Bio

Clinical Focus

  • Anesthesia

Academic Appointments

Administrative Appointments

  • Director of Regional Anesthesia, Oregon Health Science University (2003 - 2013)
  • Chief, Division of Regional Anesthesia, Stanford University (2013 - Present)

Honors & Awards

  • Medical/Professional Staff Chairman?s Award for Outstanding Contributions in Clinical Care Quality, Oregon Health & Science University (November 26, 2006)
  • Outstanding Teacher Award, CA2, Department of Anesthesiology, Oregon Health & Science University (2003)
  • Outstanding Teacher Award, CA3, Department of Anesthesiology, Oregon Health & Science University (2003)
  • Outstanding Teacher Award, Department of Anesthesiology, Oregon Health & Science University (2001)

Professional Education

  • Fellowship: Vanderbilt University Medical Center (1996) TN
  • Board Certification: Medecin Specialiste en Anesthesiologie, Anesthesia (1991)
  • Residency: Cliniques Universitaire St Luc (1990) Belgium
  • Medical Education: Catholic University of Louvain (1986) Belgium
  • MD, Université Catholique de Louvain (UCL) Brussels, Belgium (1986)

Contact

  • Anesthesia Department 300 Pasteur Dr Rm S238 Grant Bldg Stanford, CA 94305
    • Tel: (650) 723-6412
    Fax: (650) 725-5844

Links

Teaching

2020-21 Courses

Graduate and Fellowship Programs

Publications

All Publications

  • Comparison of Postoperative Pain From Catheter Over the Needle (CON) Versus Catheter Through Needle (CTN) Techniques for Erector Spinae Plane Blockade in Patients Undergoing Open Heart Surgery: A Single-Center Retrospective Review. Journal of cardiothoracic and vascular anesthesia Pfaff, K., Brodt, J., Basireddy, S., Boyd, J., Boublik, J., Horn, J., Tsui, B. C. 2020

    View details for DOI 10.1053/j.jvca.2020.11.060

    View details for PubMedID 33342733

  • Clinical effect of normal saline injectate into interscalene nerve block catheters given within one hour of local anesthetic bolus on analgesia and hemidiaphragmatic paralysis. Regional anesthesia and pain medicine Gerber, L. N., Sun, L. Y., Ma, W., Basireddy, S., Guo, N., Costouros, J., Cheung, E., Boublik, J., Horn, J., Tsui, B. C. 2020

    Abstract

    BACKGROUND: Previous case reports describe the reversal of phrenic nerve blockade from the interscalene nerve block using normal saline injectate washout. This randomized clinical trial aimed to evaluate whether using normal saline injectate to wash out local anesthetic from an interscalene nerve block catheter would restore phrenic nerve and diaphragm function, while preserving analgesia.METHODS: Institutional review board approval, clinical trial registration and consent were obtained for patients undergoing shoulder surgery with an interscalene nerve block catheter. 16 patients were randomized to receive three 10mL aliquots of normal saline injectate (intervention group, n=8) or three sham injectates (control group, n=8) via their perineural catheters in the postanesthesia care unit (PACU). Primary outcome measures were the effects on ipsilateral hemidiaphragmatic paralysis, and secondary outcome measures included PACU opioid consumption, pain scores and change in brachial plexus sensory examination and motor function.RESULTS: There was no significant difference in reversal of hemidiaphragmatic paralysis. However, there was a greater number of patients in the intervention group who ultimately displayed partial, as opposed to full, paralysis of the hemidiaphragm (p=0.03). There was no significant difference in pain scores, PACU opioid requirement, and brachial plexus motor and sensory examinations between the two groups.CONCLUSIONS: All patients had persistent hemidiaphragmatic paralysis after the intervention, but fewer patients in the intervention group progressed to full paralysis, suggesting that a larger bolus dose of normal saline may be needed to completely reverse hemidiaphragmatic paralysis. Although normal saline injectate in 10mL increments given through the interscalene nerve block catheter had no clinically significant effect on reversing phrenic nerve blockade, it also did not lead to a reduction in analgesia and may be protective in preventing the progression to full hemidiaphragmatic paralysis.TRAIL REGISTRATION NUMBER: NCT03677778.

