Anesthesia and Analgesia Commons^™

An Update On The Role Of Multimodal Analgesia In Perioperative Pain Management, Whitney N. Kuwamoto, Grace C. Eddy, Edward R. Mariano, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

Multimodal analgesia has become a foundational principle of acute perioperative pain management and enhanced recovery and involves the application of nonpharmacologic, pharmacologic, and/or interventional techniques. The overall goal of this approach is to apply a combination of different modalities that target discrete points along the pain pathway and thereby avoid the overreliance on opioids and associated side effects. Since our review in 2018, there have been significant developments that have prompted an updated review of multimodal analgesia. In this article, we identify and summarize important trends that influence the current approach to acute perioperative pain management as well as provide …

Bilateral Intracranial Subdural Hematoma Following Epidural Anesthesia, Eric B. Cox, Adaeza Onuoha

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Improving Anesthesia Provider Confidence In The Identification, Management, And Treatment Of Postoperative Delirium, Brittany M. Whistle, Charles Dustin Phelps

Scholars Week

Purpose: Postoperative Delirium (POD) is a potentially devastating complication of anesthesia that is poorly understood by clinical staff leading to poor outcomes for surgical patients. This study is meant to determine if a focused knowledge presentation accompanied by visual aids could increase anesthesia providers confidence in identifying, diagnosing, and treating Postoperative Delirium.

Methodology: Utilizing a statistical model to analyze respondents results on a standardized test administered before and after an informational presentation with visual aids on the topic of Postoperative Delirium.

Results: Results indicated a statistically significant difference between pretest and posttest scores, with a p-value of .002, t(11) = …

Tylenol Or Toradol? Iv Acetaminophen Vs. Parenteral Ketorolac For Prehospital Analgesia, Conrad Stallings, Kevin Crocker, Michael Wells, Nick Smith, Casey Patrick

Gulf Coast Division GME Research Day 2026

No abstract provided.

Breaking The Pain Cycle: Ultrasound-Guided Sciatic Nerve Blocks For Acute Sciatica In The Ed, Pranav Bommineni, Taryn Hoffman

South Atlantic Division GME Research Days 2026

No abstract provided.

7-Hydroxymitragynine Induced Perioperative Hyperalgesia In 27-Year-Old Trauma Patient, William Hickman, Katherine David, Vincent Hoffman, Ruzanna Nalbandyan

South Atlantic Division GME Research Days 2026

No abstract provided.

A Multidisciplinary Approach To Acute-On-Chronic Pain Management In The Emergency Department, Lisa Persaud, Cameron Burr, Ursula Des Bordes, Noah Novembre, Abhishek Desai, Kaitlyn Phelps, Desiree Aird

South Atlantic Division GME Research Days 2026

No abstract provided.

The Great Mimicker: Intrathecal Opioid-Induced Esophageal Dysfunction, Abhishek Desai, Lisa Persaud, Desiree Aird

South Atlantic Division GME Research Days 2026

No abstract provided.

Subanesthetic Ketamine Use For Uncontrolled Pain In Hospice Care, Tiffany Rey, Ana Sanchez

South Atlantic Division GME Research Days 2026

No abstract provided.

Education For Residents And Patients On Pain Management For Gyn Procedures, Claire Moen, Jeffrey Edwards, Dominique Rehl, Kenyon Weidle

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

A Single-Center, Retrospective Analysis Of The Safety And Efficacy Of Disc Tissue Allograft Supplementation For Discogenic Axial Low Back Pain, Nomen Azeem, Ali Amirzadeh

West Florida Division GME Research Day 2026

No abstract provided.

Rethinking Acute Pain Management: Evidence For Suzetrigine As An Opioid-Sparing Strategy In Outpatient Care, Shana-Kay Lambert-Johnson, Tasaduq Mir

North Texas GME Research Forum 2026

BACKGROUND: The ongoing opioid epidemic underscores the urgent need for effective nonopioid options for acute pain management. Suzetrigine, a selective voltage-gated sodium channel NaV1.8 inhibitor, represents a mechanistically novel analgesic targeting peripheral nociception and may reduce reliance on opioid therapy. It received FDA approval on January 30, 2025, for the treatment of moderate-to-severe acute pain in adults. This evidence-based review evaluates the efficacy and safety of suzetrigine as an opioid-sparing option for outpatient acute pain management.

