Anthony Machi, MD

All Publications

• Nerve stimulation and neuromodulation for painful nerves: a narrative review. International orthopaedics Machi, A., Patel, A., Ottestad, E. 2025

  Abstract

  Nerve injury primarily leads to neuropathic pain but may also have overlapping elements of nociplastic pain or ongoing nociceptive pain. Electrical stimulation is particularly effective in the treatment of neuropathic pain and may be effective for nociplastic and nociceptive pain. While multiple mechanisms contribute to the analgesic effect of electrical stimulation, the most widely accepted theory for the predominant effect is that of Melzack and Wall's gate control theory. According to this theory, non-painful sensory input carried by low-threshold large-diameter Aβ fibres disrupt the transmission of pain signals in small pain fibers (Aδ and C fibres). This occurs through the activation of inhibitory interneurons in the dorsal horn, which ultimately blocks pain signal transmission.This theory has been employed for different forms of stimulation, including transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS), and peripheral nerve stimulation (PNS). Each of these methods offers a different approach to localized stimulation and neuromodulation for the treatment of pain. TENS is a non-invasive technique, that delivers electrical currents via surface electrodes placed on the skin. PENS, in contrast, is a minimally invasive method that applies electrical currents through small needles inserted near a target muscle or neural structure. PNS involves the implantation of temporary or permanent electrodes to deliver electrical stimulation directly to peripheral nerves. These modalities are widely used to manage various pain conditions including non-malignant, chronic musculoskeletal and neuropathic pain, such as chronic low back pain, neck pain, neuropathic pain, myofascial pain, and post-operative pain. TENS is particularly notable as a non-invasive device that is affordable, over-the-counter, self-administered, and nonpharmacological option that does not pose the risk of toxicity or overdose. PENS stands out for its ability to integrate electrical stimulation therapy with electroacupuncture through a minimally invasive technique. PNS, on the other hand, is unique in its capacity to precisely target specific nerves and provide a range of stimulation options for extended treatment durations.This article provides a narrative overview of TENS, PENS and PNS with a particular focus on their application for neuropathic pain management and for athletes. We will review mechanisms of action, indications, diagnostic and treatment algorithms, as well as complications and limitations. The overview concludes with a complex case study demonstrating the use of various electrical stimulation therapies, ultimately to successful pain resolution for the patient.

  View details for DOI 10.1007/s00264-025-06498-0

  View details for PubMedID 40111452

  View details for PubMedCentralID 9419727

• Perioperative Pain Management and Enhanced Recovery Protocols Musculoskeletal Pain: Evidence-Based Clinical Evaluation and Management Gu, L., Liu, J., Machi, A. Springer International Publishing. 2025
• Superior Cluneal neuralgia-An underappreciated cause of low back pain? Interventional pain medicine Ottestad, E., Machi, A. 2024; 3 (3): 100436

  View details for DOI 10.1016/j.inpm.2024.100436

  View details for PubMedID 39318392

  View details for PubMedCentralID PMC11420446

• General Principles of Perioperative Pain Management Perioperative Pain Management Speaks, T., Epner, M., Chavez-Carmona, S., Kim, J., Machi, A. 2024
• Thoracic Interfascial Plane Blocks and Outcomes After Minithoracotomy for Valve Surgery. Seminars in cardiothoracic and vascular anesthesia Cheruku, S. R., Fox, A. A., Heravi, H., Doolabh, N., Davis, J., He, J., Deonarine, C., Bereuter, L., Reisch, J., Ahmed, F., Skariah, L., Machi, A. 2023; 27 (1): 8-15

  Abstract

  Introduction. Thoracic interfascial plane blocks are increasingly used for pain management after minimally invasive thoracotomy for valve repair and replacement procedures. We hypothesized that the addition of these blocks to the intercostal nerve block injected by the surgeon would further reduce pain scores and opioid utilization. Methods. In this retrospective cohort study, 400 consecutive patients who underwent minimally invasive thoracotomy for mitral or aortic valve replacement and were extubated within 2 hours of surgery were enrolled. The maximum pain score and opioid utilization on the day of surgery and other outcome variables were compared between patients who received interfascial plane blocks and those who did not. Results.193 (48%) received at least one interfascial plane block while 207 (52%) received no interfascial plane block. Patients who received a thoracic interfascial plane block had a maximum VAS score on the day of surgery (mean 7.4 ± 2.5) after the block was administered which was significantly lower than patients in the control group who did not receive the block (mean 7.9 ± 2.2) (P = .02). Opioid consumption in the interfascial plane block group on the day of surgery was not significantly different from the control group. Conclusion. Compared to intercostal blocks alone, the addition of thoracic interfascial plane blocks was associated with a modest reduction in maximum VAS score on the day of surgery. However, no difference in opioid consumption was noted. Patients who received interfascial plane blocks also had decreased blood transfusion requirements and a shorter hospital length of stay.

