AnesthesiaExam Podcast
David Rosenblum, MD, creator of AnesthesiaExam.com and ABAstagedExam.com discusses anesthesiology board prep and issues relevant to anesthesiologists.
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Post Operative Pain after Shoulder Replacement: Peri-operative Ablation?
04/17/2024
Post Operative Pain after Shoulder Replacement: Peri-operative Ablation?
Dr. Rosenblum describes a patient with chronic shoulder pain who failed shoulder replacement, steroid injections, nerve blocks, cryotherapy, and peripheral nerve stimulation of the axillary and suprascapular nerve block. In this podcast, he discusses his perfomance of Shoulder Radiofrequency Ablation targeting the articular branches of the suprascapular nerve, axillary nerve, nerve to subscapularis and lateral pectoral nerve. Reference: https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2020/11/01/how-i-do-it-shoulder-articular-nerve-blockade-and-radiofrequency-ablation Other Announcements from : PainExam App almost ready Pain Management Board Prep migrated to AnesthesiaExam Board Prep migrated to PMRExam Board Prep migrated to For Anesthesia Board Prep
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IRO's (Independent Review Organizations)- Physicians Lobby for Oversight and Transparency
04/03/2024
IRO's (Independent Review Organizations)- Physicians Lobby for Oversight and Transparency
Advocating for Transparency and Oversight in Pain Management Introduction: Welcome back to Painexam, where we delve into the latest advancements and challenges in pain management. Today's episode highlights a significant advocacy effort made by leading Interventional Pain Physicians and industry experts. Summary of Lobbying Effort: On March 20, 2024, a group of esteemed physicians and industry leaders, including Drs. Sean Li, Peter Staats, Mehul J. Desai, David Reece, Hemant Kalia, and David Rosenblum, alongside industry figures Mark Stultz, Christopher Conrad, and Cecelia Ruble, visited Capitol Hill to advocate for greater oversight and transparency in independent review organizations. Despite their busy schedules, they recognized the critical need to address the 0% turnover rate in appeals for denied treatments, which disproportionately affects patients seeking alternatives to surgery and opioid medication. Importance of Transparency: The issue extends beyond pain management, impacting patients across various medical fields. While opioid therapy may seem economically favorable initially, the long-term consequences, including delayed care and medication side effects, often outweigh the costs. The group emphasized the importance of an unbiased review for accessible, cutting-edge treatments to improve patient outcomes and reduce overall healthcare expenses. Purpose of the Lobbying Effort: Contrary to pushing any specific company agenda, the initiative aims to highlight the challenges patients and physicians encounter in securing optimal treatment outcomes. For Board Prep, Ultrasound Training and more, visit: Dr. David Rosenblum, a pioneer in interventional pain medicine, particularly in ultrasound- guided procedures and regenerative pain medicine, underscores the necessity of addressing these issues for the benefit of countless patients suffering from chronic pain. Conclusion and Actionable Steps: To schedule a consultation with Dr. Rosenblum, patients can visit or contact the Brooklyn Office at 718-436-7246 or the Garden City Office at 516-482-7246. Stay tuned for more updates on advancements and advocacy efforts in pain management. Outro: Thank you for joining us on this episode of Painexam. Be sure to subscribe for future discussions on navigating the complexities of pain management.
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Stellate Ganglion, Ketamine Infusions and Interventional Psychiatry
03/13/2024
Stellate Ganglion, Ketamine Infusions and Interventional Psychiatry
Dr. Rosenbum discusses Interventional Psychiatry, the role of Stellate Ganglion Blocks in PTSD, Ketamine Infusions for Depression, and the role of Magnesium as a co-factor in ketamine infusions. Other Announcements from : PainExam App almost ready Pain Management Board Prep migrated to AnesthesiaExam Board Prep migrated to PMRExam Board Prep migrated to Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep References References Górska N, Cubała WJ, Słupski J, Wiglusz MS, Gałuszko-Węgielnik M, Kawka M, Grzegorzewska A. Magnesium in Ketamine Administration in Treatment-Resistant Depression. Pharmaceuticals (Basel). 2021 May 3;14(5):430. doi: 10.3390/ph14050430. PMID: 34063604; PMCID: PMC8147622. Hanling SR, Hickey A, Lesnik I, et al Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder: A Randomized, Double-Blind, Controlled Trial Regional Anesthesia & Pain Medicine 2016;41:494-500. https://www.psychiatrist.com/jcp/oral-ketamine-for-depression/
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Stellate Ganglion Block and Hot Flashes- Rudy Malayil, MD of WVSIPP
02/28/2024
Stellate Ganglion Block and Hot Flashes- Rudy Malayil, MD of WVSIPP
Dr. Rosenblum interviews West Viriginia Society of Interventional Pain Physician's President Rudy Malayil, MD and discusses the upcoming WVSIPP meeting in April 2024 as well as Dr. Rosenblum's upcoming ultrasound course. Rudy Mathew Malayil, M.D., completed his internship in General Surgery at New York Presbyterian/Cornell Hospital in New York City, followed by residency training in Physical Medicine and Rehabilitation at New York University Medical School. Dr. Malayil further completed a Pain Medicine Fellowship at the Albert Einstein School of Medicine at the Beth Israel Medical Center Campus in New York City. After training he went settled in West Virginia and eventually became the president of West Virginia Society of Interventional Pain Physicians and started private practice Pain Management 360. Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep References https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1293358/full
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PENG, PNS, Cryoablation for Acute and Chronic Hip Pain
02/08/2024
PENG, PNS, Cryoablation for Acute and Chronic Hip Pain
