M. Irfan Suleman, MD, third from right, teaches a workshop on ultrasound-guided pediatric regional anesthesia to University of Arkansas for Medical Sciences faculty, residents, fellows and medical students.

Anesthesiologist Shares Nerve-block Technique with UAMS Colleagues

For years, surgeons have had limited options in preventing post-operative pain in their younger patients.

Complicating matters, “In small patients, it’s very hard to assess their pain and differentiate it from crying from hunger, fear or other factors,” said M. Irfan Suleman, MD, a pediatric anesthesiologist and assistant professor at Arkansas Children’s Hospital.

Nerve blocks, which are delivered by a needle inserted into the targeted nerve, have been used with adults for several years to control pain during and after surgery. Adults can be awake or sedated during the procedure, Suleman said, and this technique has proven popular with the general population.

But in pediatrics, “the patients are less cooperative, and have trouble staying still,” he said. “We have to knock them out to go in with the needle and target that nerve.”

That opened up the possibility of nerve damage and other complications, he said. But using ultrasound to guide them, anesthesiologists can see exactly where they are inserting the needle and administer the nerve-blocking medication to the targeted area.

As Suleman describes it, “With the use of ultrasound technology, the operator is able to view an image of the target nerve directly, guide the needle under real-time observation, navigate away from sensitive anatomy, and monitor the spread of local anesthetic.

“This new procedure is safer,” Suleman said. “I’ve had no complications from it after 1 ½ years, and now my colleagues are encouraged by my results and want to learn it.”

Suleman learned how to perform ultrasound-guided nerve blocks at Harvard Medical School’s Boston Children’s Hospital during his fellowship in pediatric pain and anesthesia at the University of Arkansas for Medical Sciences. He brought the technique to Arkansas in September 2009, and gave his first workshop for UAMS faculty, residents, fellows and medical students that November.

As director of regional anesthesia in the main operating room at Children’s, he is now focused on teaching the surgeons and anesthesiologists there so the hospital can have someone available around the clock to provide this service.

“This will have a significant impact on patient satisfaction,” Suleman said.

Besides giving workshops, Suleman teaches every day in the OR, and through formal lectures with live demonstration on standardized patients every other month for students, residents and fellows.

For this new style of teaching at ACH/UAMS, the Department of Anesthesiology has nominated him for this year’s UAMS Educational Innovation Award.

He was assigned to provide this training by his boss, Tim Martin, MD, MBA, who is chief of the Division of Pediatric Anesthesiology at ACH. Martin said Suleman “is passionate about the teaching and spread of quality regional anesthetic and analgesic techniques in patients of all ages, particularly children.”

Orthopedic surgeon Theresa Wyrick, MD, who often works with Suleman and his team at ACH/UAMS, called having regional anesthesia available for kids “invaluable.”

“It has allowed my patients who undergo big surgical procedures for upper-extremity traumatic injuries or correction of congenital abnormalities to have essentially minimal to no pain after surgery,” Wyrick said.

She added that the anesthesiologists even call her patients at home to check on them and make sure their post-op pain is under control.

Allison Jones, an RN who cares for patients as they recover in the PACU, sees a difference in patients who get nerve blocks. She said they have a smoother recovery and fewer complications.

“It’s easier to manage pain and prepare the patient for discharge to home,” she said.

As far as Suleman knows, he is the only person in Arkansas using the ultrasound-guided technique on pediatric patients.

“Currently my goal is I really love teaching, and this is a technique I think other anesthesiologists either in practice or in training need to learn,” he said. “A few practices like private practices might be doing this, I’m not sure, but I’m very much interested and willing to teach them.”

In fact, with help from the Arkansas Society of Anesthesiologists, Suleman will soon begin offering workshops in the technique for anesthesia practices throughout the state.

He’s also teaching on the national level. In October, he’ll be part of an ultrasound-guided regional anesthesia teaching team at the American Society of Anesthesiologists meeting in Chicago. Anesthesiologists from all over the world will attend the event.

Suleman’s patients typically range from ages 5 to 15, he said. Most are in the 12- to 15-year-old age group, “because they have most of the injuries from sports,” he said. He works mostly alongside orthopedic surgeons because the kids often have nasty fractures or dislocations.

“They really require some good pain control,” he said.

For Suleman, the payoff comes after surgery.

“In the recovery room, they are alert and interacting with their families, talking and laughing,” he said. “They come in really scared, but afterward don’t even feel like they had surgery.

“That’s the reason I’m in anesthesia and pain control. At the end of the day, I feel I really did something good for the kids. They are happy and smiling, and no pain.”

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