American Society of Regional Anesthesia and Pain Medicine August 2018 - 5
From the Editor's Desk
A
s I am writing this, spring has turned to summer and, with it,
I have been exposed to the wild weather swings that one can
expect when living in Wisconsin. One day, we have record
high temperatures. The next is spent shivering, huddled around a
fire.
Within my own practice, I have encountered an entirely new set of
changes, challenges, and practice swings. We have been forced
to creatively provide compassionate, effective patient care in an
era of medication and equipment shortages. Never before have I
been forced to pay so much attention to what was in my spinal kit
because medications and even kits themselves are in short supply
and high demand. If you want hyperbaric bupivacaine, good luck:
This medication is locked away and guarded 24/7 by three trained
assassins (or so it seems) to ensure that it remains available only
for obstetric patients. Each week, we receive sobering reminders
from our pharmacist colleagues about dwindling medication
supplies for our institution and any "hot" leads they may have on
how to obtain a medication in short supply.
Although the shortages certainly
have been frustrating, they have
provided pain specialists a real
opportunity to demonstrate our
worth to patients, colleagues,
and hospital administrators. It
has taken some effort but, given
all the medication shortages we
currently face, now might be
the time for us to contemplate
using techniques or agents
we would not have previously
considered. Maybe methadone
can provide the N-methylD-aspartate receptor blockade that you are looking for. Perhaps
magnesium or dexmedetomidine might be just what a perioperative
patient suffering from chronic pain is lacking (coincidentally, both
these agents are featured in this issue). Possibly it is time to
reach across the aisle to your chronic pain colleague for advice on
how to manage a patient with an intrathecal pump or spinal cord
stimulator.
a candidate for epidural analgesia
was routinely administered a
ketamine infusion. As I write this, we
no longer have adequate supplies
of ketamine for this to continue as a
viable option. Thanks to attendance
at annual ASRA meetings, the
members of our group have been
equipped to meet these challenges
with new and creative approaches
to dealing with a number of pain
and medication shortage-related
Kristopher Schroeder, MD
issues. The description of the fall
ASRA News Editor
ASRA meeting is phenomenal, and it
appears that this conference is going
to take over where the World Congress left off.
The one thing I can say is "hang in there." You are not alone. We
are all in the same boat regarding these career challenges and
medication shortages. If you have a question or a way to work
around a given medication
shortage, either get your
question or the secret to your
success out there for other
ASRA members to provide
guidance or give benefit (see
May's ASRA News article, "A
Primer for Setting Up Your
Professional Twitter Account").
It is certainly heartening to
know that ASRA leadership
and the American Society of
Anesthesiologists are working
on the medication shortage
issues (see article by Dr Mariano in this edition).
"It has taken some effort but, given
all of the medication shortages we
currently face, now might be the
time for us to contemplate using
techniques or agents we would not
have previously considered."
The benefit of the medication shortages is that it forced us to
rethink what is possible from a regional anesthesia perspective.
Previously at my home institution, any patient with rib fractures not
On an unrelated note, if you are looking for a new challenge or
a way to build your skills in ultrasound management, ASRA can
provide that too. I am thrilled that I will be able to attend ASRA's
Introduction to Point-of-Care Ultrasound (POCUS) course this
December in Chicago. I am tremendously excited to work on
developing and mastering this relatively novel and valuable skill
set. I hope to meet some of you there. If you weren't able to register
for this offering, the course will be held again March 2-3, 2019
(registration opens soon).
American Society of Regional Anesthesia and Pain Medicine
2018
5
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine August 2018
American Society of Regional Anesthesia and Pain Medicine August 2018 - 1
American Society of Regional Anesthesia and Pain Medicine August 2018 - 2
American Society of Regional Anesthesia and Pain Medicine August 2018 - 3
American Society of Regional Anesthesia and Pain Medicine August 2018 - 4
American Society of Regional Anesthesia and Pain Medicine August 2018 - 5
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