  View details for DOI 10.1177/10892532221136386

  View details for PubMedID 36282242

• Local Anesthetic Systemic Toxicity Machi, A., Wong, J. Openanesthesia.org. 2023
• Development of entrustable professional activities for regional anesthesia and pain medicine fellowship training. Regional anesthesia and pain medicine Porter, S., Prendiville, E., Allen, B. F., Booth, G., Boublik, J., Burnett, G. W., Elkassabany, N., Hausman, J., Klesius, L., Le-Wendling, L., Machi, A. T., Maniker, R., Parra, M., Rosenquist, R., Spofford, C. M., Suresh, S., Tedore, T., Wilson, E. H., Zhou, J. Y., Woodworth, G. 2022

  Abstract

  INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) offers descriptions of competencies and milestones but does not provide standardized assessments to track trainee competency. Entrustable professional activities (EPAs) and special assessments (SAs) are emerging methods to assess the level of competency obtained by regional anesthesiology and acute pain medicine (RAAPM) fellows.METHODS: A panel of RAAPM physicians with experience in education and competency assessment and one medical student were recruited to participate in a modified Delphi method with iterative rounds to reach consensus on: a list of EPAs, SAs, and procedural skills; detailed definitions for each EPA and SA; a mapping of the EPAs and SAs to the ACGME milestones; and a target level of entrustment for graduating US RAAPM fellows for each EPA and procedural skill. A gap analysis was performed and a heat map was created to cross-check the EPAs and SAs to the ACGME milestones.RESULTS: Participants in EPA and SA development included 19 physicians and 1 medical student from 18 different programs. The Delphi rounds yielded a final list of 23 EPAs, a defined entrustment scale, mapping of the EPAs to ACGME milestones, and graduation targets. A list of 73 procedural skills and 7 SAs were similarly developed.DISCUSSION: A list of 23 RAAPM EPAs, 73 procedural skills, and 7 SAs were created using a rigorous methodology to reach consensus. This framework can be utilized to help assess RAAPM fellows in the USA for competency and allow for meaningful performance feedback.

  View details for DOI 10.1136/rapm-2022-103854

  View details for PubMedID 35878963

• Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project. Regional anesthesia and pain medicine Ahmed, H. M., Atterton, B. P., Crowe, G. G., Barratta, J. L., Johnson, M., Viscusi, E., Adhikary, S., Albrecht, E., Boretsky, K., Boublik, J., Breslin, D. S., Byrne, K., Ch'ng, A., Chuan, A., Conroy, P., Daniel, C., Daszkiewicz, A., Delbos, A., Dirzu, D. S., Dmytriiev, D., Fennessy, P., Fischer, H. B., Frizelle, H., Gadsden, J., Gautier, P., Gupta, R. K., Gurkan, Y., Hardman, H. D., Harrop-Griffiths, W., Hebbard, P., Hernandez, N., Hlasny, J., Iohom, G., Ip, V. H., Jeng, C. L., Johnson, R. L., Kalagara, H., Kinirons, B., Lansdown, A. K., Leng, J. C., Lim, Y. C., Lobo, C., Ludwin, D. B., Macfarlane, A. J., Machi, A. T., Mahon, P., Mannion, S., McLeod, D. H., Merjavy, P., Miscuks, A., Mitchell, C. H., Moka, E., Moran, P., Ngui, A., Nin, O. C., O'Donnell, B. D., Pawa, A., Perlas, A., Porter, S., Pozek, J., Rebelo, H. C., Roques, V., Schroeder, K. M., Schwartz, G., Schwenk, E. S., Sermeus, L., Shorten, G., Srinivasan, K., Stevens, M. F., Theodoraki, K., Turbitt, L. R., Valdes-Vilches, L. F., Volk, T., Webster, K., Wiesmann, T., Wilson, S. H., Wolmarans, M., Woodworth, G., Worek, A. K., Moran, E. M. 2022

  Abstract

  BACKGROUND AND OBJECTIVES: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia.METHODS: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement.RESULTS: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29.CONCLUSION: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.

