Anesthesia clinicians’ perspectives on peripheral nerve blocks for hip fractures in older adults

BMC Anesthesiology · 2026-02-18

Peripheral nerve blocks (PNBs) have emerged as a promising pain management strategy for older adults undergoing hip fracture surgery. This study aimed to identify factors influencing PNB use and assess opinions on their effectiveness and implementation among physician anesthesiologists, certified registered nurse anesthetists (CRNAs), and certified anesthesiologist assistants (CAAs). A cross-sectional study surveyed physician anesthesiologists, CRNAs, and CAAs caring for adults aged 50 years and older with hip fractures from May 2024 to July 2024. The 22-item questionnaire explored demographics, PNB practices, perceived advantages, disadvantages, barriers to use, and interest in future research. A total of 185 surveys were returned: 94.5% from physician anesthesiologists, 4.9% from CRNAs, and 0.5% from a CAA. While 86% of respondents perceived PNBs as beneficial, 14% reported they were unsure or opposed the use of PNB for older adults undergoing surgical fixation of hip fractures. The reported primary perceived advantages of using PNB in older adults with hip fractures included reduced pain and decreased opioid use within 72 h postoperatively. The reported primary difficulties in using PNB included surgical delays and institutional culture against PNB use. Most respondents (86%) supported further research on PNB outcomes to assess if benefits beyond acute pain exist. The majority of anesthesia clinicians surveyed perceived PNBs as potentially beneficial for pain management in hip fracture patients. However, numerous reported barriers to PNB use were identified. Given the convenience sampling approach, these findings should be considered hypothesis-generating and further research on PNB's association with patient-centered outcomes and implementation strategies may help address these obstacles.

Do Pediatrician Interpersonal and Personality Characteristics Affect Patient Experience?

Academic Pediatrics · 2022 · 5 citations

• Psychology
• Clinical psychology
• Medicine

Perfectionism as a predictor of physician burnout

BMC Health Services Research · 2022 · 50 citations

• Medicine
• Clinical psychology
• Psychology

BACKGROUND: Burnout is common among physicians and has detrimental effects on patient care and physician health. Recent editorials call attention to perfectionism in medicine; however, no studies to date have examined the effect of perfectionism on burnout in physicians practicing in the United States. This study examined associations among demographics, perfectionism and personality traits, and burnout among practicing physicians. METHODS: = 44.16 ± 9.98; 61% female). Emotional exhaustion, depersonalization, and personal accomplishment burnout were assessed via the Maslach Burnout Inventory. Validated instruments were used to measure personality and perfectionism. Data were analyzed using linear regression models. RESULTS: Across physicians assessed, 42% reported either high emotional exhaustion burnout or depersonalization burnout. High self-critical perfectionism uniquely predicted both high emotional exhaustion burnout (B = 0.55, 95%CI 0.25-0.85) and depersonalization burnout (B = 0.18, 95%CI 0.05-0.31). Low conscientiousness (B = -6.12; 95%CI, -10.95- -1.28) predicted higher emotional exhaustion burnout and low agreeableness (B = -3.20, 95%CI -5.93- -0.46) predicted higher depersonalization burnout. CONCLUSIONS: Perfectionism is understudied among physicians and the current findings suggest that addressing system and individual-level factors that encourage perfectionism is warranted and may reduce risk for physician burnout.

Perfectionism as a Predictor of Physician Burnout

Research Square · 2022-03-28

Abstract Background: Burnout is common among physicians and has detrimental effects on patient care and physician health. Recent editorials call attention to maladaptive perfectionism in medicine and the potential role of perfectionism in physician burnout; however, no studies to date have examined the effect of perfectionism on burnout in physicians practicing in the United States. This study examined the unique effects of demographics, perfectionism and personality traits on burnout among physicians. Methods: This was a cross-sectional study and included 69 attending physicians. Emotional exhaustion, depersonalization, and personal accomplishment burnout were assessed via the Maslach Burnout Inventory. Validated instruments were used to measure personality and perfectionism. Data were analyzed using linear regression models. Results: Across physicians assessed, 42% reported either high emotional exhaustion burnout or depersonalization burnout. High self-critical perfectionism uniquely predicted both high emotional exhaustion burnout ( B =0.55, 95%CI 0.25-0.85) and depersonalization burnout ( B = 0.18, 95%CI 0.05-0.31). Low conscientiousness ( B = -6.12; 95%CI, -10.95- -1.28) predicted higher emotional exhaustion burnout and low agreeableness ( B = -3.20, 95%CI -5.93- -0.46) predicted higher depersonalization burnout. Conclusions: Perfectionism is understudied among physicians and the current findings suggest that addressing system and individual-level factors that encourage maladaptive perfectionism is warranted and may reduce risk for physician burnout.