    View details for DOI 10.1136/rapm-2020-101922

    View details for PubMedID 33184166

  • Quadratus lumborum block: an imaging study of three approaches. Regional anesthesia and pain medicine Balocco, A. L., Lopez, A. M., Kesteloot, C., Horn, J., Brichant, J., Vandepitte, C., Hadzic, A., Gautier, P. 2020

    Abstract

    BACKGROUND AND OBJECTIVES: Different injection techniques for the quadratus lumborum (QL) block have been described. Data in human cadavers suggest that the transverse oblique paramedian (TOP) QL3 may reach the thoracic paravertebral space more consistently than the QL1 and QL2. However, the distribution of injectate in cadavers may differ from that in patients. Hence, we assessed the distribution of the injectate after the QL1, QL2, and TOP QL3 techniques in patients.MATERIALS AND METHODS: Thirty-four patients scheduled for abdominal surgery received QL blocks postoperatively; 26 patients received bilateral and 8 patients received unilateral blocks. Block injections were randomly allocated to QL1, QL2, or TOP QL3 techniques (20 blocks per each technique). The injections consisted of 18 mL of ropivacaine 0.375% with 2 mL of radiopaque contrast, injected lateral or posterior to the QL muscle for the QL1 and QL2 techniques, respectively. For the TOP QL3, the injection was into the plane between the QL and psoas muscles, proximal to the L2 transverse process. Two reviewers, blinded to the allocation, reviewed three-dimensional computed tomography (3D-CT) images to assess the distribution of injectate.RESULTS AND DISCUSSION: The QL1 block spread in the transversus abdominis plane (TAP), QL2 in the TAP, and posterior aspect of the QL muscle, whereas TOP QL3 spread consistently in the anterior aspect of the QL muscle with occasional spread to the lumbar and thoracic paravertebral areas.CONCLUSIONS: The spread of injectate after QL1, QL2, and QL3 blocks, resulted in different distribution patterns, primarily in the area of injection. The TOP QL3 did not result in consistent interfascial spread toward the thoracic paravertebral space.

    View details for DOI 10.1136/rapm-2020-101554

    View details for PubMedID 33159007

  • Transversus Abdominis Plane Block With Liposomal Bupivacaine for Pain After Cesarean Delivery in a Multicenter, Randomized, Double-Blind, Controlled Trial. Anesthesia and analgesia Nedeljkovic, S. S., Kett, A., Vallejo, M. C., Horn, J., Carvalho, B., Bao, X., Cole, N. M., Renfro, L., Gadsden, J. C., Song, J., Yang, J., Habib, A. S. 2020

    Abstract

    BACKGROUND: In women undergoing cesarean delivery under spinal anesthesia with intrathecal morphine, transversus abdominis plane (TAP) block with bupivacaine hydrochloride (HCl) may not improve postsurgical analgesia. This lack of benefit could be related to the short duration of action of bupivacaine HCl. A retrospective study reported that TAP block with long-acting liposomal bupivacaine (LB) reduced opioid consumption and improved analgesia following cesarean delivery. Therefore, we performed a prospective multicenter, randomized, double-blind trial examining efficacy and safety of TAP block with LB plus bupivacaine HCl versus bupivacaine HCl alone.METHODS: Women (n = 186) with term pregnancies undergoing elective cesarean delivery under spinal anesthesia were randomized (1:1) to TAP block with LB 266 mg plus bupivacaine HCl 50 mg or bupivacaine HCl 50 mg alone. Efficacy was evaluated in a protocol-compliant analysis (PCA) set that was defined a priori. The primary end point was total postsurgical opioid consumption (oral morphine equivalent dosing [MED]) through 72 hours. Pain intensity was measured using a visual analog scale. Adverse events (AEs) after treatment were recorded through day 14.RESULTS: Total opioid consumption through 72 hours was reduced with LB plus bupivacaine HCl versus bupivacaine HCl alone (least squares mean [LSM] [standard error (SE)] MED, 15.5 mg [6.67 mg] vs 32.0 mg [6.25 mg]). This corresponded to an LSM treatment difference of -16.5 mg (95% confidence interval [CI], -30.8 to -2.2 mg; P = .012). The area under the curve of imputed pain intensity scores through 72 hours supported noninferiority of LB plus bupivacaine HCl versus bupivacaine HCl alone (LSM [SE], 147.9 [21.13] vs 178.5 [19.78]; LSM treatment difference, -30.6; 95% CI, -75.9 to 14.7), with a prespecified noninferiority margin of 36 (P = .002). In an analysis of all treated patients, including those not meeting criteria for inclusion in the PCA, there was no difference in postsurgical opioid consumption between groups. In the LB plus bupivacaine HCl group, 63.6% of patients experienced an AE after treatment versus 56.2% in the bupivacaine HCl-alone group. Serious AEs after treatment were rare (3% in both groups).CONCLUSIONS: TAP block using LB plus bupivacaine HCl as part of a multimodal analgesia protocol incorporating intrathecal morphine resulted in reduced opioid consumption after cesarean delivery in the PCA set. Results suggest that with correct TAP block placement and adherence to a multimodal postsurgical analgesic regimen, there is an opioid-reducing benefit of adding LB to bupivacaine TAP blocks after cesarean delivery (ClinicalTrials.gov identifier: NCT03176459).

