, forward flexion, transitioning from a sitting to a standing position, sit-ups, Valsalva manoeuvres, and rotation while subjected to an axial load. Provocative discography is an invasive diagnostic spine procedure to determine if the disc is the origin of a patient’s chronic spine pain.
Lecture connection to a hot topic: Discography is the only confirmatory diagnostic tool of discogenic pain. But, it is an invasive tool and has a false positive and false negative ratio.
Importance of topic: To improve the success rate of disc related procedure, a sophisticated diagnostic test should be backed up.

Prof. Brian Ilfeld

Session/lecture title: Perioperative Pain Therapy: More than Just Single Shot Blocks
Presentation title: Cryoneurolysis for Treatment of Acute Pain Instead of Continuous PN Blocks
Learning Objectives: After this presentation, participants will understand the history, mechanism of action, available equipment, application techniques, potential benefits and associated risks of cryoneurolysis used to provide postoperative analgesia.  Data from available prospective published studies will be presented.
Lecture connection to a hot topic: The “hot topic”, at least in the United States, is non-opiate analgesics (due to the opioid crisis here).
Importance of topic: The topic is important to anyone who provides postoperative analgesia: cryoneurolysis provides over a month of analgesia with risks far lower than nearly any other analgesic method. The per-subject costs are a fraction of continuous peripheral nerve blocks, there is no equipment to “manage” following the procedure, and there are no systemic side effects of this modality.

Dr. Mert Akbas

Session/lecture title: Spinal Epidural Endoscopic or Percutaneous Adhesiolysis. Is it All the Same?
Learning Objectives: Experience and safety are important steps.
Lecture connection to a hot topic & importance of topic: Current topics because they are consistently increasing their role in evidence-based medicine.

Prof. Jörgen Bruhn

Session/lecture title: Multimodal Analgesia in Orthopaedic Surgery: The Way Ahead!
Lecture connection to a hot topic & importance of topic: Opioids can’t (and won’t) do it all. How enhanced multimodal approaches (beyond just adding regional anaesthesia) will benefit your patients and will change your approach to anaesthesia.

Session/lecture title: Pain Rebound in Day Surgery: How can we Avoid it?
Learning Objectives: Expected and unexpected options to solve a common clinical problem.

Prof. Lucas Rovira Soriano

Session/lecture title: Perioperative Administration of Oxygen risks and benefits Intraoperative Hyperoxemia is a Valuable Recommendation?Perioperative Oxygen Administration
Learning Objectives: Oxygen is the most used drug in the perioperative period. Are we aware that it is a drug? We must know the risks and benefits of the oxygen that we administer to our patients. In addition, we must know when and how much oxygen we should administer in each patient and situation.
Lecture connection to a hot topic: Inspired oxygen fraction is a hot topic, we try to clarify best practice related to this topic.
Importance of topic: Oxygen is the most used drug in the perioperative period, the goal is to improve our clinical practice with the latest evidence on oxygen therapy

Session/lecture title: Strategies to Reduce Hemidiaphragmatic Paresis and Related Risks after Blocks/ for Shoulder Surgery
Learning Objectives: When we plan locorregional anaesthesia for shoulder surgery

  • Which is the incidence of phrenic palsy depending on site of brachial plexus block? Which are the clinical implications (could we asses in which patients hemidiaphragmatic palsy will produce acute clinical complications?
  • Nerve blocks for shoulder surgery: classical technics modification to reduce phrenic block rate and new diaphragm-sparing nerve blocks.

Lecture connection to a hot topic: Diaphragm-Sparing Nerve Blocks for Shoulder Surgery
Importance of topic: Nerve block above the clavicle are common procedures used for Shoulder Surgery, we present recent evidence related to Diaphragm-Sparing Nerve Blocks and clinical implications of hemidiaphragm palsy.

