V. Dimitriou

Ultrasound and regional anesthesia techniques--is there any limitation?

translational (bench-to-bedside) science with the potential for clinical use in 5 to 10 years. I certainly wish that more NIH funding was directed toward improving our ability to detect outcome differences based on anesthetic care plans. However, patient outcome differences (and the psychometric basis of detecting these differences) in our specialty may continue to lag behind in research priority in the grand scheme of public health, perhaps due to the relative underrepresentation of anesthesiologists on NIH study sections (a vicious cycle). Toward the end of my 5-year K23 award period, I submitted 3 “pre-R01” applications/revisions that were scored but did not ultimately meet the pay line. Suffice it to say that if such “pre-R01” applications (such as R03s, R21s, and R34s) do not make the pay line, neither would the R01s themselves. The applications addressed varying types of nerve block comparisons for varying types of orthopedic surgery, and proposed to further advance our psychometric basis of detecting outcome differences. I am now “starting over” in a sense, pursuing basic (i.e., bench) research training in a well experienced basic science pain laboratory (under the direction of G.F. Gebhart, Ph.D., who recently relocated to our university). My personal “path to research independence,” for the moment, is detouring in a direction that promises to be replete with translational opportunities for years to come, even though my original plan was to advance the psychometrics of outcomes research in our subspecialty. Future research trainees are encouraged to embrace the probability of a diverse portfolio of research mentors, and to be prepared to shift from one research interest to another (and from one mentor to another) as new, fundable topics of interest evolve. Both department chairs and clinical residency/fellowship directors should be sensitive to the extreme complexities (and required protected time) involved with research career development. There may be no remaining trees to provide us shade, if the rare seeds are not cultivated properly for the needed years.

Imaging in anesthesia: the role of 4 MHz to 7 MHz sector array ultrasound probe in the identification of the sciatic nerve at different anatomic locations.

o the Editor: Few studies have examined the use of ultrasound for ciatic nerve identification or blockade and thus the clincal utility of such is still being determined.1-4 Additionlly, linear probes are used to identify the sciatic nerve at he popliteal1 and the posterior part of the upper thigh,2 hile a curved probe (2 MHz-5 MHz) is used for the glueal, infragluteal,3 and upper anterior thigh approaches.4 ur experience has shown that a 4 MHz to 7 MHz sector rray probe can provide significant advantages in the dentification and blockade of the sciatic nerve at the opliteal fossa, the lateral thigh (upper and midfemoral evel) and the infragluteal region. Additionally, the sciatic erve can be clearly identified at the anterior thigh in ormally weighted individuals (Fig 1).

Ultrasound and transcutaneous neurostimulator combined technique as a training method for nerve identification in anesthesia residents.

To the Editor: We thank the editor for a chance to respond to the astute comments made by Drs. Michalek and Gabrhelik concerning our article.1 We have chosen the stellate ganglion as a target of our therapy because it is more comfortable to the patient, technically easy, and less time consuming. The optimal ganglion to be treated might vary, depending on the pain condition, and should be studied separately by comparing the treatment of different sites. The report published by Spacek et al.,2 which does not show a statistical relation between saline and buprenorphine when applied to the superior cervical ganglion, could be interpreted as a lack of any pathophysiologic role for this particular ganglion in trigeminal neuralgia. Knowing what results GLOA would have upon application to the gasserian ganglion, which is the more prominent culprit in trigeminal neuralgia, would be interesting. We have not tried this treatment on patients other than those reported in our article. However, we do plan to evaluate this treatment option in other painful conditions of the head and neck. As we clearly mentioned in our article, the placebo effect of GLOA cannot be completely ruled out. The true therapeutic effect of GLOA can be accurately evaluated only by conducting a well-designed double-blinded, placebo-controlled study at different ganglia.