My training and practice as anesthesiologist focuses primarily on regional and orthopedic anesthesia and has included postoperative pain management, cardiac anesthesia and intensive care. Currently, as Director of the Division of Regional and Orthopedic Anesthesia at the Brigham and Women’s Hospital, I spend the majority (approximately 75%) of my work time in the operating rooms, teaching regional anesthesia, coordinating care and work flow in 6-8 orthopedic operating rooms, leading a team of 10 to 14 anesthesiologists who collectively provide anesthesia for more than 5000 patients per year. The rest of my work time is split between administrative duties, including daily orthopedic anesthesia staff scheduling, daily and monthly resident evaluations preparation, committee meetings, and academic activities, including didactic training and research.
My clinical work days start and end with teaching residents, fellows and medical students, while directing and providing patient care. Orthopedic surgery at BWH provides volume, complexity and diversity of cases, necessary for clinical research, innovation and advanced training in regional anesthesia. Our team and I are available for consultation, direct help and teaching in the other anesthesia sectors, whenever the need for advanced peripheral nerve block techniques arises. My leadership role also encompasses coordinating and organizing interactive workshops and didactic lectures, directing the weekly regional anesthesia morning seminars and developing programs for training and credentialing in ultrasound-guided regional anesthesia with didactic, simulation and clinical components.
Being the Regional Anesthesia Fellowship Director provides the unique opportunity to be the principal mentor for our subspecialty fellows. I have also directed our regional anesthesia cadaver anatomy program for fellows and residents from 1999 to 2003.
Clinical and Administrative Work:
Promoting regional anesthesia and analgesia has been the center of my clinical efforts. The multitude of trauma and geriatric orthopedic cases inherent to our field with the frequent option to avoid general anesthesia, provides a great potential for improving care and studying the effects of inhalation agents, pathophysiological stress, trauma and inflammation on the aging brain.
Together with the Oncology Pain team, I participate in treating complex cases of intractable cancer pain with nerve blocks, contributing nerve localization expertise – some blocks are safely feasible only with ultrasound guidance.
I am also leading the effort to improve efficiency and team-building in the orthopedic ORs, focusing on improved communication between surgeons, nurses and anesthesiologists. In addition, I am responsible for developing protocols for pre-operative assessment, intraoperative management and post-operative care.
Research and Innovation:
In 2008, the new “retroclavicular” ultrasound-guided brachial plexus block was introduced to clinical practice by me and colleagues. It offers an alternative approach when patient anatomy and/or function are significantly altered by disease or injury. Clinical trials are planned with our pain research group to test drug combinations, producing prolonged differential sensory block and pain relief.
Building a strong and productive working relationship between our experimental researchers and our daily clinical practice remains a personal ambition of mine.