Dr. Steve Coppens

Session/lecture title: Regional Anaesthesia in Multidisciplinary Fast-track.
Presentation title: Regional Anaesthesia for Vascular and Cardiac Surgery
Learning Objectives: In a fast-changing medical environment where NOACS and new minimally invasive surgery types are getting the upper hand, learn the possibilities of regional anaesthesia. New blocks, new techniques, and expert opinion. Colorectal surgery was in the front row when the Enhanced Recovery Programs were developed. Learn what is new, what has remained and what has changed over the years.
Lecture connection to a hot topic: Enhanced Recovery! Better outcome!
Importance of topic: It is important because enhanced recovery, a better outcome, and perioperative medicine is THE way to define the future of anaesthesiology!

Dr. Can Aksu

Session/lecture title: Chronic Pain Neuromodulation for the Anaesthesiologist not in Practice, but why not in the Future.
Learning Objectives: The role of neuromodulation in preventing and treating chronic pain.The role of Anaesthesiologists in modulating acute and chronic pain.
Lecture connection to a hot topic: Neuromodulation improves the life quality of people suffering from chronic pain and it’s a safe alternative to long-term drug therapies. Anaesthesiologists are unaware of how they can modulate the transition of acute pain to chronic pain.
Importance of topic: Anaesthesiologists can use simple measures to modulate pain. Neuromodulation is safe and effective in managing chronic pain. Anaesthesiologists, who are experienced in regional anaesthesia, can easily learn the ways of neuromodulation.

Dr. Alan Macfarlane

Session/lecture title: Regional Anaesthesia for Vascular and Cardiac Surgery
Presentation title: Does Plexus Anaesthesia Improve Outcome for Av Fistula Surgery Compared to Local Anaesthesia?
Learning Objectives: Understand the different anaesthetic options for AV fistula creation. Be aware of recent evidence of how anaesthetic technique can influence medium- and long-term surgical outcomes.
Lecture connection to a hot topic & importance of topic: The topic is important because brachial plexus blocks are something that we as anaesthetists can do that significantly influences surgical outcome.

Session/lecture title: Hip Fracture Management: from Pre-op to Post-op
Presentation title: Does Regional Anaesthesia Improve Outcome after Hip Arthroplasty?
Learning Objectives: Be aware of the different patient and institutional outcomes and the various measurement tools to examine outcomes. Understand how regional anaesthesia may influence these outcomes
Lecture connection to a hot topic & importance of topic: Patient outcomes and what ‘outcomes’ are the best to measure are of great interest. It is currently topical as there are a series of papers being published on defining endpoints and outcomes to study for all operations, not just hips. There are a number of contemporary ‘big data’ studies (including patients undergoing hip arthroplasty) that will be examined in this talk.

Prof. Saule Sviedene

Session/lecture title: Influence of Hypotension on the Brain Oxygenation during Shoulder Arthroscopy in Sitting Position
Learning Objectives: Patients undergoing shoulder arthroscopy in beach chair position are at increased risk for cerebral hypoperfusion and desaturation, devastating neurologic ischemic episodes or postoperative neurocognitive disorders, whereas the mean requirement for surgical field visualization is peri-operative hypotension. Different anaesthesia regimens have been poorly analysed in this type of operations.
Lecture connection to a hot topic: One of the recent actualities in anaesthesia – optimal intra-operative oxygen administration to the patient under different anaesthesia types.
Importance of topic: Choice of anaesthesia technique and limits of hemodynamic variation is very important to the patient’s safety.