In this episode, Garden City (long island) based Pain Physician, Dr. David Rosenblum explores Peripheral Nerve Stimulation, Biologics and Ablations for hip pain. He reviews a case report of a 67-year-old female with a history of a mechanical fall causing injury to her lumbar spine and pelvis resulting in hip and pelvic pain is presented. The patient had hypertrophic non-union of the right iliac wing fracture and displacement of the pubic symphysis and right sacroiliac joint. Medications were not effectively managing her pain, so she sought treatment at a pain management clinic. The patient underwent diagnostic obturator and femoral articular nerve branch injections, as well as a middle cluneal nerve steroid injection, all guided by fluoroscopy and ultrasound. She experienced improvement in her pain following these procedures. Subsequently, she had a peripheral nerve stimulator (PNS) trial and underwent implantation of leads targeting the right middle cluneal nerve and right obturator and femoral articular nerve branches. The patient reported significant relief in both the posterior and anterior distribution of her pain. Her activities of daily living improved, and she was able to sleep without pain after the PNS implantation. The successful use of combined fluoroscopy and ultrasound in targeting the specific nerves and replicating the patient's pain distribution before permanent PNS implantation is highlighted in this case. Additionally, the show notes mention an events calendar located at this link: . Upcoming Course schedule for NRAP Academy includes the following events: Ultrasound Guided Pain & Regional Anesthesia Course in New York City on February 10, 2024. This course will cover nerve blocks, joint injections, and more. Attendees will have the opportunity to scan live models after the didactic session. MSK Pain & Regional Anesthesia Course in Miami, Florida on February 18, 2024. This course will focus on ultrasound-guided nerve blocks and MSK (musculoskeletal) pain management. Ultrasound Guided Pain Course in Key West, Florida on February 23, 2024. This 4 CME (Continuing Medical Education) course will cover ultrasound-guided nerve blocks, MSK, PRP (platelet-rich plasma), BMAC (bone marrow aspirate concentrate) targets, and regional anesthesia. Regional Anesthesia and US Guided Pain Management Course in New York City on March 9, 2024. This course will provide training in ultrasound-guided interventional pain management and regional anesthesia. Ultrasound Guided IPM (Interventional Pain Management) Course in West Virginia on April 14, 2024. This course is part of the Appalachian Regional Spine and Pain Meeting and will be conducted by NRAP Academy. It will focus on interventional pain management using ultrasound guidance. Regenerative Pain Medicine Course in New York City on May 4, 2024. This course will cover PRP (platelet-rich plasma) and other regenerative pain medicine techniques. In addition to the live training, attendees will receive bonus material including access to the On Demand Ultrasound Guided MSK Interventional Pain Management Course, a course workbook and certificate, post-course guidance and discounts, and the opportunity to join the mailing list for calendar updates. Please note that these course details are subject to change, so it's recommended to visit the NRAP Academy website for the most up-to-date information. Reference Fu E, Elsharkawy H #35977 Peripheral nerve stimulation implant for chronic post-traumatic hip and pelvic pain Regional Anesthesia & Pain Medicine 2023;48:A193.
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Journal Club- Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves
01/24/2024
Journal Club- Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves
Painexam Podcast Show Notes: Journal Club on "Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves" Special Thanks to Robert Stall, MD Introduction: Welcome to another episode of the Painexam Podcast! In today's journal club edition, we delve into a fascinating study by Dr. Joel E. Pessa on cerebrospinal fluid (CSF) circulation in human nerves. Background: The study addresses the growing evidence of CSF circulation in human nerves and its implications in various conditions encountered by plastic surgeons. Conditions such as nerve transection, stretch injuries, and peripheral neuropathy may be related to dysregulation of the CSF system. Methods: Dr. Pessa and his team developed the ventricular infusion technique using buffered saline in 2017. The technique was applied to eight fresh cadavers before dissecting the median nerve. Fluorescent imaging and nanoprobe injections were combined with ventricular infusion in selected specimens. Results: The eight cadaver specimens (six female, two male) aged 46–97 underwent successful ventricular infusion. Ventricular cannulation was performed successfully using specific coordinates. Results suggest that CSF flows in neural sheaths, including pia meninges, epineurial channels, perineurium, and myelin sheaths (neurolemma). Conclusions: Ventricular infusion and nanoprobes effectively identify CSF flow in neural sheaths of human nerves. CSF flow in nerves is described as an open circulatory system occurring via channels, intracellular flow, and cell-to-cell transport associated with glial cells. Neural sheaths, including neurolemma, may play a role in glucose and solute transport to axons. The techniques showcased in this study can be utilized in anatomic dissection and live animal models and have been extended to the central nervous system to identify direct ventricle-to-pia meninges CSF pathways. Significance: This study opens new avenues for understanding the intricate mechanisms of CSF circulation in neural tissues. Plastic surgeons and researchers can benefit from these techniques in studying and addressing conditions related to CSF dysregulation in nerves. The findings have implications not only for nerve-related conditions but also for broader applications in the central nervous system. Closing: Thank you for joining us on this insightful journey through Dr. Joel E. Pessa's study. Stay tuned for more engaging discussions on pain management and neurology in future Painexam Podcast episodes! Reference Pessa JE. Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves. Plast Reconstr Surg Glob Open. 2022 Feb 17;10(2):e4126. doi: 10.1097/GOX.0000000000004126. PMID: 35198353; PMCID: PMC8856590.
