October 16, 2008

Education Guides Best Practice in Anesthesia

Driven by its commitment to maximizing patient safety while helping clinicians make more informed decisions in today's complex healthcare environment, B. Braun Medical Inc. (B. Braun), the world market leader in regional anesthesia, announced today the publication of a first-of-its-kind educational guide, Dual Guidance - A Multimodal Approach to Nerve Location. The educational guide will be introduced at the 2008 Annual Meeting of the American Society of Anesthesiologists (ASA), to be held Oct. 19-21 in Orlando.

Authored by three key opinion leaders in the anesthesiology field - Drs. Ralf Gebhard, William Urmey, and Admir Hadzic, with an introduction from Dr. Richard Brull - the four-chapter information resource defines the concept of "dual guidance," or the use of ultrasound with nerve stimulation, as a best practice for nerve location in modern regional anesthesia, and presents an objective analysis of ultrasound and nerve stimulation studies.

Peripheral nerve blocks, which block pain at its source through precise injection of a local anesthetic, are used in an estimated two million procedures each year in North America. Nerve stimulation has long been the "gold standard" for nerve location when performing peripheral nerve blocks, stimulating the nerve and causing the target muscle to twitch. More recently, high-frequency ultrasound imaging has increasingly gained ground as a supplementary or complementary modality as it enables the anesthesiologist to see the nerve and the needle, as well as the spread of local anesthesia.

"Just as the introduction of the airbag in automobiles didn't trigger calls to eliminate the seatbelt, the anesthesia community shouldn't abandon one method for another," said Dr. Gebhard, Associate Professor of Anesthesiology at University of Miami Leonard M. Miller School of Medicine. "Rather, anesthesiologists should turn their attention to research regarding how the two techniques (ultrasound and nerve stimulation) together can enhance success rates and patient safety."

Nerve stimulation and ultrasound-guided regional anesthesia each offer distinct advantages and limitations. Until now, however, a comprehensive information source for anesthesiologists that provides an objective, clinical review of best practices using both technologies did not exist.

"Patients benefit most when their clinicians - including anesthesiologists - are knowledgeable about all of the tools and technologies available to them," said Tim Richards, Senior Vice President of U.S. Marketing, B. Braun Medical Inc. "We recognized a void in the objective literature available to today's anesthesiologists. Working with key opinion leaders in anesthesia, we developed our new educational guide to provide sound, clinical-based advice on maximizing the potential of nerve stimulation with ultrasound to heighten patient safety."

Stimulating Discussion for Dual Guidance

"A dual guidance technique affords the anesthesiologist an unprecedented level of understanding and respect for the mysterious needle-to-nerve interaction," said Dr. Brull, Assistant Professor and Director of the Regional Anesthesia Fellowship Program, University of Toronto. "The technique can also facilitate learning and improve trainee performance compared to teaching one technique in isolation. Most importantly, it affords the anesthesiologist a higher level of confidence and comfort by drawing on two objective end points - real time visualization of local anesthetic spread and minimum stimulating threshold current - to predict the likelihood of block success and, possibly, minimize block-related complications."

Focused on the evolution of nerve location, the educational guide cites several key nerve stimulation and ultrasound studies that have influenced the use of nerve stimulation and ultrasound in clinical practice.

"It is important for the clinical practitioner to be open to the use of either technique or the combination of the two," said Dr. Urmey, Attending Anesthesiologist at New York's Hospital for Special Surgery, and Associate Professor of Clinical Anesthesiology at Weill Cornell Medical College. "The use of ultrasound guidance is in its infancy, and we can only hope that it achieves the same high success rate and low complication rate associated with nerve stimulation. Thus far, it has shown great promise."

Developing a "Multimodal" Approach to Peripheral Nerve Blocks

Parallel with the resurgence of interest in regional anesthesia over the last two decades, the technological and scientific evolution of nerve stimulators has made the devices and the practice of nerve stimulation more specialized and sophisticated.

"Ultrasound and nerve stimulation are complementary and not mutually exclusive monitoring technologies," said Dr. Hadzic, Director of Regional Anesthesia at St. Luke's Hospital and Professor of Clinical Anesthesiology at the College of Physicians and Surgeons at Columbia University in New York City. "When used in conjunction with ultrasound, the functional information obtained by nerve stimulation may add additional beneficial nerve localization and safety information. Rather then dispensing with what is still considered the standard of care - nerve stimulation - in most practices worldwide, many clinicians have adopted all currently available monitoring technologies (including ultrasound) in their quest to transform regional anesthesia into a more objective and reproducible discipline than it has been in the past."

For more information or to obtain a complimentary copy of the educational guide, please email [email protected]

About B. Braun

B. Braun is a global leader in infusion therapy and pain management, and a pioneer in passive safety devices and PVC-/DEHP-free products. Every day, some 36,000 B. Braun employees worldwide share their knowledge with colleagues and customers to improve working processes in hospitals and medical practices, and to enhance safety for patients, doctors and nurses.

Consistently recognized by Frost & Sullivan and KLAS for its medical technology and support services, B. Braun promotes best practices for continuous improvement of healthcare and, guided by its "Sharing Expertise(R)" philosophy, helps today's healthcare workers address critical issues including environmental responsibility, medication errors reduction and infection prevention. For more information, call 800-854-6851, e-mail us at [email protected] or visit B. Braun at www.bbraunusa.com.

Keywords: B. Braun Medical Inc., patient safety, regional anesthesia, dual guidance, educational guide, multimodal, nerve location, Ralf Gebhard, William Urmey, Admir Hadzic, Richard Brull, ultrasound, nerve stimulation, peripheral nerve blocks, local anesthesia, needle-to-nerve interaction, nerve localization