METHODS: A structured literature search of PubMed was conducted from database inception through January 2026 using the terms “suzetrigine” and “NaV1.8.” Eligible studies were …

Intraosseous (Io) Analgesia Medication Administration In Orthopaedic Surgery: A Brief Review, Jenna Chrabolowski, Troy B. Puga, Abanoub Attallahm, Mckenna W. Box, John T. Riehl

North Texas GME Research Forum 2026

Introduction

Intraosseous (IO) analgesia is a novel strategy for pain control in orthopaedic surgery. This brief review aims to provide an overview of IO analgesia in orthopaedic surgery.

Methods

A search was conducted across seven databases. Titles and abstracts were screened followed by full-text review for inclusion criteria. Demographics and results were extracted from included articles.

Results

Ten studies met inclusion criteria and involved patients undergoing knee surgery and spinal surgery. IO lidocaine was shown to be effective for postoperative and intraprocedural pain control during vertebroplasty and kyphoplasty. IO morphine and IO NSAIDs were shown to be effective in reducing …

Nitrous Oxide Vs. Ketamine: Impacts On Pediatric Emergency Department Length Of Stay, Tabitha Brock, Anna Suessman

North Texas GME Research Forum 2026

Background Nitrous oxide (N₂O) is a well-established analgesic and anxiolytic agent, widely used for procedural sedation in pediatric dentistry. Despite its demonstrated safety and efficacy, its use in Pediatric Emergency Departments (PEDs) remains limited and underexplored. To address this gap, we implemented a comprehensive training program for PED providers and introduced N₂O as an alternative sedation agent.

Objective We hypothesized that using N₂O for procedural sedation would significantly reduce patient length of stay (LOS) without compromising safety or outcomes.

Methods We conducted a retrospective chart review of pediatric patients who underwent painful procedures in a tertiary children’s hospital emergency department. …

Utilization Of Multimodal Therapy Including Ketamine And Methadone In Cancer-Related Pain: A Case Report, Austin Mccrea, Carol Elsakr, Tyler Kilgore

South Atlantic Division GME Research Days 2026

No abstract provided.

Objective Structured Clinical Examination (Osce) For Interscalene Brachial Plexus Block Utilizing Ultrasound Guidance And Landmark Technique, Madison Mize, Mckayla Moore, Peyton Shell

Doctoral Projects

The purpose of this doctoral project was to create learning and evaluation tools for interscalene brachial plexus blocks (ISBPB) to be used by certified registered nurse anesthetists (CRNAs) and students in the Nurse Anesthesia Program (NAP) at The University of Southern Mississippi (USM). ISBPB is a regional anesthesia technique used to provide anesthesia for procedures of the shoulder and upper arm. CRNAs and students can use these tools to refresh their current knowledge and enhance their regional anesthesia skills.

The objective structured clinical examination (OSCE) and cognitive aid for ISBPB utilizing landmark and ultrasound-guided techniques were evaluated by the USM …

Reply To Fernández Et Al. Comment On "Goudra Et Al. Anesthesia For Bronchoscopy-An Update, Basavana Goudra, Lalitha Sundararaman, Prarthna Chandar, Michael Green

Department of Medicine Faculty Papers

No abstract provided.

Low Unintended Dural Puncture Rate Using A Flush-Measure-Check-Advance Technique To Perform Combined Spinal-Epidural Anesthesia In Parturients: A Quality Improvement Clinical Series, James Riopelle, Julie Gayle, Zubaer Anwar, Jeff Burton

School of Medicine Faculty Publications

Background: Reported rates of unintended dural puncture during performance of continuous epidural anesthesia (CEA) or combined spinal-epidural anesthesia (CSEA) have remained steady at approximately 0.5% to 1% since the 1970s. Methods: A modified method of inserting the Tuohy epidural catheterization needle was used during performance of CSEA in 393 parturients. A single staff/faculty anesthesiologist performed or supervised resident use of a flush-measure-check-advance Tuohy needle insertion algorithm. Results: The rate of evident Tuohy needle dural puncture during the series was 0%. One parturient experienced a post-dural puncture headache possibly because of intentional subarachnoid puncture with a very small diameter (25 gauge) …

Enhancing Patient Outcomes: Developing A Comprehensive Database For Tracking Post- Dural Puncture Headache Incidence And Contributing Factors, Meredith B. Auge, Brittany Bogonovich