  View details for DOI 10.1136/rapm-2021-103136

  View details for PubMedID 35193970

• Epidural Catheter Infusion for Post-Operative Analgesia for Major Spine Surgery Multidisciplinary Spine Care Machi, A., Kandil, E. 2022
• Superficial vs. deep serratus anterior plane block for analgesia in patients undergoing mastectomy: A randomized prospective trial. Journal of clinical anesthesia Edwards, J. T., Langridge, X. T., Cheng, G. S., McBroom, M. M., Minhajuddin, A., Machi, A. T. 2021; 75: 110470

  Abstract

  In the initial description of the serratus anterior plane block (SAPB), both superficial and deep SAPB provided effective blockade. The purpose of this study was to investigate the difference in opioid consumption and postoperative analgesia between superficial and deep SAPB for patients undergoing mastectomy.Randomized prospective trial.Academic hospital.64 women, >18 years of age, ASA I-III, undergoing single or bilateral mastectomy, with and without lymph node biopsy, with and without tissue expander reconstruction.Either superficial or deep SAPB by an ultrasound-guided technique in addition to multimodal analgesia.The primary outcome was opioid consumption in the first 24 h. Secondary outcomes were pain scores, satisfaction scores, incidence of PONV, length of stay and block performance time.Subjects who received a deep SAPB required 30% less oral morphine equivalents (OME) (113.5 mg vs. 147 mg, p = 0.009) and reported lower pain scores. There were no significant differences in satisfaction scores, incidence of PONV, LOS, or block performance time between the two groups.There was a significant difference in opioid consumption between the deep and superficial SAPB groups. Subjects in the deep SAPB group had lower pain scores at 12 h; however, the difference was not statistically significant at other time points. While both the superficial and the deep SAPB can be used for post-operative analgesia in patients undergoing mastectomy, our study suggests that the deep SAPB may improve analgesia to a greater degree than the superficial SAPB as shown through decreased opioid consumption of 30% over a 24-h period post-block. CLINICAL TRIAL NUMBER AND REGISTRY URL: clinicaltrials.gov: NCT03154658.

  View details for DOI 10.1016/j.jclinane.2021.110470

  View details for PubMedID 34364099

• Immediate Effects of a Continuous Peripheral Nerve Block on Postamputation Phantom and Residual Limb Pain: Secondary Outcomes From a Multicenter Randomized Controlled Clinical Trial. Anesthesia and analgesia Ilfeld, B. M., Khatibi, B., Maheshwari, K., Madison, S. J., Ali Sakr Esa, W., Mariano, E. R., Kent, M. L., Hanling, S., Sessler, D. I., Eisenach, J. C., Cohen, S. P., Mascha, E. J., Yang, D., Padwal, J. A., Turan, A., PAINfRE Investigators, Morris, B. A., Szmuk, P., Beck, G. J., Abdullah, B., Aleshi, P., Buys, M. J., Cata, J. P., Chen, G., De Oliveira, G. S., Elsharkawy, H., Finneran, J. J., Ganaway, T., Govindarajan, S. R., Kalasbail, P., Kendall, M. C., Zafeer Khan, M., Kopp, S., Loland, V. J., Machi, A. T., Malik, T., Memtsoudis, S. G., Missair, A., Ilfeld, A. M., Mounir-Soliman, L., Braun, B., Vlassakov, K. V., Warren, L., Wen, C. H., Woodworth, G. E., Young, A. C. 2021

