Trends are evolving in decreasing intraoperative and postoperative opioid use. Therefore, anesthesiologists are constantly learning new regional techniques to help with postoperative pain. For shoulder surgeries, I’ve moved away from interscalene blocks toward supraclavicular blocks. I think the interscalene block provides a better block of a total shoulder surgery, however, certain patient comorbidities often make the supraclavicular block a better choice.
Conclusions: The anterior suprascapular block, but not the supraclavicular, provides noninferior analgesia compared to the interscalene approach for major arthroscopic shoulder surgery. Pulmonary function is best preserved with the anterior suprascapular nerve block.
I chose not to include biased studies where sick patients were not compared as well as morbidity and mortality.
As an anesthesiologist, I work in an MD-only anesthesia group. This is by choice: I prefer doing my own cases and being responsible for my own liabilities. The times I have required an anesthetic, I have requested a physician anesthesiologist. As a resident, I had very good insurance coverage, so I wanted a physician for my surgery. At that time, I was ok with having a resident anesthesiologist paired with an attending anesthesiologist for my case. My second surgery was done at my current hospital, and we only have MD anesthesiologists. Perhaps I’m biased? I know and I understand the path/journey/training it takes to get to become a physician anesthesiologist. I want someone who is well-trained, independently thinks, vigilant, and knowledgeable.
I’m sure there are great CRNAs out there… but when I was a resident… we used to supervise CRNAs in our final training year…. and it was scary some of things they would do. Who extubates from a trach R&R on 30% FiO2? Yeah, that particular CRNA told me they had 30 years experience. 30 years experience of doing something wrong doesn’t equate to 30 years of knowledgeable experience. And let’s not forget that CRNAs need a 15 minute morning break, 30 minute lunch break, and 15 minute afternoon break and they go home when their “shift” ends (even if it’s in the middle of a complex case). I take a break when I can… I eat lunch and take a bathroom break when I can…. and I choose to stay and finish complex cases for better continuity of care.
Would you want a nurse practitioner or physician assistant solely performing your surgery without a surgeon? I know I would NOT. I think there’s plenty of room for teamwork in healthcare. This is how to improve hospital efficiency and patient care. My fear is if CRNAs gain independence for purely financial reasons. But then, they will have to carry their own liability, cover their own breaks, take night call and discover that they had it so good in a healthcare team.
Physicians endure years of grueling medical education that starts with the why, how, and treatment of disease. This is followed with years of residency training specifically in anesthesia. There’s also further training in the form of a fellowship for specialized fields.
Getting into medical school is an extremely competitive process. You take the top 1% of college graduates and high MCAT scores to get into medical school. The board certification for becoming certified in anesthesiology is quite complex and difficult in both the written and oral board exams.
I will continue to be FOR team-based physician-led anesthesia care.
I think in residency it was a tad easier to deal with the insane work hours bc all my friends were in the same boat. We all suffered together and had minimal free time. But now in the real world, where a lot of my friends are non-medical or have better work hours… I see a huge discrepancy in free time available. It’s taking a toll on me bc I want that free time too and I find myself overwhelmed with being a “Yes” person and ignoring “me”. Lately, it’s catching up and I need a disconnect.
But apparently, according to this recent report, I’m not working that hard. Maybe hospital administrators should know that OR efficiency (or lack thereof) is the bottleneck. Perhaps parallel incentives where productivity-based pay instead of salaries would provide a bit of motivation.