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INTRODUCTION

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Regional anesthesia was established early in the history of medicine, but became somewhat obsolete, if not abandoned following the introduction of modern and safer general anesthetics. Acute pain management has regained attention and popularity by anesthesiologists over the past few decades due to several factors, such as significant advances in regional anesthesia technology, patient parameters of a continuing search for improved safety and satisfaction criteria in medicine, and an enhanced accountable evaluation of healthcare system resource utilization. The demand for and acceptance of regional anesthesia practices from both surgeons and patients has also increased over the past few decades. Patients benefit with enhanced approval and outcome and surgeons receive increased patient referrals and decreased perioperative complications with better pain management.1 Advancement of medical technologies, especially ease and availability of ultrasound developments, have reshaped regional anesthesia into a more accurate, effective, and efficient modality toward enhanced patient care. Trained and experienced anesthesiologists from regional anesthesia fellowship programs are now able to deliver fast, safe, consistent, and reliable regional techniques, especially peripheral nerve blocks, in contrast to the previous conventional (e.g., paresthesia) “hit or miss” methods of regional anesthesia. An enhanced emphasis on effective and adequate pain control, patient autonomy, and patient satisfaction (both surgical and pain management experiences) play a significant role in this continuing transition. Additional benefits of practicing regional anesthesia techniques by fellowship-trained physicians became appreciated by hospital administrators, other healthcare providers besides surgeons, such as earlier ambulation, shorter hospital stay(s), an improved proactive role in rehabilitation, and minimization of adverse side effects often associated with narcotic-based pain medications, to list a few of the clinically relevant advantages. In addition, economic pressure(s) to enhance cost-efficiency of surgical centers, shorten both operating room time and postanesthesia care unit (PACU) stay, improve Hospital Consumer Assessment of Health Plans Survey (HCAHPS) scores (nationally standardized patient outcome survey), and advance perioperative pain control have all made regional anesthesia/analgesia more appealing as an readily available option toward both patient-specific and procedure-specific anesthesia care. Incorporating regional anesthesia can also provide an alternative for the aging population with complex comorbidities that continue to pose significant risks in healthcare management.

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Regional anesthesia continues to play an ever-increasing role and is recognized as a vital component toward more effective patient pain medicine and complementary fulfillment of perioperative medical care. Regional anesthesia/acute pain medicine fellowships are positioned to further emphasize patient and healthcare system value-added when incorporating regional anesthesia/analgesia options into medical management of the surgical patient. The first documented regional anesthesia fellowships were founded at Brigham and Women’s Hospital in Boston, Massachusetts (by Benjamin Covino) and at Virginia Mason Medical Center in Seattle, Washington (by Daniel Moore) in the 1980s.2 The decades that followed were characterized as a continued developmental stage. As of 2007, a total of 11 American Society of Regional Anesthesia/Acute Pain Medicine (ASRA)–recognized regional anesthesia fellowship programs were documented followed by another 10 programs under consideration in the next few subsequent years. ...

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