Integrated Anesthesia Associates Department of Research

Research Trials in Regional Anesthesia & Acute Pain Management

LIposomal Bupivacaine vERsus Adjuncts in Total shouldErs (LIBERATE)

An ongoing randomized controlled trial (Clinicaltrials.gov ID NCT03887650) at the Bone & Joint Institute (BJI) comparing single-shot interscalene blocks with our standard bupivacaine plus the adjuncts epinephrine and dexamethasone to liposomal  upivacaine for total shoulder arthroplasty patients. Primary outcomes include VAS pain scores, the number of morphine milliequivalents (MMEs) consumed in the first three days postoperatively, and block duration. We have completed over 50% of our enrollment to date. Of note, no one involved with the study has any financial conflicts of interest and we received no industry support for any part of the trial.

CONtinuous Fascia Iliaca blocks for Reduction in Morbidity (CONFIRM):

A single-center retrospective analysis at BJI looking at fascia iliaca catheters for hip fragility fractures. These patients are compared to a retrospective control group without a nerve block. Primary outcomes include VAS pain scores, MME consumed, hospital length-of-stay, and incidence of postoperative delirium. We are currently entering the data analysis phase of this project.

Method of Anesthesia in Knee ARthroplasty: Measuring a Retrospective Cohort (MAKe A MaRC)

A single-center retrospective analysis at BJI comparing two sets of anesthetic techniques used for patients undergoing total knee arthroplasties. We are comparing a cohort of patients who received general anesthesia with one set of peripheral nerve blocks to another cohort who received spinal anesthesia with a different unique set of nerve blocks. We are currently performing data analysis and seeing significant reductions in hospital length-of-stay, VAS pain scores, and MMEs consumed.

SystemAtiC RevIew of FInancial Conflicts of interest in ExparelⓇ (SACRIFICE) trials

A systematic review currently in manuscript-writing phase that was presented at virtual ASA 2020 (click here for abstract). This comprehensive, prisma-guided review details randomized controlled trials involving liposomal bupivacaine (Exparel) in the past 20 years. Our focus is to identify and summarize any disclosed conflicts of interest, specifically to Pacira BioSciences, the manufacturer of Exparel, and the influence these interests have on the outcomes of the studies.

Blocking Eyes with QUality and SafeTy (BEQUEST)

An analysis of a prospective registry of over 11,000 patients receiving retrobulbar blocks for eye surgeries, mostly by our anesthesiologists. We are examining the incidence of complications, including major and minor bleeds, and any association with anticoagulants and antiplatelet medications. We are also examining the quality of the blocks and identifying any patient or provider factors associated with block quality. Initial data have been presented at the 2019 American Society of Regional Anesthesiologist Annual Meeting (click here to see poster) and we are currently writing the manuscript. We anticipate that our results will fill a large void in the literature with regard to the safety of these blocks.

POStoperative Serratus anterior and Erector spinae plane BLock catheters In video-assisted Thoracoscopic surgerY (POSSEBiLITY)

A single-center, retrospective cohort study at Hartford Hospital in the protocol stage looking at the evolution of serratus anterior and erector spinae blocks for video assisted thoracoscopic surgical patients. We are investigating the patient outcomes of VAS pain scores, hospital length-of-stay, and opioid consumption.

Opioid Reduction After Surgery (ORAS, part 1): Focus on anterior lumbar interbody fusion (ALIF) surgery

A single-center, retrospective analysis at BJI in the protocol phase looking at initiation of a standardized multimodal protocol and transversus abdominis plane (TAP) with rectus sheath blocks for ALIF surgery. Primary analyses include the patient outcomes of VAS pain scores, hospital length-of-stay, and opioid consumption. We plan for this to be part of a series focusing on regional anesthesia and different approaches to spine surgery.

EXparel blOcks During Open vascular Surgery (EXODOS)

An interdepartmental, randomized controlled trial looking at TAP and rectus sheath blocks for open vascular surgery patients. We are examining the outcomes of VAS pain scores, opioid consumption, hospital length-of-stay, ambulation distance, and incentive spirometry effort.

Publications & Presentations

Presentations for 2020:

ePoster, Medically Challenging Case:
“Scalp Blockade Reduces Opioid Consumption in a Complex Craniotomy Patient”

Presentation Number: MC2130. Session Number: MCC12.
Authors: Uju Momah, B.A., Kevin Finkel, M.D., Carla Maffeo-Mitchell, M.D.
October 5, 2020

Oral Presentation: “Systematic Review of Reported Financial Conflicts of Interest in Exparel (SACRIFICE) Trials”Presentation Number: A2044

Session Number: OR16-2
Session Title: Regional Anesthesia and Acute Pain II
Authors: Kevin Finkel, M.D., Carla Maffeo-Mitchell, M.D., Lauren Clement, D.O., Samuel Gammerman, M.D., William Stuart, M.D., Aseel Walker, M.D., Barbara Braffett, Ph.D., Matthew Nankin, MS4, Jonathan Neal, M.D.
October 4, 2020

Presentations for 2019:

ePoster, Medically Challenging Case:
“Scalp Blockade Reduces Opioid Consumption in a Complex Craniotomy Patient”

Kevin Finkel, M.D., Jennifer Sposito, M.D., Andrew Raisbeck, M.D., Matthew Mitchell, M.D., Carla Maffeo-Mitchell, M.D., Ling Lei, MS4, Pranjali Kainkaryam, M.D.

American Society of Regional Anesthesia (ASRA) annual meeting

Presentation Date: April 12, 2019

“Percutaneous Stellate Ganglion Block for Refractory Electrical Storm.”

Carla Maffeo-Mitchell, M.D., Matthew Mitchell, M.D., Andrew Raisbeck, M.D., Rachel Randolph, M.D., Jennifer Sposito, M.D., Kevin Finkel, M.D., Pranjali Kainkaryam, M.D.

ASRA annual meeting

April 12, 2019

“Prothrombin Complex Concentrate for Rapid Correction of Coagulopathy Prior to Thoracic Epidural Placement.”

Matthew Mitchell, M.D., Carla Maffeo-Mitchell, M.D., Andrew Raisbeck, M.D., Casey Savage, D.O., Kevin Finkel, M.D.

ASRA

April 12, 2019