Clinical Program

The Division of Orthopedic, Plastics and Regional Anesthesiology, formed in 1998, serves a large patient population requiring total joint replacement, adult and pediatric spine surgery, advanced plastic surgery and orthopedic trauma surgery. The division operates in concert with Duke University Hospital’s Acute Pain Service (APS) and the Musculoskeletal Center, directed by Dr. Ginsberg and Dr. Bolognesia. Incorporated into the Division in 2008, the APS and Regional Anesthesia partnership offers patients a team approach to anesthesia, surgery and postoperative analgesia. Since 2004 and under the guidance of Dr. Grant, our team has been successful using ultrasound-guided placement of central venous lines and peripheral nerve blocks improving safety and reliability. The use of ultrasound allows visualization of the nerve that is being blocked and identifies other structures such as blood vessels, which should be avoided.

Our regional anesthesiologists are trained in the delivery of state-of-the-art neuraxial and peripheral nerve blocks and in the management of acute pain in the perioperative period. We pride ourselves in performing nerve blocks efficiently, effectively and safely. Part of our mission is to develop and utilize new technologies in the field of regional anesthesia. We continue to investigate new peripheral block stimulating catheters to increase the success rate or our patients.

All joint replacements patients wherever possible receive a form of continuous regional anesthesia that extends pain management into the postoperative period. The use of these techniques leads to improved pain control; reduced opioid requirements and thus reduced side effects from opioids. We hope to improve the continuation of care for our patients throughout both the perioperative and postoperative periods. Faculty members play instrumental roles within the Department of Anesthesiology, the Duke University School of Medicine, the Duke University Medical Center, the state of North Carolina, the United States and worldwide. These roles encompass operations, medical education for medical students/residents, continuing medical education for physicians, research and memberships on state wide societies.

Operations

Dr. Martin and Dr. Parrillo along with Dr. Muir, serve as co-chairs of the Duke University Hospital North Perioperative Services Committee ensuring that daily operations within the Duke North ORs run efficiently and safely for our patients. Within our state, Drs. Jennifer Fortney serves on the Judicial Affairs Committee in the North Carolina Medical Society.

Training Program

Dr. Grant, professor of Anesthesiology and recipient of the prestigious Golden Apple Award for excellence in Medical Education services as the Medical Director for Medical Student Education, Department of Anesthesiology, Duke University Medical Center. He serves as an active member on the Resident Education Committee. With his commitment to excellence, we hope to continue to offer residents educational opportunities in regional techniques for managing postoperative pain.

Dr. MacLeod has continued to update his web-based education site, “The ABCs of Regional Anesthesia.” This site not only offers the residents descriptions of the regional anesthetic techniques but includes films of blocks being performed and direct links to relevant literature.

Dr. Ginsberg, national expert in the area of acute pain management, serves as the Director of the Duke University Medical Center, APS. He plays an active role in the education of medical students, residents and faculty with regards to perioperative pain management. Our division in conjunction with the Duke University Ambulatory Division, offers fellowship training in Ambulatory and Regional Anesthesiology. This program offers training for three fellows per year. Fifty percent of their training occurs at Duke University North Hospital in-patient center, where they are exposed to the management of joint replacement cases. The fellows are taught advanced regional anesthesia techniques such as peripheral nerve block catheter placements and the use of ultrasound for the placement of blocks. The training includes detailed education with regards multimodal management of acute pain.

Research Program

Dr. Martin continues studies in 2009 investigating the use of a novel new delivery system for morphine. Extended release epidural morphine is based on liposomal technology that allows the slow release of morphine into the epidural space over a 48 hour period with the use of a single epidural injection. The present study is looking at the feasibility of using only oral medication postoperatively for supplemental pain medication. This may not only obviate the need for epidural catheters but also the need for patient controlled analgesia. This drug was approved by the FDA in July 2004 for use in managing acute postoperative pain. We have also recently started a trial using liposomal local anesthetics for the management of postoperative pain.

Dr. Martin recently completed a clinical trial investigating the use of suggamedex in the reversal of non-depolarizing muscle relaxants.

The division working with Dr. Gan of the General Vascular Liver Transplant Division continues to investigate Arterio-Venous Fistula patency in renal dialysis patients. We hope to show that continuous brachial plexus blocks will increase the patency of these grafts by increasing blood flow through the graft.

Dr. MacLeod continues his directorship of the Human Pharmacology Laboratory. In addition, Dr. Keita Ikeda, PhD, continues his role in the laboratory. His invaluable biomedical engineering skills were quickly put to use as he helped develop the software to run a new computer-controlled gas delivery system. This has been developed in conjunction with the Respiratory Laboratory at the University of Toronto. The sequential gas delivery system allows precise control of end-tidal concentrations of both oxygen and carbon dioxide. The device is currently being used in an NIH-funded study to validate a new cerebral oximeter. The laboratory is presently running a number of industry-sponsored studies using a variety of cerebral oximters.

Dr. MacLeod and Dr. Grant, in collaboration with Dr. Palmeri of the Biomedical Department are looking at a novel ultrasound technology using acoustic impedance to improve imaging of nerve structures. A number of federal grants have been applied for with regards the use of this technology in regional anesthesia. Dr. Flanagan continues with her research on, “End of Life Care”, and the role of the anesthesiologist.

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Gavin Martin, MB, ChB, DA, FRCA

Chief, Orthopaedics, Plastics and Regional Anesthesiology Associate Clinical Professor of Anesthesiology

Faculty

C. Scott Brudney, MB, ChB, FRCA
Joshua Dooley MD
Mitchell Fingerman MD
Ellen M. Flanagan, MD
Jennifer T. Fortney, MD
Brain Ginsberg, MB, ChB, Director, Acute Pain Service
Stuart A. Grant, MB, ChB, FRCA, Director, Medical Student Education
David B. MacLeod, MB, BS, FRCA, Director, Human Pharmacology Lab
Stephen J. Parrillo, MD
Srinivas Pyati, MD
John B. Winchester, MD

Fellows

Patrick Armstrong, MD
Sean Dobson, MD
Jennifer Sposito, MD

CRNA Coordinator

Henry J. Walker, CRNA, MS, MBA

CRNA Staff

Patricia M. Allusshuski, CRNA, MSN
Ann M. Connell, CRNA
David H. Gleason, CRNA
Timothy McCarl, CRNA
Yvonne Overcast, CRNA
Dale Potter, CRNA
Susan Tomso, CRNA
Joe Rybiki, CRNA

Support Staff

Katherine Siler
Shelia Johnson