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The Iliohypogastric Nerve: An Anatomical Review
11/27/2023
The Iliohypogastric Nerve: An Anatomical Review
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Peptitdes for Wellness
10/12/2023
Peptitdes for Wellness
Dr. Rosenblum reviews information he found regarding the various types of peptides that private practices are useing for healht and wellness. Upcoming Pain Management Conferences Upcoming Workshops and Events Saturday, October 28, 2023 8:00 AM Sunday, October 29, 2023 9:00 AM Saturday, November 11, 2023 8:00 AM Saturday, December 16, 2023 7:30 AM Saturday, January 6, 2024 7:30 AM For up to date Calendar, !
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Nerve Block Reimbursement, Genicular plus Pain Management Board Prep Webinar Oct 4
09/28/2023
Nerve Block Reimbursement, Genicular plus Pain Management Board Prep Webinar Oct 4
Dr. Rosenblum discusses his concerns over: RFA of the Genicular Nerves being a non reimbursed service when the patient already had them in the past with excellent relief. Plus a discussion on CMS policy toward Peripheral Nerve Block reimbursement limitations and documentation! Pain Management, Anesthesiology, PMR Board Review Upcoming Workshops and Events Saturday, October 28, 2023 8:00 AM Sunday, October 29, 2023 9:00 AM Saturday, November 11, 2023 8:00 AM Saturday, December 16, 2023 7:30 AM Saturday, January 6, 2024 7:30 AM For up to date Calendar, !
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Interview with Dr. Myrdalis Diaz-Ramirez, MD Physician Coach, Mastermind, Pain Management and more!
09/11/2023
Interview with Dr. Myrdalis Diaz-Ramirez, MD Physician Coach, Mastermind, Pain Management and more!
Drawing from her own experience of transformation from being a burnout physician to regaining, designing, and retaining control of her physician life, Dr. Myrdalis Diaz-Ramirez created the maxAllure Mastermind. It is now her passion to help physicians who feel overwhelmed and lost in medicine to find a new path and control their lives through entrepreneurship. She is a born and self-made entrepreneur with experience in owning different clinics which she successfully sold in the past. She has also owned other businesses, including an entertainment company. Dr. Myrdalis Díaz-Ramírez is a dual Board-Certified Anesthesiologist and Interventional Pain Management Physician. She is also a Medical Expert, Professor, Author, Speaker, Podcaster, Entrepreneur, and Mastermind Facilitator. Through her Mastermind, physicians can transform their personal and professional lives. They have been able to define, plan, and execute a designed vision for their life and business that was once only a dream! Upcoming Workshops and Events Wednesday, September 20, 2023 8:00 PM Saturday, October 28, 2023 8:00 AM Sunday, October 29, 2023 9:00 AM Saturday, November 11, 2023 8:00 AM Saturday, December 16, 2023 7:30 AM Saturday, January 6, 2024 7:30 AM
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Superior Gluteal and Clueneal Nerve Stimulation
08/24/2023
Superior Gluteal and Clueneal Nerve Stimulation
Dr. Rosenblum discusses posterior hip pain/buttock pain near scar after Total Hip Arthroplasty. Included in this episode: Patient Testimonial re: SPRINT PNS (superior gluteal and superior cluneal nerve) Superior Gluteal Nerve Anatomy Hip Innervation Upcoming Private and Group Ultrasound Training Upcoming Pain Management Conferences Course Calendar 2023 2024 For up to date Calendar, ! Board Review References Pierre Laumonerie and others, Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature, Pain Medicine, Volume 22, Issue 5, May 2021, Pages 1149–1157, Pinho, A.R.; Leite, M.J.; Lixa, J.; Silva, M.R.; Vieira, P.; Nery-Monterroso, J.; Bezerra, M.C.; Alves, H.; Madeira, M.D.; Pereira, P.A. Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region. Diagnostics 2023, 13, 2314. Lung K, Lui F. Anatomy, Abdomen and Pelvis: Superior Gluteal Nerve. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535408/
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The Cervical Plexus
08/12/2023
The Cervical Plexus
Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management and , discusses: a case of paresthesia in the upper neck realted to C3 and C4 stenosis and considers a selective nerve root block while wondering if a deep cervical plexus block would suffice. Rational : Desire to avoid epidural due to proximity to spinal cord Ultrasound approach of cervial plexus may anesthetize C3 and C4 roots and may be sufficient to do with ultrasound alone Unfortunately, no data found to support this particular situation, however, it may be safe and effective if performed properly. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/lubWXJ Also discussed on this podcast: The Superficial Cervical Plexus and applications for headache, neck pain, and clavicular fractures. Caution: Phrenic Nerve Anatomy The cervical plexus is a complex network of nerves located in the neck region, originating from the anterior rami (branches) of the cervical spinal nerves, specifically those stemming from the upper cervical segments (C1 to C4). This intricate network serves to provide sensory and motor innervation to various structures within the neck and surrounding areas. The cervical plexus is positioned within a groove between the longus capitis and the middle scalene muscles in the neck. It is organized into different nerve loops and branches that radiate outwards to supply various regions. The cervical plexus can be divided into deep and superficial components, each with distinct functions and innervation patterns. Cervical Plexus: The plexus involves nerve loops and branches that provide both sensory and motor functions. The superficial sensory branches originating from adjacent anterior spinal nerves (C2 to C4) are responsible for providing sensation to specific areas of the skin, particularly in the head, neck, and shoulder regions. These sensory branches include the lesser occipital nerve (C2, C3), great auricular nerve (C2, C3), transverse cervical nerve (C2, C3), and supraclavicular nerves (C3, C4). These nerves typically run posteriorly and then penetrate the prevertebral fascia before reaching the skin and superficial structures. For Pain Management and Anesethesiology Board Review, go to For the Virtual Pain Fellowship Experience, Go to: Subscribe to Receive Free Content, Discounts and Course Updates! * indicates required Email Address * Ultrasound Workshops and Courses For up to date Calendar, ! Refereces Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol. 2018 Aug;71(4):274-288. doi: 10.4097/kja.d.18.00143. Epub 2018 Jul 4. PMID: 29969890; PMCID: PMC6078883.
