Massachusetts General Hospital Department of Anesthesia, Critical Care and Pain Medicine - News and Events
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DACCPM Launches Block Service

Research Award WinnersThe DACCPM launched a new dedicated Block Service this year, with the goal of increasing efficiency in the operating room, improving the patient experience during surgery, and strengthening regional anesthesia training for the residency program.

The mission of the new dedicated block service is to expand the availability of regional anesthesia while providing excellence in patient care and resident education, said Dr. Lisa Warren, Director of Ambulatory and Regional Anesthesia.

A nerve block is a regional anesthetic that causes a limb or other area of the body to become numb and weak for a period of time. A block typically lasts for 12 hours, but can supply pain relief for as long as 24 hours after a surgical procedure.

A block may be used alone as the primary operative anesthetic, or combined with a general or spinal anesthetic to provide postoperative analgesia and potentially reduce the use of pain medications after surgery and the side affects associated with such drugs. Regional anesthesia is used for a variety of specialties, including orthopedic surgery, plastic surgery, and general surgery.

Before the establishment of a dedicated block service, regional anesthesia was performed by physicians in the operating room.

"It was very hard to be efficient if you were running in between cases and trying to get a block done," Dr. Warren said.

The new service enables a block team to perform the procedure in a dedicated space without additional OR assignments, allowing a more comprehensive approach to patient care and resident teaching.

"Their job is purely to perform blocks, follow up on the patients after blocks and then pre-op the next set of block patients for the subsequent day," Dr. Warren said.

The three-month pilot project, which launched Jan. 5, 2009, included four attending anesthesia staff members, Drs. Sunder, Peter Stefanovich, Katharine Fleischmann, and Lisa Warren, one resident, Dr. Jon Bloom, and a core of Block Service nurses, Laura Cameron, Elizabeth Ryder and Kathy Farrell-Alexander. The trial period focused on the patients of four surgeons: Drs. Thomas Holovacs, Dennis Burke, J.P. Warner, and Sang Gil-Lee.

"All the patients were pre-identified by surgeons as candidates for a block," Dr. Warren said. "Patients' charts were then either screened, or the patients were called 48 hours in advance to confirm their desire and suitability to have a nerve block."

When patients arrived to the hospital, they were shuttled to the new Block Service area, where they were cared for by a daily Block Service team consisting of two to three Block Service nurses and a block anesthesia team, including one attending and one resident, Dr. Warren said.

Because of the success of the trial period, on April 1, the service expanded to include two anesthesia attending physicians and one resident in order to provide regional anesthesia for the patients of the other SDCU surgeons not previously included in the trial period.

The new service not only improves efficiency and delivery of care, it "gives us the opportunity to bring in additional people who want to learn regional anesthesia," Dr. Warren said.

The Block Service currently includes Drs. Vicki Modest, Lisa Wollman, Laurie Shapiro, Tim Canty, Jatinder Gill, Catherine Mullaly, Chase Stadtlander, and Brinda Kamdar. Residents during the pilot period also included Ethan Small and Karsten Bartels.

Feedback on the Block Service from both surgeons and patients has been overwhelmingly positive, and the success of the service rests solely on the efforts of its team members, Dr. Warren said.

"They've worked extremely hard and have done an excellent job," she said.

Pictured: Members of the Block Service perform a procedure.

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Department of Anesthesia,
Critical Care and Pain Medicine
Gray-Bigelow 444
55 Fruit Street
Boston, MA 02114

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