    View details for DOI 10.1213/ANE.0000000000005075

    View details for PubMedID 32739962

  • Pain management in the orthopaedic trauma patient: Non-opioid solutions INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED Gessner, D. M., Horn, J., Lowenberg, D. W. 2020; 51: S28?S36

    View details for DOI 10.1016/j.injury.2019.04.008

    View details for Web of Science ID 000577563000008

  • The use of extended release bupivacaine with transversus abdominis plane and subcostal anterior quadratus lumborum catheters: A retrospective analysis of a novel technique. Journal of anaesthesiology, clinical pharmacology Elsharkawy, H., Saasouh, W., Cho, Y. J., Soliman, L. M., Horn, J. L. 2020; 36 (1): 110?14

    Abstract

    Liposomal bupivacaine (LB) is a formulation of local anesthetic that may exert analgesia over a prolonged period. Anecdotal use of LB suggests benefit and prolonged analgesia when used to supplement infiltration blocks. Our aim was to test the effect of a bolus of LB delivered through a nerve catheter in two types of interfascial plane blocks (transversus abdominis plane and anterior subcostal quadratus lumborum). The effect was evaluated through patient self-reporting of postsurgical pain up to 48 postoperative hours.Medical records of adult postoperative patients who received LB in a peripheral nerve catheter were followed retrospectively and analysed for pain scores and spread of dermatomal numbness over 48 h following the postoperative dose. A chart review of patients who qualified between June 2015 and March 2017 was performed, and clinical data were obtained from the institutional Perioperative Health Documentation System.Pain scores decreased following LB bolus, and all patients reported efficient block analgesia after bolus injection. Dermatomal numbness decreased gradually and was minimal by 48 h following bolus.LB can be injected through a peripheral nerve catheter to prolong analgesia after catheter removal.

    View details for DOI 10.4103/joacp.JOACP_358_18

    View details for PubMedID 32174670

    View details for PubMedCentralID PMC7047671

  • Anesthesia residency training in regional anesthesiology and acute pain medicine: a competency-based model curriculum. Regional anesthesia and pain medicine Woodworth, G., Maniker, R. B., Spofford, C. M., Ivie, R., Lunden, N. I., Machi, A. T., Elkassabany, N. M., Gritsenko, K., Kukreja, P., Vlassakov, K., Tedore, T., Schroeder, K., Missair, A., Herrick, M., Shepler, J., Wilson, E. H., Horn, J. L., Barrington, M. 2020

    Abstract

    The Accreditation Council for Graduate Medical Education has shifted to competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills and behaviors expected of competent trainees. It also requires an assessment program to provide formative feedback to trainees as they progress to competency in each outcome. Critical to the success of a curriculum is its practical implementation. This article describes the development of model curricula for anesthesiology residency training in regional anesthesia and acute pain medicine (core and advanced) using a competency-based framework. We further describe how the curricula were distributed through a shared web-based platform and mobile application.