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ISPN: International Society of Pain and Neuroscience Conference Chair: Reda Tolba, MD
08/03/2023
ISPN: International Society of Pain and Neuroscience Conference Chair: Reda Tolba, MD
ISPN Dubai 2023 David Rosenblum, MD interviews Reda Tolba, MD on the PainExam Podcast In this episode, we delve into the realm of Pain Management in the US and the Middle East. Our international pain experts discuss the upcoming ISPN (International Society for Pain and Neuroscience) meeting in Dubai this december. Subscribe to the PainExam Newsletter to Receive Free Content, Discounts and Course Updates! Email Address * Dr. Reda Tolba, MD, chairs the Pain Management Department at Cleveland Clinic Abu Dhabi. He's internationally recognized for his contributions to Pain Medicine, boasting a wealth of experience from institutions like Wake Forest University Medical Center and Ochsner Health System. Dr. David Rosenblum, MD, is the Director of Pain Management at Maimonides Medical Center and a driving force behind pain education platforms like PainExam.com and NRAP Academy. He's a pioneer in ultrasound-guided pain procedures, having trained thousands of physicians online and in person. Tune in to hear Dr. Tolba's journey to being named Chair of Pain at Cleveland Clinic, Abu Dhabi, and his impressive academic and clinical achievements.Dr. Rosenblum, on the other hand, is known through his contributions to safe pain management protocols, and his mission to spread knowledge through podcasts and educational events. Patients, interested he's scheduling an appointment with Dr. Rosenblum at his Long Island or Brooklyn Locations can go to or call 718 436 7246 or 516 482 7246 To learn more about their work and educational initiatives, explore NRAPpain.org and PainExam.com/events. Join us in this episode to uncover insights from these leading figures in Pain Management. For up to date Calendar, !
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Investing and Passive Income for Physicians
07/11/2023
Investing and Passive Income for Physicians
On this episode, Dr. Rosenblum has a chat with Premier Heritage's Greg Alerte. Greg has over 15 years of experience helping families and small business to achieve their financial goals. As co-owner and Certified Financial Planner at Premier Heritage, he focuses on helping people to preserve and grow their wealth, and to leave a legacy for future generations to build on. Greg’s research and professional opinions, have been quoted in several financial publications, including Wall Street Journal, NerdWallet, Financial Planning magazine, and the Huffington Post. Greg’s favorite quote is by the late Mia Angelou “when you learn teach, when you get give” For more information, Email: Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management and , discusses: Attend and NRAP Course! For up to date Calendar, !
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Phenol Neurolysis Explained
06/21/2023
Phenol Neurolysis Explained
Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management and , discusses: Genicular Nerve Ablation with Phenol The history of phenol The mechanism of action Indications Complications Clinical concerns when considering neurolysis with phenol The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: Ultrasound Workshops and Courss For up to date Calendar, ! References D'Souza RS, Warner NS. Phenol Nerve Block. [Updated 2023 Jan 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. CR e tal.Chemical Ablation of Genicular Nerve with Phenol for Pain Relief in Patients with Knee Osteoarthritis: A Prospective Study. April 2021Pages 438-444
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Ketamine Infusion for Neuropathic Pain
06/14/2023
Ketamine Infusion for Neuropathic Pain
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/ATmqM6 Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, and , discusses Ketamine infusions, optimal infusion protocols and the evidence or lack of to support them. Ketamine infusions have been used for chronic neuropathic pain, CRPS and depression. Dr. Rosenblum is accepting new patients and consultations could be scheduled by visiting or calling 718 436 7246 or 516 482 7246. Pain Management Board Prep Anesthesiology Board Prep For up to date Calendar, ! References Maher, Dermot P MD, MS; Chen, Lucy MD; Mao, Jianren MD, PhD. Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization. Anesthesia & Analgesia 124(2):p 661-674, February 2017. | DOI: 10.1213/ANE.0000000000001787
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Anesthesia and Maternal Physiology During Pregnancy
06/08/2023
Anesthesia and Maternal Physiology During Pregnancy