Dr. Fatma Saricaoglu

Session/lecture title: ERAS for TKA Surgery
Presentation title: Procedure Specific Pain Therapy Total Knee Arthroplasty
Learning Objectives: Total knee arthroplasty (TKA) is among the most successful orthopaedic procedures in treating knee osteoarthritis and improving quality of life. However, arthroplasty procedures, especially knee replacements, are commonly associated with severe postoperative pain.
Essentially, anaesthesia and pain management protocols consist of either general anaesthesia combined with femoral nerve block (FNB) or spinal anaesthesia associated with morphine; recently, patient-controlled analgesia has been widely reported, because of its therapeutic effects and safety.
Lecture connection to a hot topic: Pain is a challenge and hot topic as ever. TKA is one of the most painful procedure and we have to improve our knowledge to have better results.
Importance of topic: No gold treatment for pain treatment after TKA exists in the literature. The GRADE rated recommendations varied from very low to moderate (except for one high) for the different interventions. High or unclear risk of bias, heterogeneity of trial designs, and the small trial sample sizes are challenges in the designation of a best proven optimal postoperative analgesic regimen for TKA. A way to overcome these challenges may be to establish standard research guidelines regarding postoperative pain management and focus on conducting high-quality upscale trials. In this lecture, we have a chance to listen to all types of techniques and results.

Session/lecture title: Ketamine for Pain: Complications and Best Practice
Learning Objectives: There is good evidence that perioperative ketamine decreases postoperative pain scores and opioid requirements, but there is a lack of consensus on dose, for both bolus and infusion. Ketamine has dose-dependent adverse effects, and there are good arguments for avoiding high doses. Spinal administration is associated with neurotoxicity, whereas oral ketamine has low bioavailability and is associated with adverse effects.
Lecture connection to a hot topic: In recent years new research shows that ketamine can be effective for treating pain, and could be an alternative to opioids.
Ketamine has captured headlines recently as a possible treatment for severe depression and posttraumatic stress syndrome. Ketamine is also being used more in inpatient and outpatient settings to manage pain. This Old drug comes to our scene in a new role.
Importance of topic: Opioid sparing analgesia is an important factor for anaesthesia and analgesia if we can use ketamine in a safe way it will be a good choice for us to manage pain.

Prof. Dr. Emin Alp Yentür

Session/lecture title: I am in Pain, and Nobody Pays Attention. I  have Sickle Cell Anemia.
Learning Objectives: In this lecture, the possible management strategies, their effects and limits will be discussed. How can we help them? Is there anything that we can do?
Lecture connection to a hot topic & importance of topic: Sickle Cell Anemia pain is one of the most challenging problems for patients and also doctors. Mostly the physicians feel insufficient and desperate against these patients and their family.

Session/lecture title: My Children has Cancer and is in Pain. Is there a Solution?
Learning Objectives: Can we use any invasive pain management strategies? Can we use the same/similar drugs and tools for pain management as we do for the adults? We will try to find answers to these questions.
Lecture connection to a hot topic & importance of topic: Because of the unmature physiology of children, pain management is very confusing and has limited tools compared to adults. Unmature metabolism, diversity of physiology dealing with the age, and dosage of pain killers cause the physicians to feel not confident and confused against these group of patients.

Dr. Emmanuel Guntz

Session/lecture title: Spinal Subarachnoid Anaesthesia in the Daily Practice
Presentation title: Spinal Underused Drugs: Prilocaine & Chloroprocaine?
Learning Objectives: How to use Prilocaine and Chloroprocaine: indications, limitations, advantages
Lecture connection to a hot topic: Can be considered as a hot topic: a new way of using local anesthetics with major implication for one-day surgeries and fast-track concept
Importance of topic: Taking into account that both drugs have a place in one-day surgery.

Prof. Miguel Angel Reina

Session/lecture title: Nerve Lesion as Part of the Practice of Regional Anaesthesia?
Presentation title: New Concepts in Physiopathology of the Nerve Lesions: Intraneural Injection Microanatomy in Humans and Animal Models.
Learning Objectives: Intraneural injection during standard nerve blockade should be avoided in order to prevent possible damage to nerves being blocked.  In previous reports, intrafascicular injection has been associated with devastating neurological complications.
Lecture connection to a hot topic & importance of topic: A novel substance marker has been used to demonstrate distribution patterns of injected volumes across internal structures of nerves. This technique showed that after the injection of a volume inside nerves the marker does not reach intraneural fascicles. Contrary to the previous hypothesis, the event of intrafascicular injection of any substance during nerve blockade may not even be physically possible in clinical practice. Our studies bring about new lines of research in which knowledge related to the microanatomy of nerves become an essential part of anaesthesia.