    View details for DOI 10.1136/rapm-2020-101480

    View details for PubMedID 32474420

  • Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique PAIN MEDICINE Elsharkawy, H., Saasouh, W., Babazade, R., Soliman, L., Horn, J., Zaky, S. 2019; 20 (9): 1750?55

    View details for DOI 10.1093/pm/pnz026

    View details for Web of Science ID 000493046300013

  • Opioid-Free Ultra-Fast-Track On-Pump Coronary Artery Bypass Grafting Using Erector Spinae Plane Catheters JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Chanowski, E. P., Horn, J., Boyd, J. H., Tsui, B. H., Brodt, J. L. 2019; 33 (7): 1988?90

    View details for DOI 10.1053/j.jvca.2018.10.012

    View details for Web of Science ID 000473249900033

  • Successful reversal of phrenic nerve blockade following washout of interscalene nerve block as demonstrated by ultrasonographic diaphragmatic excursion. Journal of clinical anesthesia Ngai, L. K., Ma, W., Costouros, J. G., Cheung, E. V., Horn, J., Tsui, B. C. 2019; 59: 46?48

    View details for DOI 10.1016/j.jclinane.2019.06.022

    View details for PubMedID 31212125

  • Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique. Pain medicine (Malden, Mass.) Elsharkawy, H., Saasouh, W., Babazade, R., Soliman, L. M., Horn, J., Zaky, S. 2019

    Abstract

    OBJECTIVE: The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view.DESIGN: Prospective descriptive trial on a novel approach.SETTING: Operating room and preoperative holding area at a tertiary care hospital.SUBJECTS: Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia.METHODS: Consented adult patients aged 30-80years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2-5MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10minutes.RESULTS: Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48hours after the procedure.CONCLUSIONS: We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.

    View details for PubMedID 30865772

  • Le bloc du muscle carre des lombesanterieur par approche supra-iliaque : une etude cadaverique et une serie de cas. Canadian journal of anaesthesia = Journal canadien d'anesthesie Elsharkawy, H., El-Boghdadly, K., Barnes, T. J., Drake, R., Maheshwari, K., Soliman, L. M., Horn, J., Chin, K. J. 2019

    Abstract

    PURPOSE: The local anesthetic injectate spread with fascial plane blocks and corresponding clinical outcomes may vary depending on the site of injection. We developed and evaluated a supra-iliac approach to the anterior quadratus lumborum (QL) block and hypothesized that this single injection might successfully block the lumbar and sacral plexus in cadavers and provide analgesia for patients undergoing hip surgery.METHODS: Ultrasound-guided bilateral supra-iliac anterior QL blocks were performed with 30 mL of India ink dye in six fresh adult cadavers. Cadavers were subsequently dissected to determine distribution of the dye. In five patients undergoing hip surgery, a unilateral supra-iliac anterior QL block with 25 mL ropivacaine 0.5% followed by a continuous catheter infusion was performed. Patients were clinically assessed daily for block efficacy.RESULTS: The cadaveric injections showed consistent dye involvement of the majority of the branches of the lumbar plexus, including the femoral nerve, lateral femoral cutaneous nerve, ilioinguinal nerve, and iliohypogastric nerve. The majority of cadaveric specimens (83%) also exhibited thoracic paravertebral spread of dye to the T10 level. No specimens showed L5 or sacral nerve root staining or caudal spread below L5. All patients had effective analgesia for total hip surgery and a T11-L3 sensory level following the initial bolus of local anesthetic as well as during the period of continuous catheter infusion.CONCLUSION: This cadaveric study and case series show that a supra-iliac approach to the anterior QL block involved T10--L3 nerve territories and dermatomal coverage with no sacral plexus spread. This technique may have clinical utility for analgesia in hip surgery.