In this episode of the AnesthesiaExam podcast, New York Anesthesiologist, delves into the topic of maternal physiological changes during pregnancy and the associated concerns for anesthesia providers. The episode emphasizes the importance of understanding these changes to ensure safe and effective anesthesia management for pregnant patients. Dr. Rosenblum discusses the significant physiological changes that occur during pregnancy, particularly in the cardiovascular, respiratory, and hormonal systems. These changes impact drug distribution, elimination, ventilation, and the risk of aspiration. Throughout the discussion, the host and guest highlight the need for anesthesia providers to stay updated on the latest evidence-based practices and guidelines for managing pregnant patients. They stress the importance of appropriate dosing, ventilation strategies, and addressing the increased risk of aspiration to maintain the well-being of both the mother and the fetus. To further support Anesthesiologists and CRNAs in their board exam preparation, we are offering the NRAP board review course. The course is designed to provide comprehensive coverage of anesthesia with lectures, videos and question bank to ensure candidates are well-prepared for their exams. Listeners are encouraged to visit to access more information and register for the course. The NRAP Academy is offering the exciting opportunity for anesthesia professionals interested in regional anesthesia ultrasound to train at one of our live ultrasound CME workshops. Dr. Rosenblum mentions regional anesthesia ultrasound courses in NY, the US and abroad. These courses offer valuable hands-on training and insights into the latest techniques. Our course calendar is listed here: For more information and to register for the regional anesthesia ultrasound courses, ! Reference
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Blocks for Head, Neck, and Spinal Surgeries
06/04/2023
Blocks for Head, Neck, and Spinal Surgeries
Neurosurgery and Regional Anesthesia Claim CME Credit: The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: In this episode, we will explore the various regional anesthesia techniques used in neurosurgery, specifically focusing on blocks for head, neck, and spinal surgeries. Segment 1: Blocks used in Head and Neck Surgeries Scalp Block: The scalp block involves blocking six nerves that provide sensory innervation to the scalp. It is performed by subcutaneous infiltration of local anesthetics (such as bupivacaine, ropivacaine, or levobupivacaine) for each nerve. Ultrasound guidance has improved the precision of block administration. The main indication for a scalp block is awake craniotomy, but it is also used in other procedures like deep brain stimulation and cranioplasty surgery. Scalp block offers advantages such as accurate neurological evaluation, pre-emptive analgesia, and hemodynamic stability during surgery. It also reduces postoperative pain, the need for rescue analgesics, and pain scores in the early postoperative period. Infraorbital Block (IOB): The infraorbital nerve block targets the infraorbital nerve, which supplies the skin and mucous membrane of the upper lip, lower eyelid, and cheek. The IOB can be performed using the classical landmark technique or ultrasound guidance. Ultrasound guidance provides real-time visualization and accurate needle placement. IOB combined with general anesthesia is beneficial for postoperative pain relief in procedures like endoscopic trans-nasal trans-sphenoidal (TNTS) approach for pituitary tumor excision. Other regional techniques like sphenopalatine ganglion block and maxillary nerve blocks have also been attempted for transsphenoidal surgeries. Trigeminal Nerve Block: Trigeminal nerve block is used for patients unresponsive to medical management of trigeminal neuralgia. Traditionally performed using the paresthesia technique, ultrasound guidance allows real-time visualization and confirmation of local anesthetic spread. Ultrasound guidance helps locate the Gasserian ganglion and visualize the trigeminal ganglion, providing a safe and radiation-free procedure for pain relief. Segment 2: Blocks used for Spinal Surgeries Cervical Plexus Block (CPB): CPB is commonly used in carotid endarterectomy (CEA) and cervical spine surgery. Different levels of CPB can be performed depending on the depth of injection. Superficial CPB involves injecting local anesthetic superficially into the deep cervical fascia. Deep CPB requires depositing local anesthetic deep to the prevertebral fascia. CPB helps in monitoring cerebral blood flow during CEA and provides postoperative pain relief. Ultrasound guidance can be used for superficial CPB, ensuring accurate needle placement and local anesthetic spread. Erector Spinae Block (ESB): ESB is used for pain control in spinal surgeries. It involves depositing local anesthetic in the plane between the erector spinae muscle and the transverse process. ESB provides effective postoperative analgesia and reduces opioid consumption. Regional anesthesia techniques play a crucial role in neurosurgery, providing effective pain relief and improving patient outcomes. Blocks like scalp block, infraorbital block, trigeminal nerve block, cervical plexus block, and erector spinae block offer numerous advantages in specific procedures. Ultrasound guidance has enhanced the precision and safety of block administration. These techniques contribute to improved surgical outcomes and patient satisfaction in neurosurgical procedures. Upcoming Courses and Workshops! Course Calendar Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain! For up to date Calendar, ! References Kaushal A, Haldar R. Regional Anesthesia in Neuroanesthesia Practice. Discoveries (Craiova). 2020 Jun 29;8(2):e111. doi: 10.15190/d.2020.8. PMID: 32637571; PMCID: PMC7332314.