  Abstract

  BACKGROUND: We recently reported that a 6-day continuous peripheral nerve block reduced established postamputation phantom pain 3 weeks after treatment ended. However, the immediate effects of perineural infusion (secondary outcomes) have yet to be reported.METHODS: Participants from 5 enrolling academic centers with an upper or lower limb amputation and established phantom pain received a single-injection ropivacaine peripheral nerve block(s) and perineural catheter insertion(s). They were subsequently randomized to receive a 6-day ambulatory perineural infusion of either ropivacaine 0.5% or normal saline in a double-masked fashion. Participants were contacted by telephone 1, 7, 14, 21, and 28 days after the infusion started, with pain measured using the Numeric Rating Scale. Treatment effects were assessed using the Wilcoxon rank-sum test at each time point. Adjusting for 4 time points (days 1, 7, 14, and 21), P < .0125 was deemed statistically significant. Significance at 28 days was reported using methods from the original, previously published article.RESULTS: Pretreatment average phantom and residual pain scores were balanced between the groups. The day after infusion initiation (day 1), average phantom, and residual limb pain intensity was lower in patients receiving local anesthetic (n = 71) versus placebo (n = 73): median [quartiles] of 0 [0-2.5] vs 3.3 [0-5.0], median difference (98.75% confidence interval [CI]) of -1.0 (-3.0 to 0) for phantom pain (P = .001) and 0 [0-0] vs 0 [0-4.3], and median difference 0.0 (-2.0 to 0.0) for residual limb pain (P < .001). Pain's interference with physical and emotional functioning as measured with the interference domain of the Brief Pain Inventory improved during the infusion on day 1 for patients receiving local anesthetic versus placebo: 0 [0-10] vs 10 [0-40], median difference (98.75% CI) of 0.0 (-16.0 to 0.0), P = .002. Following infusion discontinuation (day 6), a few differences were found between the active and placebo treatment groups between days 7 and 21. In general, sample medians for average phantom and residual limb pain scores gradually increased after catheter removal for both treatments, but to a greater degree in the control group until day 28, at which time the differences between the groups returned to statistical significance.CONCLUSIONS: This secondary analysis suggests that a continuous peripheral nerve block decreases phantom and residual limb pain during the infusion, although few improvements were again detected until day 28, 3 weeks following catheter removal.

  View details for DOI 10.1213/ANE.0000000000005673

  View details for PubMedID 34314392

• How I(We) Do It: Enhanced Recovery Pathway for Geriatric Hip Fracture Machi, A., Sorich, M., Street, S. ASRA Newsletter. 2021
• Acute Pain Management to Prevent Chronic Postsurgical Pain Machi, A. ASRA Newsletter. 2021
• Anesthesia residency training in regional anesthesiology and acute pain medicine: a competency-based model curriculum. Regional anesthesia and pain medicine Woodworth, G. n., Maniker, R. B., Spofford, C. M., Ivie, R. n., Lunden, N. I., Machi, A. T., Elkassabany, N. M., Gritsenko, K. n., Kukreja, P. n., Vlassakov, K. n., Tedore, T. n., Schroeder, K. n., Missair, A. n., Herrick, M. n., Shepler, J. n., Wilson, E. H., Horn, J. L., Barrington, M. n. 2020

  Abstract

  The Accreditation Council for Graduate Medical Education has shifted to competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills and behaviors expected of competent trainees. It also requires an assessment program to provide formative feedback to trainees as they progress to competency in each outcome. Critical to the success of a curriculum is its practical implementation. This article describes the development of model curricula for anesthesiology residency training in regional anesthesia and acute pain medicine (core and advanced) using a competency-based framework. We further describe how the curricula were distributed through a shared web-based platform and mobile application.

  View details for DOI 10.1136/rapm-2020-101480

  View details for PubMedID 32474420

• Perioperative Pain Management Pain Management for Clinicians: A Guide to Assessment and Treatment Machi, A. 2020
• Ambulatory continuous peripheral nerve blocks to treat post-amputation phantom limb pain a multicenter, randomized, quadruple-masked, placebo-controlled clinical trial. Pain Ilfeld, B. M., Khatibi, B. n., Maheshwari, K. n., Madison, S. J., Sakr Esa, W. A., Mariano, E. R., Kent, M. L., Hanling, S. n., Sessler, D. I., Eisenach, J. C., Cohen, S. P., Mascha, E. J., Ma, C. n., Padwal, J. A., Turan, A. n. 2020

  Abstract

  Phantom limb pain is thought to be sustained by reentrant neural pathways which provoke dysfunctional reorganization in the somatosensory cortex. We hypothesized that disrupting reentrant pathways with a 6-day-long continuous peripheral nerve block reduces phantom pain 4 weeks after treatment. We enrolled patients who had an upper- or lower-limb amputation and established phantom pain. Each was randomized to receive a 6-day perineural infusion of either ropivacaine or normal saline. The primary outcome was the average phantom pain severity as measured with a Numeric Rating Scale (0-10) at 4 weeks, after which an optional crossover treatment was offered within the following 0-12 weeks. Pretreatment pain scores were similar in both groups, with a median [interquartile range] of 5.0 [4.0, 7.0] for each. After 4 weeks, average phantom limb pain intensity was a mean (SD) of 3.0 (2.9) in patients given local anesthetic versus 4.5 (2.6) in those given placebo (difference (95% CI) 1.3 (0.4, 2.2), P=0.003). Patients given local anesthetic had improved global impression of change and less pain-induced physical and emotional dysfunction, but did not differ on depression scores. For subjects who received only the first infusion (no self-selected crossover), the median decrease in phantom limb pain at 6 months for treated subjects was 3.0 [0, 5.0] vs. 1.5 [0, 5.0] for the placebo group; there appeared to be little residual benefit at 12 months. We conclude that a 6-day continuous peripheral nerve block reduces phantom limb pain as well as physical and emotional dysfunction for at least 1 month.