    View details for DOI 10.1007/s12630-019-01312-z

    View details for PubMedID 30953311

  • Pain management in the orthopaedic trauma patient: Non-opioid solutions. Injury Gessner, D. M., Horn, J. L., Lowenberg, D. W. 2019

    Abstract

    When treating pain in the orthopaedic trauma patient opioids have classically represented the mainstay of treatment. They are relatively inexpensive and modestly effective for basic pain management. However, they are fraught with considerable side effects as well as the very high risk of addiction. Their use in pain management has been implicated in the opioid epidemic. For this reason, as well as their only moderate efficacy, alternative modes of treatment have been sought for both the patient with isolated limb trauma and the patient with poly trauma. We review alternative treatment methods in pain management for those with isolated limb trauma and poly trauma. These methods include topical agents, as well as non steroidal anti-inflammatory medications, acetaminophen, gabapetoids, intravenous agents, varying degrees of local anesthetic infiltration and peripheral nerve blocks, and the newer modality of fascial plane blocks. Often, it is a combination of these analgesic modalities that gives the most optimum treatment for the trauma patient. This also, more frequently than not, must be individually tailored to the patient, as no two patients act the same in this regard. It is therefore of importance that the physician managing such patients's pain be experienced and well-versed in all these treatment modalities. We also provide a basic stepwise algorithm we have found useful in treating those with single extremity or single site trauma versus those patients with poly trauma and resultant multiple sources as pain generators. It is hoped that this breakdown of the different modalities along with a better understanding of each modality's potential benefits and indications will aid the surgeon in providing better care to patients following orthopedic trauma.

    View details for PubMedID 31079833

  • Opioid-Free Ultra-Fast-Track On-Pump Coronary Artery Bypass Grafting Using Erector Spinae Plane Catheters. Journal of cardiothoracic and vascular anesthesia Chanowski, E. J., Horn, J., Boyd, J. H., Tsui, B. C., Brodt, J. L. 2018

    View details for PubMedID 30424939

  • Cervical erector spinae plane block catheter using a thoracic approach: an alternative to brachial plexus blockade for forequarter amputation. Canadian journal of anaesthesia = Journal canadien d'anesthesie Tsui, B. C., Mohler, D., Caruso, T. J., Horn, J. L. 2018

    View details for PubMedID 29868941

  • Perioperative Pain Management for Total Knee Arthroplasty: Need More Focus on the Forest and Less on the Trees. Anesthesiology Webb, C. A., Madison, S., Goodman, S. B., Mariano, E. R., Horn, J. L. 2018; 128 (2): 420?21

    View details for PubMedID 29337751

  • Transversus Abdominis Plane Block and Free Flap Abdominal Tissue Breast Reconstruction Is There a True Reduction in Postoperative Narcotic Use? ANNALS OF PLASTIC SURGERY Hunter, C., Shakir, A., Momeni, A., Luan, A., Steffel, L., Horn, J., Dung Nguyen, D., Lee, G. K. 2017; 78 (3): 254-259

    Abstract

    The use of the transversus abdominis plane (TAP) block is increasing in abdominally based autologous tissue breast reconstruction as a method to provide postoperative donor site analgesia. The purpose of this study was to evaluate the efficacy of the TAP block in the immediate postoperative period.A retrospective analysis of all patients who underwent autologous microsurgical breast reconstruction over a 2-year period (2013-2015) was conducted. Only patients with an abdominal donor site were included. Patients were grouped based on the presence or absence of TAP blocks. Primary endpoints included patient-reported pain score, daily and total narcotic use during the hospitalization, antiemetic use, as well as complications.We identified 40 patients that had undergone abdominal-based free flap breast reconstruction and TAP block catheter placement for postoperative analgesia that met inclusion criteria. This group was then compared with a matched cohort of 40 patients without TAP blocks. There were no complications associated with using the TAP catheters. There was no statistically significant difference in postoperative pain scores, daily or total narcotic use during the hospitalization, or antiemetic use between the 2 groups. Although not statistically significant, linear regression analysis identified trends of improved donor site analgesia in select groups, such as unilateral immediate reconstructions, body mass index greater than 30 kg/m, and those without abdominal mesh placed at the time of donor site closure in the TAP block group.Constant delivery of local anesthetic through the TAP block appears to be safe; however, it did not reduce narcotic requirements or postoperative pain scores in patients undergoing abdominal-based free flap breast reconstruction.