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Pediatric Anesthesia Considerations in the Orthopedic Patient
05/17/2023
Pediatric Anesthesia Considerations in the Orthopedic Patient
Introduction: Providing anesthesia for pediatric orthopedic patients poses unique challenges for anesthesiologists. The approach must consider the psychological development of the child and the prevalence of respiratory infections. Pain management, management of concomitant diseases, and risk reduction for adverse events are crucial aspects of anesthetic care. This blog post will review the perioperative concerns specific to pediatric orthopedic procedures, discuss pain control methods used, and highlight anesthetic considerations for certain surgeries. Listen to Audio via a Advanced Board Review Course or stay updated via our newsletter below Select Pediatric Perioperative Concerns: Upper Respiratory Tract Infections (URI): Pediatric patients presenting for orthopedic surgery with current or recent URIs pose a challenge for anesthesiologists and surgeons. Children commonly experience URIs with symptoms like a runny nose, cough, and fever. While the viral infection may reside in the nasopharynx, the lower respiratory tract remains sensitive for up to 6 weeks after URI symptoms have resolved. This increased sensitivity puts patients at risk for perioperative complications like laryngospasm, bronchospasm, and oxygen desaturation. Delaying surgery for 6 weeks after URI resolution is often impractical, as another URI is likely to occur. For elective surgery, severe symptoms and complications warrant postponing surgery, but clear nasal discharge in an otherwise healthy patient may proceed with elective surgery. Clinical decision-making becomes challenging for cases falling between these extremes. Factors such as patient age, comorbidities, prior cancellations, surgery complexity, and urgency are considered when deciding whether to postpone surgery. If elective surgery is delayed, most clinicians would wait 2 to 4 weeks after URI symptom resolution. Anxiety in the Pediatric Patient: Pediatric patients undergoing orthopedic surgery often experience varying levels of anxiety and distress. Preoperative stressors can include unfamiliar environments, procedures, hunger, fear of pain, and separation from parents. Certain risk factors contribute to preoperative anxiety, such as ages 1 to 5 years, shy temperament, prior negative medical experiences, high cognitive levels, and parental anxiety. Unaddressed anxiety can lead to postoperative behavioral changes, including generalized anxiety, separation anxiety, aggression, and nighttime crying. It can also result in higher pain scores and increased pain medication requirements after surgery. Strategies to mitigate preoperative anxiety include presurgical preparation programs involving site visits, videos, books, and child-life interventions. Allowing parental presence during anesthesia induction can help alleviate separation anxiety. Pharmacologic interventions like oral midazolam can improve compliance and reduce negative behavioral changes in the short term. Anesthetic Management for Orthopedic Procedures: Anesthetic Considerations for Select Pediatric Orthopedic Surgeries: Scoliosis Surgery: Anesthetic concerns during scoliosis surgery include optimizing neuromonitoring signals, managing blood loss, preventing positioning-related injuries, and minimizing the risk of postoperative visual loss. Pain Management: Pain control for pediatric orthopedic patients involves a multimodal pharmacologic approach to minimize opioid requirements. This approach includes non-opioid analgesics, local anesthetics, and regional anesthesia techniques. Regional anesthesia, such as peripheral nerve blocks and caudal anesthesia, is particularly valuable for postoperative pain control. Recent studies have confirmed the safety of regional anesthesia in the pediatric population. Pediatric orthopedic surgeries present unique challenges for anesthesiologists. Effective management of preoperative anxiety, careful consideration of upper respiratory tract infections, and appropriate pain control strategies are essential for successful outcomes. Anesthesiologists must tailor their approach to the specific needs of pediatric patients undergoing orthopedic procedures to ensure their safety and well-being. Reference Wu JP. Pediatric Anesthesia Concerns and Management for Orthopedic Procedures. Pediatr Clin North Am. 2020 Feb;67(1):71-84. doi: 10.1016/j.pcl.2019.09.006. PMID: 31779838; PMCID: PMC7172179. Anesthesiology Board Review Newsletter Subscribe for Discounts, Free Videos, Course Calendar & More! * indicates required Email Address * Ultrasound Block Course applicable in Pediatric Anesthesia for Orthopedic Procedures includes: Certificate of Completion Ultrasound Guided Interventional Pain Atlas Continuing Medical Education Credit Online access to Webinar (additional CME Credit) Regional Anesthesia: Genicular Nerve Block Upper Extremity Anesthesia for Fractures and Reductions Erector Spinae Block PENG Nerve Block IPACK Nerve Block and much more! Caudal Epidural and Spine demonstrations available as well. Or Email to arrange a private workshop with your Department. Subscribe for Discounts, Free Videos, Course Calendar & More! * indicates required Email Address *
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The End of the Public Health Emergency. How Does this Affect your Practice?
04/27/2023
The End of the Public Health Emergency. How Does this Affect your Practice?
Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain! Join digital health leader and Upside Health CEO Rachel Trobman and PainExam.com founder Dr. David Rosenblum in a conversation about the impact of the end of the public health emergency in May could have on your pain management practice. We'll specifically discuss the changes to telehealth and remote patient monitoring. The webinar will close with one of Upside Health's clients outlining the launch and successes of RTM in their practice and be available for Q&A. Course Calendar For up to date Calendar, ! For Board Prep go to www.AnesthesiaExam.com For more questions Email Rachel Trobman at [email protected]
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Ultrasound Guided Cervical Disc PRP Injections
04/12/2023
Ultrasound Guided Cervical Disc PRP Injections
Regenerative Medicine Journal Club Dr. Rosenblum reviews a . The author mentions use of ultrasound to avoid the Internal jugular vein, carotid artery, phrenic nerve, esophagus and neural structures. The author mentions mixing lidocaine with PRP and Dr. Rosenblum comments on his experience and knowledge of the technique. Dr. Rosenblum mentions the risk of disci tis. Course Calendar Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain! Register to our For up to date Calendar, ! Claim CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: References et al. Journal of Pain Research Published online: 16 Nov 2022
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The MOTION Study: Minimally Invasive Lumbar Decompression
03/29/2023
The MOTION Study: Minimally Invasive Lumbar Decompression
The MOTION Study: Minimally Invasive Lumbar Decompression CME Credit The CE experience for this Podcast is powered by CMEfy - to reflect and earn credits: Journal Club. Minimally Invasive Lumbar Decompression (mild® Procedure) with Conventional Medical Management vs. Conventional Medical Management Alone. Descripton of Procedure, Safety, Technique, study outcome, personal experience with this minimally invasive technique that interventional pain physicians are using to treat neurogenic claudication related to ligamentum flavum hypertrophy. Dr. Rosenblum discusses spinal stenosis pathophysiology and neurogenic claudication. Dr. Rosenblum also mentions upcoming courses and webinars: Upcoming Courses and Workshops! Course Calendar Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain! For up to date Calendar, ! References Timothy R Deer, MD, Shrif J Costandi, MD, Edward Washabaugh, MD, Timothy B Chafin, MD, Sayed E Wahezi, MD, Navdeep Jassal, MD, Dawood Sayed, MD, The MOTION Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild® Procedure: One-Year Results, Pain Medicine, Volume 23, Issue 4, April 2022, Pages 625–634,
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PRP and the Nerve
03/21/2023
PRP and the Nerve
Biologics and the Peripheral Nerve. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/TgB18M Dr. Rosenblum discuss his upcoming talk at the : Incorporating Ultrasound into a Spine and Pain Practice on April 14-16 2023 and the topics he plans to include: Ultrasound Guided Knee therapies, cluneal nerve, caudal, brachial plexus and more! Today’s podcast focuses on the risk and benefits of performing PRP injection onto a nerve. Dr. Rosenblum discusses: Possible fibrosis of the ulna nerve after using PRP for partial ulnar collateral ligament tears Best Time for PRP Injection after Nerve Regeneration Alpha 2-macroglobulin (what is it?) PRP for moderate to severe carpal tunnel syndrome Featured Courses! May 25, 2023 Private Pain Group Ultrasound Course- NYC (Sold out) see the full schedule for our July and August US IPM Courses! References Robert G. Thompson, Kendall Bradley, Gary M. Lourie, Ulnar nerve dysfunction at the elbow after platelet-rich plasma treatment for partial ulnar collateral ligament injuries,JSES Reviews, Reports, and Techniques,Volume 1, Issue 1,2021,Pages 41-44,ISSN 2666-6391, Si-Ru Chen, Yu-Ping Shen, Tsung-Yen Ho, Tsung-Ying Li, Yu-Chi Su, Yu-Ching Chou, Liang-Cheng Chen, Yung-Tsan Wu,One-Year Efficacy of Platelet-Rich Plasma for Moderate-to-Severe Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial,Archives of Physical Medicine and RehabilitationVolume 102, Issue 5,2021, Pages 951-958,ISSN 0003-9993,https://doi.org/10.1016/j.apmr.2020.12.025. Rehman, A.A., Ahsan, H. and Khan, F.H. (2013), Alpha-2-macroglobulin: A physiological guardian. J. Cell. Physiol., 228: 1665-1675. Muhammad Pandunugrahadi, Komang Agung Irianto, Oen Sindrawati, "The Optimal Timing of Platelet-Rich Plasma (PRP) Injection for Nerve Lesion Recovery: A Preliminary Study", International Journal of Biomaterials, vol. 2022, Article ID 9601547, 7 pages, 2022.
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Comparing BMAC with PRP (Leukocyte Rich vs Poor) for Knee Pain
03/11/2023
Comparing BMAC with PRP (Leukocyte Rich vs Poor) for Knee Pain
Knee Osteoarthritis and Regenerative Pain Medicine Claim CME The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: Dr. Rosenblum reviews the latest evidence comparing Bone Marrow Aspirate and Platelet Rich Plasma for knee pain. He also reviews the latest publication by Di Martino et al’s study which compared Leukocyte-rich PRP vs. Leukocyte-poor PRP in the treatment of knee osteoarthritis. Upcoming Courses References El-Kadiry, A.EH., Lumbao, C., Salame, N. et al. Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study. BMC Musculoskelet Disord 23, 23 (2022). Hede, Kris, et al. "Combined bone marrow aspirate and platelet-rich plasma for cartilage repair: two-year clinical results." Cartilage 13.1_suppl (2021): 937S-947S. Anz AW, Plummer HA, Cohen A, Everts PA, Andrews JR, Hackel JG. Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):618-629. doi: Di Martino A, Boffa A, Andriolo L, et al. Leukocyte-Rich versus Leukocyte-Poor Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):609-617. doi:
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Carpal Tunnel Syndrome
02/25/2023
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: Diagnosis, Pathophysiology, Clinical Findings and Management of the Carpal Tunnel Syndrome In this episode, we will be discussing Carpal Tunnel Syndrome, a common condition that affects millions of people worldwide. But before we dive into the topic, we want to tell you about a great opportunity to advance your medical knowledge through the NRAP Academy CME courses offered on our website. Discussion on Carpal Tunnel Syndrome: Carpal Tunnel Syndrome is a condition that occurs when the median nerve, which runs from the forearm to the hand, becomes compressed or squeezed at the wrist. This compression can lead to pain, numbness, and tingling in the hand and arm, which can be debilitating. There are many causes of Carpal Tunnel Syndrome, including repetitive hand movements, wrist injuries, pregnancy, and medical conditions such as diabetes and thyroid disorders. Treatment options for Carpal Tunnel Syndrome range from non-invasive approaches like rest, ice, and wrist splints to more invasive treatments like surgery. It's important to diagnose and treat Carpal Tunnel Syndrome early to prevent long-term damage to the median nerve. A proper diagnosis can be made through a physical exam and imaging tests like an electromyography (EMG) or nerve conduction study (NCS). Don't forget to check out the NRAP Academy CME courses offered on our website, page, to continue your medical education and enhance your patient care. NRAP Academy Events Hands on Training for medical professional looking to enhance your knowledge and skills in pain management? Offering courses are designed to help you stay up-to-date with the latest advances in pain management and to help you improve patient outcomes. Visit our website, page, to learn more about the courses available and to sign up today. References Sevy JO, Varacallo M. Carpal Tunnel Syndrome. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: Sevy JO, Varacallo M. Carpal Tunnel Syndrome. 2022 Sep 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28846321.
