regional anesthesia

Training in regional anesthesia is one of the strengths of our residency program. A group of dedicated faculty concentrates their clinical time instructing residents in the principles and practice of regional anesthesia. The Department of Orthopedic Surgery at Columbia University Medical Center is consistently ranked one of the best in the country, and surgery involving the extremities, including all types of open fracture repair, corrective procedures of the hands and feet, and joint arthroscopy are performed daily, virtually all of them under regional anesthesia. We have a large group of orthopedic surgeons who specialize in sports medicine. Our residents are thus exposed to many young, healthy patients with sports-related injuries undergoing procedures under ambulatory regional anesthesia. Our Shoulder Service is particularly active: with most procedures performed under an interscalene brachial plexus block with/without an interscalene catheter for postoperative analgesia. We care for an equally large group of elderly patients with significant pathology undergoing upper and lower extremity joint replacement. Additionally we provide regional anesthesia services routinely to vascular, abdominal, breast, gynecologic and transplant surgery patients encompassing a wide range of techniques including truncal nerve blocks as well as blocks specifically tailored to provide postoperative analgesia following major breast surgery.

Major physiologic alterations brought about by general anesthesia can be avoided by the use of regional anesthetic techniques, and perioperative risk can be favorably influenced. Many of our blocks are performed with long acting agents that provide not only intraoperative anesthesia, but postoperative analgesia as well. The placement of perineural catheters (upper and lower extremity) and the use of continuous regional analgesia techniques are utilized to provide postoperative analgesia for an extended period of time. The combination of a varied caseload, a dedicated anesthesia faculty, and a high level of patient and surgeon satisfaction with regional anesthesia, makes this a wealthy and rewarding clinical experience and is one of the clinical rotations consistently requested by our residents.

Residents are first exposed to regional anesthesia in their CA-1 year, gaining experience with neuraxial blocks (epidural, spinal and combined spinal-epidural techniques) as well as a broad selection of upper and lower extremity peripheral nerve blocks for routine orthopedic procedures. Residents will gain experience performing these blocks under ultrasound guidance. A peripheral nerve stimulator may be added as an additional tool as well as for educational purposes. Skills in managing moderate to deep sedation as an adjunct to regional anesthesia is developed during the year. CA-1 residents also complete a rotation in Acute Perioperative Pain Medicine, caring for post-operative patients with acute pain and managing neuraxial and peripheral catheters and their infusions. A daily faculty and fellow-led didactic series provides an introduction to acute pain and regional anesthesia topics during this month, including the anatomy and clinical application of peripheral and neuraxial blocks.

In the second year, the resident is expected to decide independently which blocks will be appropriate for the planned procedure as well as which agents to use, and to defend their choice with the attending anesthesiologist. They are expected to identify ultrasound related anatomical landmarks for performance of regional techniques with minimal assistance, and initiate blocks for postoperative pain management. In addition to reviewing previously covered topics, new topics are introduced, including considerations for hip and knee replacement, thromboembolic prophylaxis, blood sparing techniques, orthopedic oncology as well as spinal trauma and surgery.

The CA-3 resident is the “Block Room Resident” and gains additional experience in regional anesthesia. The CA-3 resident is expected to have mastered basic knowledge related to regional anesthesia, and should be able to perform regional techniques and manage patients during surgery with minimal assistance. The senior resident is introduced to controversial topics in regional anesthesia, exposed to relevant articles in the literature, and is encouraged to discuss pertinent issues with their attending in an "Oral Board" format. The Anesthesia Toolbox website is used to provide an online platform for supplemental resident education and to organize a daily regional didactic series that is proctored by the faculty and fellows. The Toolbox website is also used to log assessments such as weekly quizzes and procedure skills assessments, allowing the resident to develop a “portfolio” demonstrating their learning and skills in regional anesthesia. The regional and acute pain residents will also participate in a monthly journal club that is both shared collaboratively online via the Anesthesia Toolbox and presented in person alongside faculty and fellows.

Experience with Acute Perioperative Pain Medicine will be gained in placement of peripheral nerve catheters for postoperative continuous regional analgesia. This is an exciting technique that has gained in popularity, and is poised to become the preferred technique for managing postoperative pain following major orthopedic as well as numerous general surgical procedures. The CA-3 resident will become familiar and proficient in a variety of regional anesthesia techniques for vascular, breast, thoracic, gynecologic and abdominal surgery.  These regional anesthesia procedures are one component of a multimodal postoperative pain management approach of our Acute Perioperative Interventional Pain Service (APIPS). In this way the resident is exposed to the full spectrum of regional anesthesia techniques that are utilized for intraoperative anesthesia and postoperative analgesia.

Unique educational experiences for Columbia anesthesia residents and fellows include the opportunity to teach in the Columbia Medical School Anatomy Laboratory.  Residents and fellows teach the medical students about the clinical applications of the brachial plexus, lumbar and sacral plexus and also have the opportunity to help dissect the cadavers for a greater understanding of human anatomy. Additionally during the PGY-1 year, residents have a one-day symposium taught by Columbia Anesthesia faculty on the use of ultrasound in clinical practice.  This course includes lectures on regional anesthesia and hands-on scanning opportunities, phantom needling practice as well as access to a full on-line curriculum.

Anthony (Robin) Brown, MBChB., FFA(SA), Chief, Orthopedic and Regional Anesthesia
Jennifer Danielsson,MD
Anis Dizdarevic, MD
Danielle Ludwin, MD
Robert Maniker, MD
Leena Matthew, MD
Oliver Panzer, MD

Fellows 2016-17:
Felicia Chiu, MD Residency: Columbia University Medical Center/NewYork-Presbyterian Hospital
Marc Gurny, MD Residency: Cornell University Medical Center/NewYork-Presbyterian Hospital
Clyde Niles, MD Residency: Columbia University Medical Center/NewYork-Presbyterian Hospital

For further information, write or contact:
Anthony (Robin) Brown. MBChB, FFA(SA)
Professor of Anesthesiology at CUMC and Vice Chair
Director, Orthopedic and Regional Anesthesia
Department of Anesthesiology.
Columbia University Medical Center
630 West 168th Street
New York. NY 10032
Telephone: 212-305-3166
Fax: 212-305-2182

Columbia University Medical Center Department of Anesthesiology