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Post-dural puncture headache (PDPH) is a debilitating complication following labor analgesia, often resulting from unintentional dural puncture (UDP). While national incidence is approximately 1.5%, institutional rates may vary due to provider experience, documentation practices, and patient factors. This Doctor of Nurse Anesthesia Practice (DNAP) quality improvement project aimed to improve identification and monitoring of UDP and PDPH through a revised tracking tool, retrospective review of 2024 data, and planning for an electronic registry. A multidisciplinary team of anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), Student Registered Nurse Anesthetists (SRNAs), and IT and quality specialists revised an existing tracking tool to better …

5x-Multiplier Vs 3-Tier Model For Discharge Opioid Prescriptions After Intra-Abdominal Cancer Surgery: Randomized Clinical Trial Protocol, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Wei Qiao, Jose A. Karam, Surena F. Matin, Larissa A. Meyer, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background

Surgeons provide up to 10% of total opioid prescriptions across all specialties, and more than one-third of surgeon-prescribed medications are opioids. Patient-reported opioid consumption and risk of persistent opioid use beyond the postoperative recovery period correlate with the initial opioid quantity prescribed at discharge. Interventions to reduce postoperative opioid prescribing have demonstrated no adverse effects on pain control or increased need for prescription refill; however, in the absence of standardized prescription protocols, opioid prescribing practices vary widely.

Objective

The study objective is to identify the opioid prescribing model that provides the lowest oral morphine equivalents (OME) volume prescribed at …

Temperature Monitoring In The Cardiac Operating Room, Abby Pint, Clint Humpherys, Dave Stubler, Nathaniel Lata

Research Days

Background: The goal of this project is to improve the accuracy of temperature readings in the cardiac operating room and, in turn, improve patient safety.

Methods: The project obtained nasopharyngeal, tympanic, and bladder/rectal temperature measurements from twenty CPB cases. Measurements were obtained at six critical points: time of incision, initiation of CPB, aortic cross clamping, removal of aortic cross clamping, CPB termination, sternal closure. Data was analyzed to determine discrepancies among methods of measuring temperature for each type of probe utilized. Plan: Tympanic probes are unreliable and provide lower temperature measurements when compared to other probes Do: Temperatures recorded from …

Persistent Improvement In Opioid Perceptions And Prescribing For Cancer Surgery: 5-Year Follow-Up, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Jessica E. Maxwell, Jose M. Soliz, Keyuri U. Popat, Christina L. Roland, Jean-Nicolas Vauthey, Matthew H. G. Katz, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background and Objectives

We previously reported that implementation of a department-wide opioid education program led to post-education improvements in opioid perceptions and prescription recommendations, with one-month and one-year retention. With ongoing programmatic and quality improvement efforts, we sought to re-evaluate the retention of these improvements five years after initial efforts.

Methods

Attending surgeons, clinical fellows, and advanced practice providers were surveyed five years after implementation of a comprehensive, departmental opioid reduction framework in August 2018. This framework initially consisted of dedicated opioid education sessions and retrospective assessment of prescribing practices, and subsequently expanded over time to include prospective quality improvement …

Early Celiac Plexus Block In Metastatic Pancreatic Cancer, Brian Fardman, Christina Sheedy, Joshua Raymond

Rowan-Virtua Research Day

Both Early and Delayed Celiac Plexus Blocks (CPBs) have been used in pancreatic cancer. Early CPB is completed when criteria for CPB is initially met, whereas Delayed CPB is implemented only after recalcitrant pain persists. We describe the benefit of early CPB in pancreatic cancer management.

Volatile Anesthetic Exposure During Organogenesis (Weeks 6-9): Implications For Fetal Brain Development, Cheryce Daniel, Kylon Coombs

Rowan-Virtua Research Day

Organogenesis, particularly during gestational weeks 6 through 9, represent a critical window for fetal brain development. During this period, neurogenesis, neural tube closure and synaptic organization are actively occurring. Disruption of these processes, especially from exogenous agents, can result in lasting developmental consequences.

The U.S Food and Drug Administration has issued warnings regarding the use of anesthetic agents such as isoflurane, sevoflurane, and desflurane. Noting the potential risk of neurotoxic effects on the developing brain. This warning is particularly highlighted when administered drugs are present for long periods of time or during repeated procedures. The goal of this literature review …

Pain Management In Pregnant Women With Opioid Use Disorder: A Systematic Review, Adeena Javed

Rowan-Virtua Research Day

Background: The prevalence of opioid use disorder (OUD) among pregnant individuals has risen significantly, posing challenges in managing labor and postpartum pain. Factors such as opioid tolerance, opioid-induced hyperalgesia, and concerns about relapse complicate analgesic strategies. Despite these complexities, evidence-based guidelines for pain management in this population remain limited.