  View details for DOI 10.1097/j.pain.0000000000002087

  View details for PubMedID 33021563

• Emerging Technologies in Acute Pain Medicine Nasiri, M., Le-Wendling, L., Ihnetsanka, B., Tighe, P., Machi, A. ASRA Newsletter. 2020
• Virtual Reality Therapy: A Guide for Clinical Implementation Alem, N., Shah, S., Machi, A. ASRA Newsletter. 2020
• Regional Anesthesia and Acute Pain Medicine Fellowship Curriculum Machi, A., Lunden, N., et al Anesthesia Toolbox. 2020
• Acute Pain Resident Core Curriculum Machi, A., Lunden, N., et al Anesthesia Toolbox. 2019
• Interfascial plane blocks Machi, A. T., Joshi, G. P. Best Practice & Research Clinical Anaesthesiology. 2019
• Surgical Site Infiltration: a Neuroanatomical Approach Joshi, G. P., Machi, A. T. Best Practice & Research Clinical Anaesthesiology. 2019
• Acute Pain Resident Advanced Curriculum Machi, A., Lunden, N., et al Anesthesia Toolbox. 2019
• FNB vs ACB: Anatomy, Tips and Clinical Pearls Choi, S., Grevstad, U., Jaeger, P., Machi, A. T. ASRA Newsletter. 2016
• Continuous peripheral nerve blocks in the ambulatory setting: an update of the published evidence. Current opinion in anaesthesiology Machi, A. T., Ilfeld, B. M. 2015; 28 (6): 648-55

  Abstract

  To review the evidence recently published involving the use of continuous peripheral nerve blocks (cPNBs) in the ambulatory setting.New evidence exists involving the risks and benefits of cPNB in ambulatory patient populations such as pediatric ambulatory and postmastectomy patients. In addition, new related equipment is now available to facilitate ambulatory cPNB.Recent advancements in equipment for cPNB facilitate the usage in the ambulatory setting. Research-supported ambulatory cPNB indications have expanded to include pediatric subpopulations and major breast surgery, while further evidence mounts for its efficacy in patient populations with previously demonstrated benefits, such as foot, ankle and shoulder surgery.

  View details for DOI 10.1097/ACO.0000000000000254

  View details for PubMedID 26356291

• Discharge Readiness after Tricompartment Knee Arthroplasty: Adductor Canal versus Femoral Continuous Nerve Blocks-A Dual-center, Randomized Trial. Anesthesiology Machi, A. T., Sztain, J. F., Kormylo, N. J., Madison, S. J., Abramson, W. B., Monahan, A. M., Khatibi, B., Ball, S. T., Gonzales, F. B., Sessler, D. I., Mascha, E. J., You, J., Nakanote, K. A., Ilfeld, B. M. 2015; 123 (2): 444-56

  Abstract

  The authors conducted a randomized, controlled, parallel-arm, superiority study to test the hypothesis that a continuous adductor canal block decreases the time to attain four discharge criteria compared with a continuous femoral nerve block after tricompartment knee arthroplasty.Subjects undergoing tricompartment knee arthroplasty were randomized using computer-generated lists to either an adductor canal or femoral perineural catheter (3-day ropivacaine 0.2% infusion) in an unmasked manner. The primary outcome was the time to attain four criteria: (1) adequate analgesia; (2) intravenous opioids independence; (3) ability to stand, walk 3 m, return, and sit down; and (4) ambulate 30 m.Subjects with an adductor canal catheter (n = 39) reached all four criteria in a median of 55 h (interquartile, 42 to 63 h) compared with 61 h (49 to 69 h) for those with a femoral catheter (n = 41; 95% CI, -13 to 1 h; P = 0.12). The percentage of subjects who reached the two mobilization criteria on postoperative days 1 and 2 were 72 and 95% for those with an adductor canal catheter (n = 39), but only 27 and 76% in subjects with a femoral catheter (n = 41; both P < 0.001). Differences in pain scores at rest and intravenous opioid requirements were minimal, but femoral infusion improved dynamic analgesia (P = 0.01 to 0.02).Compared with a continuous femoral nerve block, a continuous adductor canal block did not appreciably decrease the time to overall discharge readiness even though it did decrease the time until adequate mobilization, primarily because both groups experienced similar analgesia and intravenous opioid requirements that--in most cases--exceeded the time to mobilization.

