Carol A. Hirshman, M.D., Editor.

21st Annual Meeting of the American Society of Regional Anesthesia. San Diego, California, March 28–31, 1996.

Three factors have led to the growth and success of the American Society of Regional Anesthesia (ASRA) annual meeting, now the third largest meeting of anesthesiologists in the United States. First is the balance of emphasis on the four traditional areas of regional anesthesia: obstetrics, acute pain, chronic pain, and surgery, which leads to lively discussions from people with different points of view and expertise. Second is the international atmosphere of the meeting, with sizable groups from three continents outside of North America, leading to a diversity of views. Foreign speakers presented review lectures and workshops, and official reports from the European Society of Regional Anesthesia (ESRA) and the Latin American Society of Regional Anesthesia (LASRA) were presented. Third is the mixture of tradition (honorary and memorial lectureships, clinical review lectures) and innovation (debates, highlights of novel drugs and techniques), which meets the interests of the occasional user and expert in regional anesthesia alike.

One can divide the 3 1/2-day meeting into 4 components: research, review, discussion, and awards. Original research was highlighted in two portions of the program. First was the presentation of nearly 100 poster abstracts, published as a supplement to Regional Anesthesia. In addition to a general poster session, there were 8 poster-discussion sessions, each covering 6–7 abstracts during a 2-h period and led by an expert for informal discussion with the author. These were well attended, and the format allowed for a good exchange among participants. Themes covered were obstetrics, lower extremity anesthesia, upper extremity anesthesia, acute postoperative pain, spinal anesthesia, chronic pain, animal models for pain research, and spinal neostigmine. Examples of the breadth of topics of original research covered were a demonstration of the safety of spinal anesthesia after failed epidural analgesia in the parturient (Lowes RJ, University of Pennsylvania), reduction in epidural bupivacaine dose when clonidine is added in parturients (Parkins J, Newcastle-Upon-Tyne, England), documentation of the existence of a continuous perineural sheath enveloping the popliteal nerve and communicating with the tibial and common peroneal nerves (Vloka J, Columbia University), demonstration of fewer patient side effects when intravenous patient-controlled analgesia is managed in postoperative patients by a dedicated acute pain service rather than the primary service (Stacey BR, University of Pittsburgh), and description of a higher success rate with axillary block than supraclavicular or interscalene approaches for surgery about the elbow (Schroeder LE, Mayo Clinic). Also, Hogan et al. (Medical College of Wisconsin) showed that epidural anesthesia in rabbits eliminated the compensatory pressor response to baroreceptor activation and converted the normal pressor response during hypoxia to a depressor response, Merry (University of Auckland, New Zealand) used a meta-analysis to demonstrate efficacy of epidural steroid injection for sciatica and back pain, Burkle (University of California, San Diego) showed that intrathecal remifentanil injection in rats reduced pain behavior and spinal glutamate release from formalin injection in the paw, and Lauretti (University of Sao Paulo, Brazil) demonstrated 6 h of complete analgesia after intrathecal injection of 25 micro gram fentanyl with 25 micro gram neostigmine in women after an abdominal hysterectomy.

The ASRA supports research by two mechanisms: Carl Koller awards (up to $25,000) and the Braun/ASRA research fellowships (up to $40,000). Randall Carpenter, Chairman of the ASRA Research Committee and Editor-in-Chief of Regional Anesthesia, moderated a session in which the 1995 awardees presented their work: GR Strichartz (Brigham and Women's Hospital), O de Leon-Casasola (University of Buffalo), TJ Brennan (University of Iowa) and DE Coyle (University of Cincinnati). Topics ranged from spinal pharmacology of a new model of postoperative pain in rats to a multifaceted investigation on the mechanisms of neurotoxicity from lidocaine. The ASRA Research Committee selected two awardees each for the Carl Koller Award and Braun/ASRA fellowship for 1996.

Review topics were covered in lecture and workshop format. Among the 33 lectures presented in the refresher course and panel sessions were reviews of basic mechanisms of visceral (Gebhart G, University of Iowa) and neuropathic pain (Yaksh T, University of California, San Diego), outcomes based research in pain treatment (Brose WG, Stanford University) and the use of opioids in chronic benign pain (Rowlingson JC, University of Virginia). Patrick Narchi (LeMans, France) reviewed brachial plexus block and presented in a lecture and workshops, for the first time to an American audience, a new approach to brachial plexus block that has become popular in France. A panel session addressed how to provide obstetric anesthesia in a small practice, new developments in postoperative analgesia, current pediatric pain management, cancer pain treatment, continuous regional anesthesia, and treatment of chronic, benign pain. More than 110 workshops, each limited to 20 participants, allowed hands-on experience and review of techniques that ranged from pain-directed neurologic examination (Allen R, University of California, San Francisco) to thoracic paravertebral blockade (Lema M, University of Buffalo).

Interaction and discussion were the purpose of point-counterpoint debates and cracker barrel sessions. Brief, formal debates by experts, followed by audience discussion, were presented on the technique of seeking paresthesias for regional anesthesia, the primary role of the nurse versus the physician in acute postoperative pain treatment, whether routine use of the combined spinal-epidural technique was indicated in obstetrics, whether epidural steroid injections should be used, whether anesthesiologists should treat changes in fetal heart rate, and whether ropivacaine should replace bupivacaine. Moderators kept the highly opinionated experts to less than 15 min for formal presentations and successfully highlighted true controversies and the reasons that controversy exists on these topics. Cracker barrel sessions, scheduled for 2 h in the late afternoon, were less formal affairs, with beer, wine, soda, and appetizers. Topics covered included treatment of chronic pain, resident education (the old days versus the new days), and dealing with health-care alliances.

Manbir Batra, President of the ASRA, presided over distribution of awards and presentation of memorial lectures. John A. DeKrey, who spent many years practicing and teaching regional anesthesia in the Navy, received the Society's Distinguished Service Award. Terency Murphy (University of Washington) presented the ASRA lecture, “Painful Histories, Mysteries, and Reflex Dystrophies,” Michael J. Cousins (Sydney, Australia) presented the Labat lecture, and Robert A. Boas (University of Auckland, New Zealand) presented the Bonica lecture, “Sympathetic Blocks: In Search of a Role.” In a separate ceremony, Bruce Scott (University of Edinburgh, Scotland) received the Nils Lofgren Award.

The meeting was dedicated to Gerald W. Ostheimer, who died in 1995. Dr. Ostheimer had worn many hats, but most of his work fostered the development of regional anesthesia and the ASRA. A special Distinguished Service Award was presented to his wife. Her eloquent acceptance speech, emphasizing the family that this society has become to many people, and the importance of giving through participation in the organ donation program, crystallized the best of the society and will remain, for many, the true highlight of the meeting.

James C. Eisenach, MD; Department of Anesthesia, The Bowman Gray School of Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina 27157–1009.