    View details for DOI 10.1097/SAP.0000000000000873

    View details for Web of Science ID 000394386700004

  • Transversus Abdominis Plane Block and Free Flap Abdominal Tissue Breast Reconstruction: Is There a True Reduction in Postoperative Narcotic Use? Annals of plastic surgery Hunter, C., Shakir, A., Momeni, A., Luan, A., Steffel, L., Horn, J., Nguyen, D., Lee, G. K. 2017; 78 (3): 254-259

    Abstract

    The use of the transversus abdominis plane (TAP) block is increasing in abdominally based autologous tissue breast reconstruction as a method to provide postoperative donor site analgesia. The purpose of this study was to evaluate the efficacy of the TAP block in the immediate postoperative period.A retrospective analysis of all patients who underwent autologous microsurgical breast reconstruction over a 2-year period (2013-2015) was conducted. Only patients with an abdominal donor site were included. Patients were grouped based on the presence or absence of TAP blocks. Primary endpoints included patient-reported pain score, daily and total narcotic use during the hospitalization, antiemetic use, as well as complications.We identified 40 patients that had undergone abdominal-based free flap breast reconstruction and TAP block catheter placement for postoperative analgesia that met inclusion criteria. This group was then compared with a matched cohort of 40 patients without TAP blocks. There were no complications associated with using the TAP catheters. There was no statistically significant difference in postoperative pain scores, daily or total narcotic use during the hospitalization, or antiemetic use between the 2 groups. Although not statistically significant, linear regression analysis identified trends of improved donor site analgesia in select groups, such as unilateral immediate reconstructions, body mass index greater than 30 kg/m, and those without abdominal mesh placed at the time of donor site closure in the TAP block group.Constant delivery of local anesthetic through the TAP block appears to be safe; however, it did not reduce narcotic requirements or postoperative pain scores in patients undergoing abdominal-based free flap breast reconstruction.

    View details for DOI 10.1097/SAP.0000000000000873

    View details for PubMedID 28118232

  • Reply to Dr El-Boghdadly et al. Regional anesthesia and pain medicine Horn, J., Derby, R., Abrahams, M. 2016; 41 (5): 655-?

    View details for DOI 10.1097/AAP.0000000000000449

    View details for PubMedID 27547904

  • Quadratus lumborum catheters for breast reconstruction requiring transverse rectus abdominis myocutaneous flaps JOURNAL OF ANESTHESIA Spence, N. Z., Olszynski, P., Lehan, A., Horn, J., Webb, C. A. 2016; 30 (3): 506-509

    Abstract

    Patients diagnosed with breast cancer may opt to undergo surgical reconstructive flaps at the time of or after mastectomies. These surgeries leave patients with significant postoperative pain and sometimes involve large surgical beds including graft sites from the abdomen to reconstruct the breast. Consequently, multimodal methods of pain management have become highly favored. Quadratus lumborum catheters offer an opioid-sparing technique that can be performed easily and safely. We present a case of a patient who underwent a breast flap reconstruction and had bilateral quadratus lumborum catheters placed for perioperative pain control.

    View details for DOI 10.1007/s00540-016-2160-y

    View details for Web of Science ID 000376675600021

    View details for PubMedID 26984687

  • The Importance of the Saphenous Nerve in Ankle Surgery ANESTHESIA AND ANALGESIA Eglitis, N., Horn, J., Benninger, B., Nelsen, S. 2016; 122 (5): 1704-1706

    Abstract

    Recent evidence suggests that the saphenous nerve may be involved in the innervation of deeper structures at the medial ankle. In this study, we sought to determine the consistency and variability of the saphenous nerve innervation at the distal tibia and medial ankle joint capsule.One hundred three lower extremities from 52 embalmed cadavers were dissected to identify the deep branches of saphenous nerve along its distal course.In all specimens, the saphenous nerve had branches, emerging between 3.9 and 8.2 cm above the medial malleolus, to the periosteum of the distal tibia and the medial capsule of the ankle joint.Deep branches of the saphenous nerve innervate the periosteum of the distal tibia and talocrural capsule.

