Ultrasound-Guided Fascial Plane Blocks for Acute Rib Fracture Pain

Michelle Stotts, Class of 2021

This issue features a synopsis of the scholarly work of MTSA graduate and Acute Surgical Pain Management fellow Michelle Stotts, DNAP, CRNA. Look for future opportunities for Continuing Education focused on this and other topics in upcoming issues of Airways upon CE credit approval from the AANA.

“I’ve developed a passion for education and am eager to share the knowledge obtained through MTSA with SRNAs and my CRNA colleagues.” —Michelle Stotts, Class of 2021

TITLE: Ultrasound-Guided Fascial Plane Blocks for Acute Rib Fracture Pain in a Level IV Trauma Center: A Literature Review and Introduction of an Evidence-based Analgesia Algorithm for Uncomplicated Rib Fractures

AUTHORS: Michelle Stotts, DNAP, CRNA; Hallie Evans, DNP, CRNA, APRN; Christian Falyar, DNAP, CRNA; Bill Johnson, DNAP, CRNA.

SYNOPSIS: Effective pain management reduces the incidence of respiratory complications in rib fracture patients. The incorporation of ultrasound into regional anesthesia has led to newer fascial plane blocks of the chest wall that can be used as part of a multimodal pain management plan. While current systematic reviews focus on indications and efficacy of fascial plane blocks compared to placebo, there is little research comparing them to traditional methods of regional analgesia for rib fracture pain. A literature review was conducted comparing ultrasound-guided erector spinae or serratus anterior fascial plane blocks to thoracic epidural or paravertebral blocks for the treatment of acute chest wall pain to support development of a rib fracture analgesia algorithm. Overall, studies comparing the fascial plane and traditional regional analgesia groups found comparable analgesia, opioid consumption and improved respiratory function in thoracic surgery and rib fracture patients. Development of an evidence-based multimodal analgesic algorithm incorporating ultrasound-guided fascial plane blocks to guide the management of acute rib fracture pain provides additional regional pain management options. This has implications for rural and small community facilities where traditional regional interventions may not be feasible.


Michelle Stotts, DNAP, CRNA, is a nurse anesthetist at Roane General Hospital, a Level IV Trauma Center and Critical Access Hospital (CAH), in Spencer, WV. She is a graduate of CAMC’s School of Nurse Anesthesia with a Masters in Healthcare Administration from Marshall University in 2002. The author was a student in the Doctorate of Nurse Anesthesia Practice Completion Program at Middle Tennessee School of Anesthesia at the time this article was written.

Hallie Evans, DNP, CRNA, APRN, is an Associate Professor at MTSA.

Christian Falyar, DNAP, CRNA, is an Assistant Professor and Assistant Director of the Duke University Nurse Anesthesia Program in Durham, NC.

Bill Johnson, DNAP, CRNA, is the Director of the Acute Surgical Pain Management Fellowship at MTSA.

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President's Message: A Vision for 2022 and Beyond

Chris Hulin

As we move through 2022, MTSA is poised to make great strides as we help guide students through a rewarding career as a CRNA. To that end, the Board of Trustees has developed a new “Vision for 2022” and beyond, with three areas of focus:

  • Reflect Christ in a culture of service, inclusion, and diversity.
  • Deliver an exceptional student experience that attracts premier applicants, promotes individual achievement, and results in a clinically excellent practitioner.
  • Advance CRNA practice in ultrasound and pain management through education, strategic partnerships, and distinguished scholarship.

We’ve already started implementing this Vision for 2022 and beyond with new programs, partnerships, faculty and facilities that will help expand options for our students as well as experienced practitioners.

