Division of Regional Anesthesiology and Acute Pain Medicine

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Assistant Professor of Anesthesiology
Director, Program in Regional Anesthesiology and Acute Pain Medicine
Department of Anesthesiology, University of Maryland Medical Center
22 South Greene Street
Baltimore, Maryland, 21201
Telephone: 410-328-6120
Fax: 410-329-3138

The Program in Regional Anesthesiology and Acute Pain Medicine at the University of Maryland School of Medicine features a multidisciplinary group of anesthesiologists who provide advanced regional anesthetic approaches to a wide range of patients at the University of Maryland Medical Center and the R Adams Cowley Shock Trauma Center. Working with a variety of surgical and medical services, the faculty and trainees perform over 2,000 regional anesthetic blocks and over 500 acute pain medicine consults each year to urgent and elective surgical and trauma patients, cancer patients or those with challenging pain management issues.

At the forefront of the Program is the clinical care provided by our service, titled: Maryland’s Acute Pain and Regional Anesthesia Service (MAPRAS). Staffed with faculty, fellows, residents, and specialized nurses, the team utilizes a comprehensive multi-modal analgesic approach that incorporates various medicinal and interventional techniques to help patients achieve better pain relief. Coordinated efforts and algorithms have been developed between MAPRAS and many of the surgical services including oncology, thoracic, transplant, cardiac, orthopedics, and trauma surgery to provide patients with state-of-the-art innovative procedures and proven protocols. Hospital-wide initiatives led by the Program ensure early identification of patient candidates and every effort is made to customize the best pain management plan for each individual to yield better hospital experiences and faster recoveries according to Enhanced Recovery After Surgery (ERAS) pathways. MAPRAS is fortunate to be able to work with skilled and experienced acute pain nurses within the University and advanced practicing pain nurses at the trauma center to further optimize care plans.

Our faculty consists of six physicians who all have specialized training in regional anesthesiology and acute pain medicine. Typical blocks include single injection and continuous catheter nerve and plexus blocks for extremity surgeries and injuries as well as epidural and spinal blocks for various insults to the chest, abdomen, or pelvis. More recently, we offer newer techniques such as ultrasound-guided paravertebral blocks, pectoralis and serratus plane blocks, transversus abdominis plane and rectus sheath blocks and have been called to assist with head and facial blocks for neurosurgical procedures. Incorporation of slow release long acting local anesthetics can at times extend patients comfort for prolonged periods. Other components of care might include intravenous patient-controlled analgesia (PCA), oral analgesics and co-analgesics. The most advanced equipment is always used to ensure excellence, accuracy, and the greatest safety in our procedures. Perhaps the division’s most unique contribution to patient care is the comfort level in safely placing regional blocks in adult patients who are heavily sedated or under general anesthesia – techniques that many other centers are still hesitant to perform. Patients and surgeons alike are reporting positive results with regional anesthesia techniques and customized acute pain medicine pathways and are more frequently requesting these services for future procedures.

Research

MAPRAS physicians are interested in expanding the knowledge and practice of Regional Anesthesiology and Acute Pain Medicine. With diverse academic interests, our faculty has collaborated with other physicians and researchers both within and outside the greater University of Maryland system. Currently we have multiple ongoing research projects exploring the use of extended release local anesthetics, the efficacy of continuous peripheral nerve blockade in patients undergoing complex elbow surgery, the impact of patient positioning on lower extremity sonoanatomy, and the use of Artificial intelligence to aid the performance of regional blocks. Our faculty members have authored numerous scholarly journal articles, book chapters, case reports, and have published books. We strongly encourage our residents and fellows to participate in the Program’s academic pursuits.

Education

Education is a key component of the Program. In 2012 the Program initiated a Regional Anesthesiology Fellowship at the University of Maryland, based both at UMROI and UMMC. In 2016, we have revised the fellowship to a comprehensive Regional Anesthesiology and Acute Pain Medicine fellowship. In addition to training our fellow we educate medical students, anesthesia residents, and other subspecialty anesthesiology fellows. Our educational curriculum is multi-faceted with dedicated hands-on training, simulation, lectures, and self-study. We have joined a consortium of world-class institutions that provide peer-reviewed expert-generated educational content via “the Anesthesia toolbox,” and have purchased a SonoSim system, a new task trainer for ultrasound-guided diagnostics and procedures. We conduct neuraxial and peripheral nerve block workshops, cadaver dissections and provide bedside teaching during clinical procedures that instill confidence in residents and fellows to function independently in any regional anesthesia practice post-training. Our Program is privileged to partner with UMROI at the annual Regional Anesthesia and Acute Pain Medicine Conference led by University of Maryland faculty in conjunction with the Henry M Jackson Foundation for the Advancement of Military Physicians. Finally, with special expertise in peripheral nerve blocks in trauma patients, ultrasound-guided techniques, and caring for many of Maryland’s sickest patients, the faculty are often invited to lecture and train others nationally and internationally in the rapidly emerging field of Regional Anesthesiology and Acute Pain Medicine.

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Faculty

2016-2017 Fellows

  • Tiffani Pittman, MD