Career Development: The applicant's primary interest is in designing perioperative anesthetic techniques to improve postoperative surgical outcomes, thereby making unique contributions to the dynamic study of anesthesia, pain management, and rehabilitation outcomes research. The ultimate objective of this K-23 Career Development Award is to prepare the applicant for a career as an independent investigator, designing and implementing hypothesis driven clinical investigations to evaluate the clinical, functional, and cost benefits of these anesthetic interventions. This will be accomplished with didactic coursework, participation in seminars, research focus groups, scientific conferences, and focused tutorials by experienced practitioners in multiple relevant, diverse fields of study. Because interdisciplinary collaboration is required to advance the field of postoperative outcomes research, the applicant will assemble an integrated, multidisciplinary team of highly-trained researchers and clinicians dedicated to this goal. Finally, implementing a clinical investigation using acquired didactic knowledge and close mentor supervision will allow integration and application of these educational components. Clinical Investigation: Following knee and hip replacement, ambulation is often limited by joint pain, greatly decreasing functional mobility, rehabilitation quality, and possibly the ultimate functional outcome. """"""""Perineural infusion"""""""" is a relatively new analgesic technique that involves the percutaneous insertion of a catheter directly adjacent to the peripheral nerves that supply the affected joint. Local anesthetic is then infused via the catheter to provide potent, site-specific analgesia free of significant side effects. The ultimate objective of the proposed research is to determine if perineural local anesthetic infusion in the immediate postoperative period has both short- and long-term benefits following knee and hip replacement surgery for osteoarthritis. The research plan consists of two (knee or hip replacement) randomized, double-blind, placebo-controlled, parallel-arm clinical investigations. Patients will randomly receive either perineural local anesthetic or normal saline for 4 days following surgery. Primary outcomes include functional mobility (ambulatory distance) and the time until specific, predefined readiness-fordischarge criteria are met following surgery. Secondary outcomes include the relationship between analgesic technique administered in the immediate postoperative period and subsequent pain, stiffness and functional disability.

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23GM077026-05
Application #
7483780
Study Section
National Center for Research Resources Initial Review Group (RIRG)
Program Officer
Cole, Alison E
Project Start
2005-08-01
Project End
2010-07-31
Budget Start
2008-08-01
Budget End
2009-07-31
Support Year
5
Fiscal Year
2008
Total Cost
$123,390
Indirect Cost
Name
University of California San Diego
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Finn, Daphna M; Ilfeld, Brian M; Unkart, Jonathan T et al. (2017) Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation. J Anesth 31:374-379
Monahan, Amanda M; Madison, Sarah J; Loland, Vanessa J et al. (2016) Continuous Popliteal Sciatic Blocks: Does Varying Perineural Catheter Location Relative to the Sciatic Bifurcation Influence Block Effects? A Dual-Center, Randomized, Subject-Masked, Controlled Clinical Trial. Anesth Analg 122:1689-95
Finn, Daphna M; Agarwal, Rishi R; Ilfeld, Brian M et al. (2016) Fall Risk Associated with Continuous Peripheral Nerve Blocks Following Knee and Hip Arthroplasty. Medsurg Nurs 25:25-30, 49
Ilfeld, Brian M; Madison, Sarah J; Suresh, Preetham J et al. (2015) Persistent postmastectomy pain and pain-related physical and emotional functioning with and without a continuous paravertebral nerve block: a prospective 1-year follow-up assessment of a randomized, triple-masked, placebo-controlled study. Ann Surg Oncol 22:2017-25
Agarwal, Rishi R; Wallace, Anne M; Madison, Sarah J et al. (2015) Single-injection thoracic paravertebral block and postoperative analgesia after mastectomy: a retrospective cohort study. J Clin Anesth 27:371-4
Heil, Justin W; Nakanote, Ken A; Madison, Sarah J et al. (2014) Continuous transversus abdominis plane (TAP) blocks for postoperative pain control after hernia surgery: a randomized, triple-masked, placebo-controlled study. Pain Med 15:1957-64
Ilfeld, Brian M; Madison, Sarah J; Suresh, Preetham J et al. (2014) Treatment of postmastectomy pain with ambulatory continuous paravertebral nerve blocks: a randomized, triple-masked, placebo-controlled study. Reg Anesth Pain Med 39:89-96
Madison, Sarah J; Humsi, Julie; Loland, Vanessa J et al. (2013) Ultrasound-guided root/trunk (interscalene) block for hand and forearm anesthesia. Reg Anesth Pain Med 38:226-32
Malhotra, Nisha; Madison, Sarah J; Ward, Samuel R et al. (2013) Continuous interscalene nerve block following adhesive capsulitis manipulation. Reg Anesth Pain Med 38:171-2
Ilfeld, Brian M; Moeller-Bertram, Tobias; Hanling, Steven R et al. (2013) Treating intractable phantom limb pain with ambulatory continuous peripheral nerve blocks: a pilot study. Pain Med 14:935-42

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