Perfectionism as a Predictor of Physician Burnout

Research Square · 2022-02-28 · 1 citations

Abstract Burnout is common among physicians and has detrimental effects on patient care and physician health. Recent editorials call attention to maladaptive perfectionism in medicine and the potential role of perfectionism in physician burnout; however, no studies to date have examined the effect of perfectionism on burnout in physicians practicing in the United States. This study examined the unique effects of demographics, perfectionism and personality traits on burnout among physicians. This was a cross-sectional study and included 69 attending physicians. Emotional exhaustion, depersonalization, and personal accomplishment burnout were assessed via the Maslach Burnout Inventory. Validated instruments were used to measure personality and perfectionism. Data were analyzed using linear regression models. Across physicians assessed, 42% reported either high emotional exhaustion burnout or depersonalization burnout. High self-critical perfectionism uniquely predicted both high emotional exhaustion burnout ( B = 0.55, 95%CI 0.25–0.85) and depersonalization burnout ( B = 0.18, 95%CI 0.05–0.31). Low conscientiousness ( B = -6.12; 95%CI, -10.95- -1.28) predicted higher emotional exhaustion burnout and low agreeableness ( B = -3.20, 95%CI -5.93- -0.46) predicted higher depersonalization burnout. Perfectionism is understudied among physicians and the current findings suggest that addressing system and individual-level factors that encourage maladaptive perfectionism is warranted and may reduce risk for physician burnout.

Milestone Learning Trajectories of Residents at Five Anesthesiology Residency Programs

Teaching and Learning in Medicine · 2020 · 26 citations

• Medical education
• Medicine
• Family medicine

Anesthesia residents' Milestone Level growth trajectories as reported to the ACGME vary significantly across individual residents as well as by program. The present study offers a case example that raises concerns regarding the validity of the Next Accreditation System as it is currently used by some residency programs.

[Figure, Transverse abdominis plane. Image courtesy O.Chaigasame]

2019-12-03

Transversus Abdominis Plane Block

StatPearls · 2019-12-03

A rise in opioid-related adverse effects and death has led to a surge in utilizing alternative methods to treat pain. The increasing adoption of ultrasound-guided regional anesthesia for acute pain management parallels the rapid rise in the availability of ultrasound machines. The abdominal wall is a common source of pain after surgical interventions involving the abdomen. Utilizing ultrasound, transversus abdominis plane (TAP) blocks can provide reliable relief of somatic incisional pain. TAP blocks are a great adjunct to a multimodal analgesic regimen. However, the lack of reliable visceral pain relief with TAP blocks may necessitate additional modes of analgesia. The TAP is a potential anatomical space that lies between transversus abdominis and internal oblique muscles, where local anesthetic can be deposited, creating a non-dermatomal “field block.”

Perioperative Management of the Surgical Patient on Suboxone (Buprenorphine and Naloxone)

2017-01-13

Over the past two decades, the incidence of legal and illegal drug abuse and dependency has increased at alarming levels, resulting in a rise in the number of associated deaths. Multiple resources are available to manage addiction, including the use of buprenorphine with or without naloxone. Consequently, more and more patients are requiring this treatment and are presenting for elective and emergent surgery where treatment of acute postoperative pain in the setting of buprenorphine use becomes challenging due to its unique properties. Buprenorphine has unique properties in which it binds to the opioid (mu) receptor with a higher affinity than other opioids. Buprenorphine is bound for a long period of time (32 hours), but its opioid effects have a ceiling. Since the receptors are occupied, when illegal or prescribed opioids are abused, they cannot activate the occupied receptors, and, in parallel, the effects that lead to addiction, tolerance, and craving are limited. However, in the surgical setting, increased opioid use may be appropriately needed to manage pain, which is hindered and limited by buprenorphine. Using current studies and strategies, we propose an algorithm to effectively manage buprenorphine in the perioperative setting.

Effects of Modification of Pain Protocol on Incidence of Post Operative Nausea and Vomiting

The Open Orthopaedics Journal · 2016-10-31 · 5 citations

Background: A Perioperative Surgical Home (PSH) care model applies a standardized multidisciplinary approach to patient care using evidence-based medicine to modify and improve protocols. Analysis of patient outcome measures, such as postoperative nausea and vomiting (PONV), allows for refinement of existing protocols to improve patient care. We aim to compare the incidence of PONV in patients who underwent primary total joint arthroplasty before and after modification of our PSH pain protocol. Methods: All total joint replacement PSH (TJR-PSH) patients who underwent primary THA (n=149) or TKA (n=212) in the study period were included. The modified protocol added a single dose of intravenous (IV) ketorolac given in the operating room and oxycodone immediate release orally instead of IV Hydromorphone in the Post Anesthesia Care Unit (PACU). The outcomes were (1) incidence of PONV and (2) average pain score in the PACU. We also examined the effect of primary anesthetic (spinal vs . GA) on these outcomes. The groups were compared using chi-square tests of proportions. Results: The incidence of post-operative nausea in the PACU decreased significantly with the modified protocol (27.4% vs . 38.1%, p=0.0442). There was no difference in PONV based on choice of anesthetic or procedure. Average PACU pain scores did not differ significantly between the two protocols. Conclusion: Simple modifications to TJR-PSH multimodal pain management protocol, with decrease in IV narcotic use, resulted in a lower incidence of postoperative nausea, without compromising average PACU pain scores. This report demonstrates the need for continuous monitoring of PSH pathways and implementation of revisions as needed.