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Post Herpetic Neuralgia: Interventions and Evidence
01/31/2023
Post Herpetic Neuralgia: Interventions and Evidence
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/tn70Yk Dr. Rosenblum discuss a challenging case and reviews the pathology, treatment and evidence for interventional pain in the the treatment of Post Herpetic Neuralgia. Discussed in this podcast: Intrathecal injection of methylprednisolone Dorsal Root Ganglion Paraveterbral Nerve Block Stellate Ganglion Block Spinal Cord Stimulation Botulinum Toxin Injection And more! Course Calendar References Lin, Chia-Shiang, et al. "Interventional treatments for postherpetic neuralgia: a systematic review." Pain physician22.3 (2019): 209. https://www.painphysicianjournal.com/current/pdf?article=NjMwMg%3D%3D&journal=120
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Ultrasound Guided Spine and Interventions- Cluneal Nerve, Stellate Ganglion, Facet, Caudal and more!
01/10/2023
Ultrasound Guided Spine and Interventions- Cluneal Nerve, Stellate Ganglion, Facet, Caudal and more!
David Rosenblum, MD, creator of PainExam.com, , PMRExam.com, NRAP Academy and International Pain Academy Co-Founder presents an excerpt from Grand Rounds Given on January 2, 2023 to the Metropolitan Hospital Physical Medicine and Rehabilitation Department. Reflect on Ultrasound Guided Interventional Spine Procedures and Agenda: Ultrasound Guided Cluneal Nerve Blocks Ultrasound Guided Stellate Ganglion Block Ultrasound Guided Facet Joint Injection Ultrasound Guided Medial Branch Blocjks Ultrasound Guided Sacroiliac Joint Inejction Ultrasound Guided Caudal Epidural Injections Dr. Rosenblum offers live regional anesthesia, regenerative medicine, board review and interventional pain management CME courses in NY and around the world. For more information, go to www.NRAPpain.org or PainExam.com/events Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Great Neck Office 516 482 7246 Upcoming Courses and Workshops! For up to date Calendar, !
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Updates to the 2023 Physician Fee Schedule + New Chronic Pain Management Codes
12/21/2022
Updates to the 2023 Physician Fee Schedule + New Chronic Pain Management Codes
Rachel Trobman, CEO of Upside Health and David Rosenblum, MD discuss updates to the 2023 Physician Fee Schedule + New Chronic Pain Management Codes, Remote Patient Monitoring and more! This Podcast is not worth any CME Credit, but Credit can be Claimed for reflecting on content: The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/9AX9LN Upcoming Courses and Workshops! For up to date Calendar, !
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CDC Opiate Prescribing Guidelines- An update by Larry Kobak Esq.
12/15/2022
CDC Opiate Prescribing Guidelines- An update by Larry Kobak Esq.
Larry Kobak, Esq. on CDC Guidelines: What You Need to Know! PendingDec 14, 2022 What you need to know: The Updated CDC Clinical Practice Guideline for Prescribing Opioids for Pain Monday, November 21 at 6:00 pm EDT NYSPS Legal Briefs New 2022 CDC Guidelines on OPIOID USE FOR TREATMENT OF PAIN The CE experience for this Webinar is powered by CMEfy - click here to reflect and earn credits: The Guidelines state very clearly: “Nonopioid therapies are preferred for subacute and chronic pain.” If you are using opioids for subacute or chronic pain, which including both terms, means treating pain for 1 month or more, your chart must contain some justification for the use of opioids. This is an extremely important matter. Appropriate reasons, such as a prior treater, attempted various nonopioid treatments of some kind that failed. There must be a very good reason why opioids were tried. It must be documented. Larry Kobak, Esq. Senior Counsel Frier Levitt ATTORNEYS AT LAW 101 Greenwich Street, Suite 8B New York, NY 10006
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Failure of the Intrathecal Drug Delivery System: Pain and Anesthesia Board Review
11/30/2022
Failure of the Intrathecal Drug Delivery System: Pain and Anesthesia Board Review
Journal Club where David Rosenblum, MD reviews the possible complications related to an intrathecal pump. Discussed in this podcast: Intrathecal pump malfunction, disconnect, granuloma, infection, MRI compatibility, related malfunctions, and evaluation of pump failure. Claim CME Credit This CME credit is not for listening to the podcast. No credit is offered for the podcast itself, but reflect on information learned and claim credit. The CE experience for this Podcast is powered by CMEfy - to reflect and earn credits: https://earnc.me/QzrQ19 Upcoming Workshops For up to date Calendar, ! For Anesthesia Board Review, go to Reference
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