Helping to Tackle Opioid Abuse with USGRA

Middle Tennessee School of Anesthesia offers training in progressive technique for pain management

NASHVILLE, April 19, 2016—For years medical experts have been scrambling to combat the opioid epidemic, especially in Tennessee. Now there’s a new weapon in their arsenal that gives patients a better way to treat pain after surgery without prescription narcotics and the addiction risk they present.

It’s called ultrasound-guided regional anesthesia (USGRA), which creates a “nerve block.” And new efforts are underway to make it more widely available throughout Middle Tennessee, the region and nation.

A nerve block uses local anesthetics to numb a specific area of the body before, during and after surgery, which effectively “blocks” pain signals from ever reaching the brain for the duration of the treatment. Often, the patient can take medications such as Tylenol or ibuprofen rather than opioids soon after surgery.

“Nerve blocks aren’t new, but we now have technology that makes them much safer, more effective and viable for a broader range of procedures than ever before,” said Dr. Chris Hulin, President of Middle Tennessee School of Anesthesia (MTSA), where nurse anesthesia students are learning the technique.

“Although there are safe uses for opioid medications, addiction can start with the first dose,” Hulin said. “So, if a patient never has to take an opioid, there’s zero chance of abuse. That’s why this method of blocking pain at the source is a game-changer. And it’s a major reason why we’re educating nurse anesthetists about the procedure’s benefits and its implementation in the operating room.”

Ultrasound technology is the critical element in making the treatment more viable, providing visual guidance to pinpoint where the local anesthetic should be administered. Prior to USGRA, anesthesia providers had to rely solely on less accurate techniques, such as nerve stimulation.

In one of the most innovative developments in nerve blocking treatment, anesthetics can be administered through a pump and catheter at home, providing continuous pain management for several days following surgery.

Therefore, the body has several days to recover from the surgery, allowing less potent medications to be used to manage the pain as local anesthetic treatment is completed.

“One of the challenges we face is that not enough certified registered nurse anesthetists (CRNAs) are practicing USGRA,” Hulin said. “At MTSA, we’re trying to change that by providing the training needed to make this treatment option more readily available. We believe it will have a significant impact on nurse anesthesia practice and patient access to this type of care, which would reduce the reliance on opioids for surgical pain.”


About MTSA’s Program

At MTSA’s nationally recognized USGRA Center of Excellence, nurse anesthetists are taught how to safely perform USGRA in a variety of medical settings. MTSA offers a robust slate of clinical rotations, which allows students hands-on experience prior to completing the program.

As an introduction to gross anatomy, MTSA students participate in cadaver lab training. Next, their coursework focuses on spinal and epidural anesthesia, peripheral nerve blocks, and ultrasound-guided regional anesthesia procedures. In addition to being required to demonstrate safe practice via simulation, students undergo a comprehensive hands-on final exam where they are assigned procedures that stimulate critical thinking. This type of educational experience allows students to more safely perform USGRA procedures when exposed to real-life clinical settings.



Nerve blocks aid in the prevention of the body’s inflammatory response to surgery, which is a major precursor in the development of pain. With reduced inflammation, the patient is able to recover more quickly and lessen the time in the hospital, which also contributes to health care cost savings.

“Due to the usage of USGRA, patients now have the capability of remaining comfortable without being dependent on opioids,” said Patrick Moss, DNAP, CRNA, Director of MTSA’s Center of Excellence for Acute Pain Management. “In the past, patients were hospitalized for longer durations following many surgical procedures. Now, because patients can receive continuous treatment via nerve catheters, they’re able to recover, be discharged more quickly, and engage in physical therapy sooner.”

According to Moss, USGRA can be used to lessen pain associated with most surgical procedures, especially orthopedics, including total hip and knee replacements. USGRA can also be used to reduce pain associated with abdominal surgeries such as C-sections and inguinal hernia repairs, among others.

A recent study published in Regional Anesthesia & Pain Medicine found that the use of USGRA was viewed more favorably when compared to alternative techniques for pain management. Another study published in Pain Medicineconcluded that practitioners use ultrasound technology to achieve a higher success rate, improve safety, and teach anesthesia trainees. Main barriers for using ultrasound technology included a lack of training, perceived decreased efficiency, and the lack of immediate availability of equipment. MTSA is addressing these barriers through education and programs that support providers.

Risks associated with USGRA are minimal, but include potential bleeding and possible infection. However, the risk of nerve damage is significantly reduced compared with anesthesia administered without the aid of ultrasound.

“This treatment option helps patients feel better faster, recover more quickly and go home sooner—all without exposure to opioid drugs and the potential for addiction and abuse. That’s great news for patients, and our hope is that more doctors and nurses are able to offer it,” Moss said.


About Middle Tennessee School of Anesthesia

Founded in 1950, Middle Tennessee School of Anesthesia (MTSA) provides graduate-level education and training of nurse anesthetists in a Christian environment born of its Seventh-day Adventist heritage. MTSA is the only independent, fully accredited anesthesia institution of its kind in the nation, instilling excellence through innovative and diverse clinical experience. More than two-thirds of Middle Tennesseans having surgery entrust their lives to its graduates on a daily basis. A leader in academic, clinical and professional distinction, MTSA is responsive to the needs of its constituents, providing affordable graduate education for students from diverse backgrounds. For more information, visit www.mtsa.eduor call (888) 353-MTSA.

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