  View details for DOI 10.1097/ALN.0000000000000741

  View details for PubMedID 26079800

• Continuous Adductor Canal Versus Continuous Femoral Nerve Blocks: Relative Effects on Discharge Readiness Following Unicompartment Knee Arthroplasty. Regional anesthesia and pain medicine Sztain, J. F., Machi, A. T., Kormylo, N. J., Abramson, W. B., Madison, S. J., Monahan, A. M., Khatibi, B., Ball, S. T., Gonzales, F. B., Sessler, D. I., Mascha, E. J., You, J., Nakanote, K. A., Ilfeld, B. M. 2015; 40 (5): 559-67

  Abstract

  We tested the hypothesis that, following unicompartment knee arthroplasty, a continuous adductor canal block decreases the time to reach 4 discharge criteria compared with a continuous femoral nerve block.Subjects were randomized to either an adductor canal or femoral perineural catheter (2-day ropivacaine 0.2% infusion) in an unmasked fashion. The primary outcome was the time to attain 4 discharge criteria: (1) adequate analgesia; (2) intravenous opioid independence; (3) ability to independently stand, walk 3 m, return, and sit down; and (4) ambulate 30 m.Subjects with an adductor canal catheter (n = 15) reached all 4 criteria in a median of 35 hours (interquartile range, 24-43 hours), compared with 40 hours (interquartile range, 27-69 hours) for those with a femoral catheter (n = 15; Wilcoxon rank sum test: P = 0.46; log-rank test: P = 0.16). However, the percentages of subjects (adductor canal: femoral) who reached the 2 mobilization criteria were 27%:0% on postoperative day (POD) 0, 93%:53% on POD 1, and 100%:73% on POD 2. Of adductor canal subjects, 100% were discharge ready by POD 2, compared with only 73% of femoral subjects (P < 0.001).Compared with a continuous femoral nerve block, a continuous adductor canal block did not appreciably decrease the median number of hours to overall discharge readiness, yet did decrease the number of discrete days until discharge readiness. These results are applicable to only unicompartment knee arthroplasty and must be considered preliminary because of the limited sample size of this pilot study.

  View details for DOI 10.1097/AAP.0000000000000279

  View details for PubMedID 26115189

• Ultrasound-guided Infraclavicular Block: To Target the Axillary Artery or the Cords? Machi, A., Soo, J., Suresh, P., Cheng, C., Bishop, M., Loland, V., Sandhu, N. Anesthesia & Analgesia. 2011
• A-P positioning of medialization thyroplasty in an excised larynx model. The Laryngoscope Czerwonka, L., Ford, C. N., Machi, A. T., Leverson, G. E., Jiang, J. J. 2009; 119 (3): 591-6

  Abstract

  Posterior positioning of medialization thyroplasty provides the best acoustic and aerodynamic outcomes.Ex vivo excised canine larynx.Unilateral thyroplasty windows were cut in the thyroid cartilages of 10 excised canine larynges. Each larynx was mounted on an artificial lung and the vocal fold opposite the thyroid window was adducted by medializing its arytenoid cartilage. Then, medialization thyroplasty was simulated with a probe placed anterior, central, and posterior in the thyroid window. The glottal area, airway reduction, medialization force, phonation threshold pressure and flow, aerodynamic power, intensity, efficiency, jitter, shimmer, and signal-to-noise ratio (SNR) were measured at each medialization position.Posterior medialization probe placement minimized the glottal area, provided the best voice as determined by perturbation measures and SNR, reduced the work of phonation, and increased efficiency. Anterior and middle probe placement minimized the work of phonation but provided only modest gains in sound quality and decreased sound intensity. Medializing the vocal fold with posterior probe placement required twice as much force as central and anterior probe placement.The results suggest that posterior medialization provides the greatest improvement in acoustic parameters and efficiency in patients who can tolerate the airway reduction. Middle and anterior medialization can decrease work of phonation, but in this experiment objective improvement in sound quality was limited. Subtle changes in displacement shim contour, especially in middle and anterior locations, have a substantial impact on voice outcome, affirming the value of intraoperative voice assessment.

  View details for DOI 10.1002/lary.20122

  View details for PubMedID 19235760

  View details for PubMedCentralID PMC3313598