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Regional Block Pioneers

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Duke Health News 919-660-1306

Greengrass and his colleagues since then have refined their
use of regional anesthesia to include more complex surgeries
and even more seriously ill patients, making Duke a leader in
regional anesthesia worldwide.

First described in the early 1900s, paravertebral block ‚
one of several forms of regional anesthesia ‚ is a technique
that offers up to 30 hours of pain relief with little
associated nausea. By contrast, breast surgery using
traditional general anesthesia has one of the highest rates of
postoperative nausea and vomiting compared to other types of
surgery.

Paravertebral block anesthesia eliminates pain to an area of
the body through a series of injections near the spine. The
injections numb the nerves that emerge from the spinal column
to the selected area of the body, without affecting overall
lung or heart functioning.

Three years ago, the department of anesthesiology began
developing a continuing medical education program for physician
anesthesiologists to learn more advanced regional anesthesia
techniques. Known as a "center of excellence" in the use of
regional anesthesia, the Duke program has captured the interest
of a variety of institutions, many from outside the United
States. The program promotes the use of several forms of
regional anesthesia as well as a new continuous peripheral
nerve block catheter system developed by the Duke team.

"Nationally, education in regional anesthesia has not
changed much in the last 30 years," says Dr. Susan Steele,
medical director of Duke's Ambulatory Surgery Center. "But
drugs and technology, as well as patient and physician demand
for regional anesthesia, have."

To help meet that demand, Greengrass, Steele and their
colleagues routinely bring international and national visitors
to the Ambulatory Surgery Center to observe and train in these
techniques to begin using them at their respective
institutions. In October, they welcomed visitors from
China.

"The purpose of our trip is to try to learn what goes on
here -- mainly focusing on the regional blockade," said Dr.
Yuguang Huang, professor of anesthesiology at Peking Union
Medical College Hospital in Beijing. "Although we have
performed regional blockade in China for a long time, we are
very impressed with this new technique. We would like to
introduce this method to the hospitals in China because we feel
it will help us get better results."

According to Huang, regional blocks have been used in China
since the 1950s and more than 80 percent of their hospitals use
older forms of the procedure.

The new peripheral nerve catheter system can offer
continuous pain relief for up to 72 hours. According to Steele,
this type of pain control allows a faster physical recovery,
allowing patients ‚ especially those undergoing breast surgery
-- to get down to the business of emotional recovery.

The Duke team began developing the catheter system in the
early 1990s to offer anesthesiologists a method of continuous
drug delivery. Coupled with a nerve stimulator, it offers more
precise control over the numbing drugs as they are injected
into a patient. By using a nerve stimulator, doctors can more
specifically target appropriate nerve areas within a patient's
body. Having more control over this aspect of drug delivery
means even smaller areas can be targeted for longer lasting
pain control, and less of the body will be effected by the
anesthetics. This means fewer side effects and better treatment
for patients.

"The Chinese were quite surprised to learn we even use
regional blocks, so they were amazed to see us doing them using
techniques they had never seen before," said Greengrass. "They
are extremely interested in what we are doing here at
Duke."

According to Steele, the Chinese doctors are accustomed to
using an older, subjective form of regional anesthesia that
Duke doctors used years ago. The anesthesia is delivered
through needles inserted toward the appropriate nerves. The
biggest problem, she says, is that doctors need a fully
cooperative patient who is able to tell them what they are
feeling.

"The newer technique offers so many benefits clinically,"
said Dr. Zhonghuang Xu, professor of anesthesiology at the
medical college in Beijing. "It is much more accurate, there
are fewer complications and at less expense to the patient, so
I really appreciate being able to learn the new technique."

Steele calls Greengrass's work some of the most brilliant
and humane she has ever seen.

"I think these types of exchanges are important," says
Greengrass. "We can show our visitors that there are no
boundaries to medicine, despite the trials and tribulations we
may share politically. We are building a nice rapport and I
foresee working collaboratively with them in the future.

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