Hypothesis: Pregnant women with OUD experience disparities in pain management during labor and postpartum periods, leading to suboptimal outcomes.

Methods: A systematic review was conducted, analyzing peer-reviewed studies from databases including PubMed and Embase. Inclusion criteria encompassed studies focusing on pain management in pregnant women with OUD. Data extraction focused on …

Carbon Footprint Of Inhaled Anesthetics – Do The Risks Outweigh The Benefits?, Liam Kerrick, Joseph Moschella

Rowan-Virtua Research Day

Global warming presents many challenges to the healthcare system. Not only does the increasing global temperature have detrimental health effects itself, but the healthcare sector is also a huge contributor to global warming. One big contributor to global warming is the use of inhaled anesthetics, which possess global warming potentials up to 2,000 times greater than carbon dioxide. Recent proposals, such as a prospective ban of desflurane in 2026 by the European Commission, demonstrate the need to reevaluate many of the common practices within anesthesiology. This review looks to investigate the environmental impact, cost, and clinical efficacy of various anesthetic …

Frequency Modulation Of Deep Brain Stimulation Targeting The Periaqueductal Gray: Effects On Pain Perception And Autonomic Regulation, Jack Hennen, Avneet Chawla, Jared Garfinkle, Wen Hao Luo

Rowan-Virtua Research Day

Introduction:

The periaqueductal gray (PAG) is a midbrain structure, and effective target for deep brain stimulation (DBS), involved in the modulation of a multitude of sensory and autonomic processes. It has distinct functional columnar organization, with each column playing its own role in alteration of the body’s ability to respond to pain and stressful stimuli.

Background:

Research regarding the effects of DBS on the PAG has shown the four main subregions of the PAG: the dorsomedial PAG (dmPAG), dorsolateral PAG (dlPAG), lateral PAG (lPAG), and ventrolateral PAG(vlPAG), produce various physiologic outputs when stimulated. These outputs are region and frequency dependent. …

Exploring The Effects Of Target Race, Gender, And Weight On Pain Perception, Catherine Awad, Theresa Miller, Azer Tuerxuntuoheti, Peter Mende-Siedlecki

Rowan-Virtua Research Day

Healthcare equity is an essential right, and while the quality of care is assumed to be uniform, notable disparities in care are associated with factors of race, gender, and weight-particularly in the domain of pain evaluation and care. In experimental work, target race and gender have varying, and interacting effects on visual thresholds for perceiving painful expressions. Racial bias in pain perception is well established as participants see pain on black faces less readily than pain on white faces; gender also impacts pain treatment, where women are susceptible to having their pain discredited. Across two experiments, the influence of weight …

Addressing Pain Management Practices And Potential Under-Medication Of Women During Iud Insertion Procedures, Malgorzata Zembrzuska

Rowan-Virtua Research Day

Intrauterine devices (IUDs) are among the most effective and safe contraceptive options available to women, yet their utilization often remains limited due in part to fear of pain, lack of adequate pain management during insertion, and absence of standardized clinical guidelines. This literature review explores current pain management strategies for IUD insertion and examines the potential under-medication of women during this procedure. Ten sources were reviewed, including randomized controlled trials, a clinical trial, linear regression analyses, and meta-analyses, with inclusion criteria focusing on pain interventions for IUD insertion in women over the past decade. Findings reveal that commonly used interventions—such …

Decreasing Extubation Times Using Adaptive Support Ventilation: A Scoping Review, Daphne Thomas, Cole Vest, Luke Wilson, Shannon Witcher, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background:This scoping review explores the effectiveness of adaptive support ventilation (ASV) compared to conventional ventilation modes in reducing postoperative extubation times in adults undergoing general anesthesia with ventilatory support. Ventilator weaning is a critical determinant of recovery and outcomes in intensive care settings. ASV, a closed-loop ventilation mode, automatically adjusts ventilator parameters based on patient-specific respiratory mechanics and demand to optimize the weaning process. Although promising, evidence regarding ASV’s effectiveness remains inconsistent across different patient populations and surgical contexts.

Methods: A systematic literature search was conducted from August 2023 to December 2024 across PubMed, CINAHL, Medline, JAMA, and Google …