This issue brings the anesthesiologist up to date on current essential topics in regional analgesia and acute pain management, including the latest state-of-the-art techniques and drugs. Subjects covered include prevention and treatment of local anesthetic systemic and neurotoxicity; complications of RA and pain management (medicolegal issues including anticoagulation, infection, etc.); assessment and treatment of post block neurologic injury (history, physical, investigations, EMG, NCS); new ultrasound guided techniques for peripheral nerve blocks and evidence based outcome review; emerging techniques and drugs for neuraxial and paravertebral blocks; local infiltration analgesia (for a variety of surgical procedures, wound infusions, infusion devices); continuous PNB in hospital and at home; recent advances in multimodal analgesia (new drugs & strategies, such as capsaisin, long acting opioid and local anesthetics); challenges in acute pain management (including the opioid tolerant patient, patients with comorbidities such as MS, DM and renal failure); economics and practice management issues associated with acute pain management; pediatric pain management; new concepts of acute pain management (including strategies to prevent chronic pain, opioid induced hyperalgesia, and more).

This issue of Anesthesiology Clinics, edited by Dr. Nabil Elkassabany and Dr. Edward Mariano, focuses on Regional Anesthesia, with topics including: Current evidence related to regional analgesia and hip surgery; Updates on billing and coding and establishing an acute pain service in private practice; Establishing a home catheter program for orthopedic surgery in pediatric patients or more broadly: updates on regional anesthesia for pediatric orthopedic surgery; Enhanced recovery after shoulder arthroplasty; Perioperative management of patient on opioid agonist antagonist therapy; Outcome metrics to be considered for regional anesthesia and acute pain medicine; Updates on multimodal analgesia (intransal ketorolac, IV acetmenophen, newer NSAIDS) for orthopedic surgery; Updates in enhanced recovery pathway for knee replacement versus updates outpatient knee replacement; Updates on new technology for regional anesthesia (peripheral nerve stimulators and cryotherapy); and Regional anesthesia and analgesia for the poly trauma patients.

This issue will cover novel approaches to demonstrating value by anesthesiologists. Articles will include Value from the Patient and Payer Perspectives, Perioperative Surgical Home, Demonstrating Value: A British perspective, Demonstrating value: A case study of enhanced recovery, Acute Pain Management/Regional, Measuring Outcomes as Demonstrating Value and many more!

Local-regional anesthesia and pain therapy represent two areas of common interest for all physicians. A thorough preparation in functional anatomy and general pharmacology, including familiarity with local anesthetics and analgesics, is considered fundamental background for further study or clinical application of such techniques. Knowledge of the mechanisms of action, efficacies and side effects of the relevant drugs is essential, as is appreciation of possible drug interactions to evaluate eventual toxic effects. Local-regional anesthesia and pain management are being increasing used in diverse medical specialties, including those requiring manual dexterity. In contemporary medicine correct evaluation of the medical outcome becomes essential, especially in relation to the cost-benefit balance, not only in terms of the resources consumed, also and more importantly for the quality of life of the patient.

This issue of Anesthesiology Clinics focuses on Pain Management.Topics will include: The Pain Treatment Imperative: Developments in the 21st Century, Imaging Pain, The Opioid Conundrum, Advancing the Pain Agenda in the Veteran Population ,Interventional Treatments of Cancer Pain, Integrating Pain Care into the Peri-Operative Surgical Home, Pain Care in the ED, Sleep and Pain, Can Chronic Pain be Prevented?, The Use of Outcome Data to Improve Patient Outcomes, and Impact of State-based Pain Legislation on Patient Outcomes.

Millions of procedures, surgical and non-surgical, are performed around the world each year. Management of perioperative pain is of great importance to patients, and a critical management issue for physicians and other health professionals who provide perioperative care. Healthcare facilities and national accrediting organizations have established standards surrounding proper management of perioperative pain. There is now an increased burden on every hospital and training program to ensure that healthcare providers understand the essentials of pain management and are able to recognize and treat pain in a timely fashion. Poorly controlled pain leads to patient dissatisfaction and contributes to increased morbidity and mortality, such as myocardial infarction, pneumonia, and emotional effects. Proper management, including appropriate pharmacologic management and regional analgesic techniques, can improve function and shorten length of hospital stay. Patients who are undergoing procedures under sedation or anesthesia need to receive adequate pain relief with drugs or regional anesthetic techniques. In the recovery room following the procedure, the staff taking care of the patient needs to be properly trained to diagnose and treat post-procedural pain. Part of the Oxford American Pain Library, this concise, evidence-based clinical guide serves as a tool for every clinician who wishes to understand the basic mechanisms, pharmacology, invasive and noninvasive treatment modalities, guidelines and development of pain management protocols. The authors address new technologies, chronic pain issues, running an acute pain service, opioid and non-opioid pharmacology (including newly approved drugs), epidural and other regional anesthesia, and special populations such as pediatric patients, the elderly, and patients with a co-existing disease.