  1. Education Track. We’re expanding our programs to include a specialized track, which helps to prepare CRNAs to serve as educators. This effort is supported by the addition of our Nurse Educator Certificate Program and grant funding from the Nurse Faculty Loan Program.
  2. Clinical Partnerships. Our Quality Enhancement Plan (QEP) is moving forward with the implementation of a new clinical assessment tool, as well as semester objectives to help our students and clinical preceptors ensure the most enriching experience for all involved.
  3. Learning Resource Center. Our newly renovated space in the Magan Building was specifically designed for collaboration among students and colleagues, providing an environment where research can be conducted and shared to advance CRNA practice.
  4. New Faculty. We have hired Dr. Christian Falyer, CRNA, as Assistant Director, Fellowship and Post Doctorate Programs. Iin addition to supporting the program’s success, Dr. Falyer will also be advancing MTSA’s contribution of PoCUS for CRNAs. We’re also welcoming Dr. Jamie Furstein, CRNA, as Senior Research Associate. Dr. Furstein will be overseeing MTSA’s strategic scholarship efforts and supporting student research and publication.

In addition, linked to our Vision for 2022 is the new appearance and content for Airways. Our goal is to provide more scholarly content that you can use to expand your knowledge and increase the value of your service in the clinical setting.

Look for more details about our Vision for 2022, which represents a unique moment of transition for MTSA. I hope you’ll be a part of this journey with us!

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2021 Commencement Ceremony

Middle Tennessee School of Anesthesia hosted Commencement Exercises for the Doctor of Nurse Anesthesia Practice Class of 2021 on Dec. 10 at the Madison Church of Christ. The program was streamed live online, and a video of the event is available at

During his opening remarks, President Chris Hulin acknowledged the difficulty faced by students and clinicians during the ongoing Covid pandemic, saying, “I could not be more proud of these students. For future employers, these are the graduates you want. They have already demonstrated resilience and professionalism during some very difficult times. This class is prepared to take the nurse anesthesia profession into the future.”

Following Hulin’s message, Class of 2021 graduate Natalie Turk offered the invocation; MTSA Board of Trustees Chairman Victor Martin, MBA, CRNA, added a message of congratulations to the graduates; and graduate Justin Johnson introduced Nathan Renner, Senior Pastor, Madison Campus Seventh-day Adventist Church, who delivered a homily.

Graduate Benjamin DeHaan then introduced commencement speaker Larry Hornsby, Executive VP & CSO of DPI Anesthesia, who encouraged the class to aim high for their career aspirations. Program Administrator Rusty Gentry, DNAP, CRNA, presented a summary of the graduates’ clinical experiences and case counts, which was followed by the presentation of degrees and individual awards.

Hulin then presented the President’s Medal to John M. Edwards III and Stace Douglas Dollar, recognizing their doctoral work which advances or has the potential to impact the current practice of nurse anesthetists locally, nationally, or even globally.

Bill Johnson, DNAP, CRNA, Director of the Acute Surgical Pain Management (ASPM) Fellowship and Doctorate Completion Program, presented the Outstanding Achievement Award to Matthew Stewart, MS, CRNA (right).

The ceremony was closed with a benediction by graduate Joshua Tootle.


Each year MTSA graduates well-exceed requirements of the National Board of Certification & Recertification for Nurse Anesthetist (NBCRNA) regarding the number of cases and procedures for clinical experiences in order for the candidate to be eligible to take the National Certification Examination.

The following statistics are derived from the information provided to the NBCRNA for certification requirements for the graduates as of November 4, 2021. NBCRNA requires a minimum number of 600 cases. The average number of cases performed by members of the class of 2021 was 782 cases. The graduate with the highest number of cases performed was Erin Brandon who completed 977 cases.

NBCRNA requires a minimum of 2,000 hours of clinical time. The average number of hours spent actually doing anesthesia by the members of the class of 2021 was 2,602 hours. The graduate with the most hours of anesthesia time was Christopher Neelly with 2,915 hours.

NBCRNA requires each graduate to have administered anesthesia to at least 40 pediatric patients. Members of the class of 2021 performed an average of 111 anesthetics for pediatric patients. The graduate with the highest number was Kailey Belote with 242 pediatric cases.

NBCRNA requires each graduate to have provided anesthesia for at least 30 obstetrical patients. The average num­ber of anesthetics in this category for members of the class of 2021 was 75. The graduate with the highest number was Elizabeth Watkins with 155 obstetrical patients.