Session/lecture title: Spinal Subarachnoid Anaesthesia in Daily Practice
Presentation title: Spinal Anaesthesia still Alive! Microanatomy of Dural Puncture Lesions. Factors Involved in the Healing of Spinal Meninges after Dural Puncture.
Lecture connection to a hot topic & importance of topic: The recent improvements on our knowledge on the microanatomy of spinal meninges, as well as the systematic examination of lesions that took place during lumbar puncture have enabled anaesthetists to move forward in regard to the technique and the type of needles and their effects on the characteristics of lesion produced. At present, significant improvements in research related to Basic Sciences have led to a better understanding of the mechanisms responsible for postdural puncture headaches. A new hypothesis has been proposed in response to new clinical and scientific challenges. Scientific research establishes the premises for the development of modern concepts relevant to clinical practice such as the role attributed to the spinal arachnoid lamina in the healing of the lesion produced while performing a dural puncture.

Prof. Andrzej Krol

Session/lecture title: Should we Use Genicular Nerve Block for Pain Control after Knee Surgery?
Learning Objectives: What is the best analgesia after TKA?  GA with opioids? LIA?  Femoral triangle block? Adductor canal block? What are genicular nerves? How many do we really name? And where they are coming from? Would you like to know more? Should we use genicular nerve block for pain control after knee surgery?

Session/lecture title: Regional Anesthesia for Vascular Surgery
Presentation title: Advantages and Indications of Continuous Peripheral Blocks in Surgical Management of Ischaemia of the Lower Limb
Learning Objectives: Have you been asking yourself and colleagues how to anaesthetise frail, elderly, ASA 4 patients for foot or below knee amputation? How often do you see on your ward round patients suffering from lower limb ischemia and then postoperative pain after amputation? Do you believe phantom limb pain can be reduced? If you are ready to learn and change your practice attend a session on Regional Anaesthesia for Vascular Surgery and continuous peripheral nerves blocks.

Session/lecture title: Pelvic Pain. Are you Sure Everything is Clear?
Presentation title
: Gluteal Pain and Piriformis Syndrome
Learning Objectives: Pain in the buttock? Is it really piriformis syndrome? See more! Know more! Methodology of posterior pelvis ultrasound scan in quest of an answer.

Prof. Amalia Douma

Session/lecture title: Nerve Lesions as Part of the Practice of Regional Anaesthesia
Title: Mechanisms of Peripheral Nerve Injury after PNBs: What’s New?
Learning Objectives: What are the most common pathophysiological mechanisms that contribute to peripheral nerve injuries after PNBs? Are we all aware and alert of the critical role of risk factors? Find out more during this networking session.
Lecture connection to a hot topic: Peripheral nerve injury after PNBs is a hot topic as the risk has not been reduced, even with ultrasound guidance, and medicolegal issues may always arise
Importance of topic: It is crucial for all anaesthetists who perform PNBs to identify risk factors, to avoid techniques that may contribute to peripheral nerve injuries, to be alert, to early recognise and manage nerve lesions.

Session/lecture title: Opioid Free Anaesthesia with Regional Anaesthesia techniques: What is the concept?
Learning Objectives: What is the role of regional anaesthesia techniques in multimodal regimens for opioid-free anaesthesia? Is it possible to totally omit opioids with these techniques? Find out more during this refresher course.
Lecture connection to a hot topic: Opioid Free Anaesthesia is a hot topic and different regimens with multimodal analgesia have been proposed.
Importance of topic: Opioid side effects, as well as opioid epidemic, are well understood and recognised by anaesthetists. Opioid free anaesthesia will be beneficial for certain patients if equivalent analgesia can be achieved with multimodal regimens.