    View details for DOI 10.1213/ANE.0000000000001168

    View details for Web of Science ID 000374664400065

    View details for PubMedID 26859876

  • Update on Ultrasound for Truncal Blocks: A Review of the Evidence. Regional anesthesia and pain medicine Abrahams, M., Derby, R., Horn, J. 2016; 41 (2): 275-288

    Abstract

    We summarized the evidence for ultrasound (US) guidance for truncal blocks in 2010 by performing a systematic literature review and rating the strength of evidence for each block using a system developed by the United States Agency for Health Care Policy and Research. Since then, numerous studies of US guidance for truncal blocks have been published. In addition, 3 novel US-guided blocks have been described since our last review. To provide updated recommendations, we performed another systematic search of the literature to identify studies pertaining to US guidance for the following blocks: paravertebral, intercostal, transversus abdominis plane, rectus sheath, ilioinguinal/iliohypogastric, as well as the Pecs, quadratus lumborum, and transversalis fascia blocks. We rated the methodologic quality of each of the identified studies and then graded the strength of evidence supporting the use of US for each block based on the number and quality of available studies for that block.Since our last review, numerous studies have been published, especially for the paravertebral and transversus abdominis plane blocks, and 3 novel US-guided blocks (Pecs, quadratus lumborum, and transversalis fascia blocks) have been described. Although some of these studies support the use of US for performing these blocks, others do not. Additional studies have used US to improve our understanding of the anatomy pertinent to these blocks and evaluated the effect on patient outcomes and risk of complications.

    View details for DOI 10.1097/AAP.0000000000000372

    View details for PubMedID 26866299

  • The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia: Executive Summary. Regional anesthesia and pain medicine Neal, J. M., Brull, R., Horn, J., Liu, S. S., McCartney, C. J., Perlas, A., Salinas, F. V., Tsui, B. C. 2016; 41 (2): 181-194

    Abstract

    In 2009 and again in 2012, the American Society of Regional Anesthesia and Pain Medicine assembled an expert panel to assess the evidence basis for ultrasound guidance as a nerve localization tool for regional anesthesia.The 2012 panel reviewed evidence from the first advisory but focused primarily on new information that had emerged since 2009. A new section was added regarding the accuracy and reliability of ultrasound for determining needle-to-nerve proximity. Jadad scores are used to rank study quality. Grades of recommendations consistent with their level of evidence are provided.The panel offers recommendations based on synthesis and analysis of literature related to (1) the technical capabilities of ultrasound equipment and its operators, (2) comparison of ultrasound to other methods of nerve localization with regard to block characteristics, (3) comparison of block techniques where ultrasound is the sole nerve localization modality, and (4) major complications. Assessment of evidence strength and recommendations are made for upper- and lower-extremity, truncal, neuraxial, and pediatric blocks.Scientific evidence from the past 5 years has clarified and strengthened our understanding of ultrasound-guided regional anesthesia as a nerve localization tool. High-level evidence supports ultrasound guidance contributing to superior characteristics with selected blocks, although absolute differences with the comparator technique are often relatively small (especially for upper-extremity blocks). The clinical meaningfulness of these differences is likely of variable importance to individual practitioners. The use of ultrasound significantly reduces the risk of local anesthetic systemic toxicity as well as the incidence and intensity of hemidiaphragmatic paresis, but has no significant effect on the incidence of postoperative neurologic symptoms. WHAT'S NEW IN THIS UPDATE?: This evidence-based assessment of ultrasound-guided regional anesthesia reviews findings from our 2010 publication and focuses on new meta-analyses, randomized controlled trials, and large case series published since 2009. New to this exercise is an in-depth analysis of the accuracy and reliability of ultrasound guidance for identifying needle-to-nerve relationships. This version no longer addresses ultrasound for interventional pain medicine procedures, because the growth of that field demands separate consideration. Since our 2010 publication, new information has either supported or strengthened our original conclusions. There is no evidence that ultrasound is inferior to alternative nerve localization methods.

