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Edward R. Mariano, MD, MAS, FASA, is a graduate of Georgetown University School of Medicine. He completed his anesthesiology residency at Stanford University Medical Center and pediatric anesthesiology fellowship at Stanford’s Lucile Packard Children’s Hospital with a special interest in regional anesthesiology and acute pain medicine (RAAPM) for children. He is double board-certified by the American Board of Anesthesiology and is a Fellow of the American Society of Anesthesiologists.He joined the Department of Anesthesiology at the University of California, San Diego (UCSD), in 2004, where he founded the RAAPM program. While working full-time, he also earned a Master of Advanced Studies degree in clinical research. He served as RAAPM Division Chief at UCSD until 2010, pioneering the use of continuous peripheral nerve blocks for patients having same-day surgery and founding the first one-year RAAPM Fellowship in California. From 2013 to 2016, Dr. Mariano took the lead in achieving accreditation status for all RAAPM fellowship programs nationwide through the Accreditation Council for Graduate Medical Education (ACGME), and under his direction the RAAPM fellowship program at Stanford became one of the first nine programs to be ACGME-accredited.Dr. Mariano is a Professor at Stanford University School of Medicine and Chief of the Anesthesiology and Perioperative Care Service at the Veterans Affairs Palo Alto Health Care System. He has developed techniques and patient care pathways to improve postoperative pain control, patient safety, and other outcomes and has published over 200 peer-reviewed articles and book chapters. He is President of the California Society of Anesthesiologists and has held leadership positions in the American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, and multiple journals. He is a recipient of the Veterans Health Administration’s John D. Chase Award for Physician Executives Excellence and has worked on key national healthcare initiatives in the U.S. including the accreditation of regional anesthesiology and acute pain medicine fellowships, pain management guidelines and hospital-based standards, development of quality and cost measures in perioperative care, and the National Academy of Medicine Action Collaborative Countering the U.S. Opioid Epidemic. Dr. Mariano manages his own self-titled blog EdMariano.com, and you can follow him on Twitter (@EMARIANOMD).
Pediatric anesthesiology and postoperative pain management in developing countries
Project Perfect World (PPW)
Philippine-American Group of Educators and Surgeons (PAGES)
My research interests have primarily focused on the development of techniques and patient care pathways to improve postoperative pain control and other surgical outcomes. As a faculty member at UCSD and founder of the RAAPM program there, I established successful research collaborations which led to the publication of multiple randomized clinical trials investigating the use of opioid-sparing continuous peripheral nerve block (CPNB) techniques for same-day surgical patients and establishing the use of ultrasound guidance for advanced nerve block procedures. My studies in regional anesthesia have proven important patient benefits such as decreased opioid use, earlier postoperative mobility, and faster times to achieve discharge eligibility. The use of non-opioid pain management modalities has become a high priority in the setting of the current opioid epidemic. Based on common research interests and facilitated by modern communication methods, I have developed collaborations with physicians and researchers around the world. I have received extramural research funding for my own investigator-initiated and collaborative studies from the Foundation for Anesthesia Education and Research, Department of Defense, and Department of Veterans Affairs (VA).I am also passionate about knowledge translation and change implementation, and I believe this research area represents an important intersection of my scholarship activities and administrative responsibilities. I have been able to study the influence of specific regional anesthesia practice models on operating room efficiency and hospital costs. I have also led successful implementation projects to establish or update clinical pathways at VA Palo Alto that have improved in-hospital and post-discharge outcomes for our patients. As examples, implementation projects refining our clinical pathways have led to earlier postoperative rehabilitation, decreased opioid use in the hospital and at home, exploration of new models of care, standardization of anesthetic techniques, and methods to maintain adherence to protocols and sustain change long term. The sharing of these projects through publications is helping to shape the clinical practice of perioperative care worldwide.
Optimizing Catheter Insertion Technique for Ultrasound-guided Continuous Peripheral Nerve Blocks
Continuous peripheral nerve blocks (CPNB; also known as "perineural" catheters) provide
target-specific pain control for a variety of surgeries. There has been increasing interest
in the use of ultrasound guidance for regional anesthesia, and many techniques using
ultrasound alone for perineural catheter insertion have been described. Catheters may be
placed at various points along the brachial plexus (for upper extremity procedures) or in
proximity to the femoral and/or sciatic nerve (for lower extremity procedures). To date, the
optimal ultrasound scanning technique, catheter insertion endpoint, catheter placement
location per indication, for the majority of ultrasound-guided continuous peripheral nerve
blocks remain unknown. This study will help provide important information related to optimal
ultrasound scanning techniques and will help identify ways to improve the success rates,
onset times, and analgesic effectiveness of these techniques for real patients undergoing
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Follow-Up Study to Assess Implementation of Ultrasound-Guided Regional Anesthesia Skills
The investigators hope to survey anesthesiologists who have participated in a non-CME
regional anesthesia workshop at VAPAHCS over the past 4 years on the number and types of
nerve block procedures that they performed, nerve localization method (e.g., ultrasound,
electrical stimulation, or both), and whether the nerve blocks performed were
single-injection or catheter-based.