Dr. Wolf Armbruster

Session/lecture title: Cervical Plexus Block for Carotid Endarterectomy and Beyond: What is Possible?
Learning Objectives: The “cervical nerves pathway” is described by MRI and cryosectional studies, with the target of an intermediate block as a standard of safety. For even more surgical procedures beneath carotid endarterectomy may analgesia be achieved: Osteosynthesis for lateral calvicular fractures, hemithyroidectomy and parathyroidectomy as shown by examples.
Lecture connection to a hot topic: Patient safety!!! If you know the anatomy, cervical plexus block is easy to perform for several procedures, without complications.
Importance of topic: Because with only one scanning procedure from supraclavicular to high cervical, 3 different blocks may be suited for numerous different procedures.

Dr. Matthew Szarko

Session/lecture title: Learning Process in Regional Anaesthesia. The Cadaver Workshops can be Replaced with Other Types of Teaching Methods
Learning Objectives: Post-Graduate anatomical learning should be focused on ‘Just-in Time’ learning. As such, the cadaver lab may be an outdated modality to keep up with the changing requirements of modern anaesthesia.
Lecture connection to a hot topic: Cadaveric training has for hundreds of years been a ‘hot topic’ amongst medical professionals. However, recent trends in technology allow us to call into question the specific time and place for cadaveric training.
Importance of topic: Anatomical training underpins all of the anaesthesia, and indeed medicine. Identifying current technological solutions to the inherent difficulties in cadaveric training is quite important in modern anaesthetist’s continual training.

Session/lecture title: Fascial Blocks: it is Necessary to Define their Usefulness, how they Work and their Limitations?
Learning Objectives: A paired down, gross anatomical approach to fascial blocks. How they can work, why they can work, and anatomical evidence as to their efficacy.
Lecture connection to a hot topic: Fascial blocks are very common in regional anaesthesia, and an anatomical understanding of anaesthesia techniques and fascia can aid more efficacious practice.
Importance of topic: Fascial blocks are quite important in regional anaesthesia. A purely anatomical discussion of how and why they can work can enhance the efficacy of such blocks.

Prof. Julien Raft

Session/lecture title: What’s New about Paraspinal Techniques?
Learning Objectives: Paraspinal techniques has shown promise as an alternative to neuraxial blockade for a variety of surgeries with good effect. This lecture will screen news about these blocks.
Lecture connection to a hot topic: My lecture connects to a current “hot topic” because the erector spinae plane block (ESPB) was first described in 2016 as a regional block, and for 2 years more than 200 articles about this block were published. This demonstrates a real interest of the community of these interfacial plane blocks.
Importance of topic: My topic is important for the participants to clarify the literature and share my experience with paraspinal techniques.

Prof. Dr. William Urmey

Session/lecture title: Is Spinal Anesthesia with Hyperbaric Local anesthetic still an Alternative in Patients Undergoing Hip Fracture Surgery?
Learning Objectives: To understand the different distributions of local anesthetic and resulting blocks when using hyperbaric, isobaric, or hypobaric local anesthetic preparations for subarachnoid block; To appreciate the anesthetic challenges associated with providing anesthesia for the patient who has sustained a hip fracture
Lecture connection to a hot topic & importance of topic: Important because anesthetic techniques for hip fracture surgery are associated with major differences in outcomes, including major morbidities and mortality.

Session/lecture title: My Patient with BMI 50 Requests Regional Anesthesia
Learning Objectives: To understand the alterations in physiology and pharmacology associated with extreme morbid obesity; To outline the best regional anesthetic techniques for morbidly obese patients as well as how we modify our approaches to regional techniques in these patients.
Lecture connection to a hot topic & importance of the topic: This is a Hot Topic because of the increased prevalence of severely morbidly obese patients.

Prof. Dr. Graeme McLeod

Session/lecture title: High Frequency Microultrasound and Photoacoustics for Analysing Nerve Trauma
Learning Objectives: To understand how trauma alters nerve morphology; To understand between pressure, injection rate and nerve damage
Lecture connection to a hot topic: Mechanisms of nerve damage. I will present the best resolution real-time images of nerve trauma ever seen
Importance of topic: Will stimulate participants to assess their own perspective on nerve trauma and pressure