    View details for DOI 10.1097/AAP.0000000000000331

    View details for PubMedID 26695878

  • Development and Validation of an Assessment of Regional Anesthesia Ultrasound Interpretation Skills. Regional anesthesia and pain medicine Woodworth, G. E., Carney, P. A., Cohen, J. M., Kopp, S. L., Vokach-Brodsky, L. E., Horn, J. E., Missair, A., Banks, S. E., Dieckmann, N. F., Maniker, R. B. 2015; 40 (4): 306-314

    Abstract

    Interpretation of ultrasound images and knowledge of anatomy are essential skills for ultrasound-guided peripheral nerve blocks. Competency-based educational models promoted by the Accreditation Council for Graduate Medical Education require the development of assessment tools for the achievement of different competency milestones to demonstrate the longitudinal development of skills that occur during training.A rigorous study guided by psychometric principles was undertaken to identify and validate the domains and items in an assessment of ultrasound interpretation skills for regional anesthesia. A survey of residents, academic faculty, and community anesthesiologists, as well as video recordings of experts teaching ultrasound-guided peripheral nerve blocks, was used to develop short video clips with accompanying multiple choice-style questions. Four rounds of pilot testing produced a 50-question assessment that was subsequently administered online to residents, fellows, and faculty from multiple institutions.Test results from 90 participants were analyzed with Item Response Theory model fitting indicating that a 47-item subset of the test fits the model well (P = 0.11). There was a significant linear relation between expected and predicted item difficulty (P < 0.001). Overall test scores increased linearly with higher levels of formal anesthesia training, regional anesthesia training, number of ultrasound-guided blocks performed per year, and a self-rating of regional anesthesia skill (all P < 0.001).This study provides evidence for the reliability, content validity, and construct validity of a 47-item multiple choice-style online test of ultrasound interpretation skills for regional anesthesia, which can be used as an assessment of competency milestone achievement in anesthesiology training.

    View details for DOI 10.1097/AAP.0000000000000236

    View details for PubMedID 26017720

  • "Pseudo" Shearing of a Peripheral Nerve Catheter After Interscalene Block REGIONAL ANESTHESIA AND PAIN MEDICINE Carvalho, B., Derby, R., Horn, J. 2014; 39 (6): 556?57

    View details for PubMedID 25340485

  • Regional anesthesia for vascular surgery. Anesthesiology clinics Flaherty, J., Horn, J., Derby, R. 2014; 32 (3): 639-659

    Abstract

    Patients presenting for vascular surgery present a challenge to anesthesiologists because of their severe systemic comorbidities. Regional anesthesia has been used as a primary anesthetic technique for many vascular procedures to avoid the cardiovascular and pulmonary perturbations associated with general anesthesia. In this article the use of regional anesthesia for carotid endarterectomy, open and endovascular abdominal aortic aneurysm repair, infrainguinal arterial bypass, lower extremity amputation, and arteriovenous fistula formation is described. A focus is placed on reviewing the literature comparing anesthetic techniques, with brief descriptions of the techniques themselves.

    View details for DOI 10.1016/j.anclin.2014.05.002

    View details for PubMedID 25113725

  • Efficacy of computer-based video and simulation in ultrasound-guided regional anesthesia training. Journal of clinical anesthesia Woodworth, G. E., Chen, E. M., Horn, J. E., Aziz, M. F. 2014; 26 (3): 212-221

    Abstract

    To determine the effectiveness of a short educational video and simulation on improvement of ultrasound (US) image acquisition and interpretation skills.Prospective, randomized study.University medical center.28 anesthesia residents and community anesthesiologists with varied ultrasound experience were randomized to teaching video with interactive simulation or sham video groups.Participants were assessed preintervention and postintervention on their ability to identify the sciatic nerve and other anatomic structures on static US images, as well as their ability to locate the sciatic nerve with US on live models.Pretest written test scores correlated with reported US block experience (Kendall tau rank r = 0.47) and with live US scanning scores (r = 0.64). The teaching video and simulation significantly improved scores on the written examination (P < 0.001); however, they did not significantly improve live US scanning skills.A short educational video with interactive simulation significantly improved knowledge of US anatomy, but failed to improve hands-on performance of US scanning to localize the nerve.

    View details for DOI 10.1016/j.jclinane.2013.10.013

    View details for PubMedID 24793714

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