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Letters to the Editor

REFERENCES REFERENCES In educational research, there is

1. Evron S, Gurstieva V, Ezri T. Transient 1. Neustein SM. The use of lidocaine for spinal a need for large multiinstitutional
neurological symptoms after isobaric sub- anesthesia. Anesth Analg 2008;106:1586–7 studies and evaluation of more
arachnoid anesthesia with 2% lidocaine: 2. Carron M, Freo U, Veronese S, Innocente meaningful and clinically relevant
the impact of needle type. Anesth Analg F, Ori C. Spinal block with 1.5 mg hyper-
2007;105:1494 –9 baric bupivacaine: not successful for ev- outcomes. The IOM report on
2. Pollock JE, Liu SS, Neal JM, Stephenson eryone. Anesth Analg 2007;105:1515– 6 Academic Health Centers recom-
CA. Dilution of spinal lidocaine does not 3. Waxler B, Mondragon SA, Patel SN, mended that Congress create a
alter the incidence of transient neurological Nedumgottil K. Intrathecal lidocaine and
symptoms. Anesthesiology 1999;90:445–50 sufentanil shorten postoperative recovery dedicated fund to foster innova-
3. Freedman JM, Li DK, Drasner K, Jaskela after outpatient rectal surgery. Can J An- tion in the methods and ap-
MC, Larsen B, Wi S. Transient neurologic aesth 2004;51:680 – 4 proaches used to prepare health
symptoms after spinal anesthesia. Anes- 4. Evron S, Gurstieva V, Ezri T, Gladkov V,
thesiology 1998;89:633– 41 Shopin S, Herman A, Sidi A, Weitzman S. professionals.4 An evidentiary
4. Carron M, Freo U, Veronese S, Innocente Transient neurological symptoms after link between education research
F, Ori C. Spinal block with 1.5 mg hyper- isobaric subarachnoid anesthesia with 2% funding and study quality has re-
baric bupivacaine: not successful for ev- lidocaine: the impact of needle type.
eryone. Anesth Analg 2007;105:1515– 6 Anesth Analg 2007;105:1494 –9 cently been demonstrated.5 How-
DOI: 10.1213/ane.0b013e31816a1b70 5. Drasner K. Local anesthetic neurotoxicity. ever, where will we find a source
Clinical injury and strategies that may of funding and who will lead in
minimize risk. Reg Anesth Pain Med
In Response: 2002;27:576 – 80 our specialty?
Dr. Neustein1 raises important con- DOI: 10.1213/ane.0b013e31816a1ba0 Since 1986, the Foundation for An-
cerns regarding the use of lidocaine for esthesia Education and Research
Education in (FAER) has been a nonprofit chari-
spinal anesthesia. The increasing num- Anesthesiology Should Be
ber of day surgery cases requires avail- table and educational organization
Evidenced-Based partially funded by the American So-
ability of a short-acting, yet safe, local
anesthetic if spinal anesthesia is em- ciety of Anesthesiologists that fulfills
To the Editor: a mission to promote the generation
ployed in outpatients and no one drug
meets all requirements. For example, In the 45th Rovenstine lecture,1 of new knowledge in anesthesiology.
bupivacaine may be less suitable for Reves states “In research we have Since inception, research in educa-
day surgery procedures because of done too little, for too long, but it is tion grants have comprised ⬍5% of
its greater failure rate, prolonged ef- not too late.” We include the pau- all grants provided. We propose that
fect,2 and reportedly greater inci- city of research related to medical FAER consider supporting a pro-
dence of urinary retention, and chlor- education in this same category and gram assisting academic anesthe-
procaine is not approved for use in propose that current and appropri- siologists in obtaining training in
spinal anesthesia. ate efforts to encourage the practice educational research. For example,
Small-dose spinal lidocaine (15 of evidence-based medicine should $20,000 from FAER and matching
mg), combined with 10 ␮g sufen- be expanded to include evidence- funds from their academic depart-
based medical education. ment would support graduate level
tanil, is associated with a very low
The Institute of Medicine’s (IOM) training in programs such as the
incidence of transient neurological
report entitled “Health Professions Master of Academic Medicine Pro-
symptoms (TNS).3 In the consenting
process, our patients were informed Education: A Bridge to Quality” notes gram at the University of Southern
of the advantages and disadvantages “there have been few rigorous long- California, which includes courses
of local anesthetics, including the in- term evaluations of any aspect of in designing, implementing, and
cidence of TNS with different local health professions education . . . It is studying innovation in academic
anesthetics and different needles. difficult to locate even a single evalua- medicine.
As we explained in the manu- tion that measures changes in patient Imagine if anesthesiology not only
script, for ethical reasons, the study outcomes or satisfaction as a result of practiced evidence-based medicine
was not completed because of the any revision of curriculum.”2 The but also was the first specialty to
ACGME Outcome Project3 is an ex- teach and train residents utilizing
high incidence of TNS.
ample of a regulatory body imposing evidence-based education.
In conclusion, we do not believe
significant and thoughtfully developed Randall M. Schell, MD
that the intrathecal administration of
but nonevidence-based changes in
lidocaine should be abandoned, but Edwin A. Bowe, MD
rather the injection technique and graduate medical education including
Regina Y. Fragneto, MD
the requirement for developing
dosage should be improved, as sug- Department of Anesthesiology
gested by our and other studies.4,5 competency-based teaching and evalu- University of Kentucky
ation. However, the 2003 IOM report Lexington, Kentucky
Shmuel Evron, MD
appropriately notes that there is “dis-
Tiberiu Ezri, MD agreement about what constitutes evi-
Department of Anesthesia
Wolfson Medical Center
dence of competency, how often it REFERENCES
Holon, Israel should be demonstrated, and who 1. Reves JG. We are what we make: trans- should judge.” forming research in anesthesiology. The

Vol. 106, No. 5, May 2008 © 2008 International Anesthesia Research Society 1587