Graduates from all programs across the United States are required to perform a minimum of at least 35 regional an­esthetics. These 35 can be from a combination of all categories of regional anesthesia. The members of this gradu­ating class administered an average of 105 regional anesthetics. Epidural and spinal anesthesia are techniques of regional anesthesia. The members of this class performed an average of 28 spinal anesthetics. The members of this class performed an average of 54 epidurals.


During the graduation ceremony, awards were presented to the following graduates:

Team Spirit Award: Alexandria Cai Johnson-Turner

This award is voted on solely by students and given to the person in their class who has continually offered encouragement and was always willing to lend a helpful hand.






Bernard Bowen Award for Academic Excellence: Matthew A. Patten

This award is named for the founder and first Program Director of the school of nurse anesthesia in 1950. The recipient was chosen by votes from the MTSA faculty and administration. The student selected for this award must have upheld the mission and core values of MTSA, achieved a GPA of 3.75 or higher, exhibited professionalism during interaction with classmates and academic faculty, and fostered a spirit of academic excellence beyond the expectations and degree requirements.




Agatha Hodgins Award for Clinical Excellence: Erin Adriel Brandon

This award is named for the founder and first president of the American Association of Nurse Anesthetists. Ms. Hodgins was also a strong advocate for the education of nurse anesthetists. The clinical affiliates of Vanderbilt, General Hospital, along with MTSA Administration, had input into the selection of the recipient for this award. The student selected for this award must have upheld the mission and core values of MTSA, achieved a GPA of 3.75 or higher, and exhibited professionalism during interaction with clinical faculty and classmates, and fostered a spirit of clinical excellence beyond the expectations and degree requirements.

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Now Open: Enrollment for 2022 Nurse Anesthesia Programs

Save 85% of tuition costs with the Nurse Faculty Loan Program

It’s a new year, with new opportunities for career growth! MTSA is now accepting applications for a wide range of nurse anesthesia programs to help you excel as a CRNA. Visit for details.

Nurse Educator Certificate Program

MTSA’s Nurse Educator Certificate Program is a 12-month course of study that prepares students to function in the Nurse Educator role. Students learn about the theoretical foundations of nursing education, how to assess educational needs, various evidence-based teaching and assessment strategies, curriculum design and development, and program evaluation. Application deadline: June 1.

Nurse Faculty Loan Program

Admitted students in the Nurse Educator Certificate Program may be eligible for HRSA Faculty Nurse Loan program (FNLP) with a four-year nurse educator employment commitment post-graduation which provides 85% loan forgiveness when this educator employment is completed. Students interested in the FNLP should contact the Grant Director, Bill Johnson, DNAP, CRNA, at for eligibility screening.

Doctor of Nurse Anesthesia Practice (DNAP)

MTSA offers the DNAP Practice Doctorate to registered nurses who have met each of the application requirements for admission. The DNAP Practice Doctorate is a full-time course of study for 36 consecutive months. Application deadline: May 31.

The DNAP Completion program is specifically designed with the working CRNA in mind and in an online format. All students accepted into the program must be currently licensed CRNAs. The program can be completed over two years. Application deadline: June 1.

Acute Surgical Pain Management Fellowship

From medical management approaches, such as multimodal therapies and opioid sparing strategies, to advanced interventional techniques, including continuous catheter utilization, CRNAs acquire the knowledge to treat patients with confidence and skill at MTSA’s Acute Surgical Pain Management (ASPM) Fellowship. Application deadline: June 1.

MTSA offers dual enrollment in the DNAP Completion program along with the ASPM Fellowship or the Nurse Educator Certificate Program, allowing students to complete two academic tracks at once!

Regional Cadaveric Workshops

Registration is now open for MTSA’s 2022 Cadaveric Ultrasound-Guided Regional Anesthesia workshops for CRNAs. These are hands-on training courses utilizing cadavers and “live” scanning models, state-of-the-art ultrasound technology, and a comprehensive approach to regional anesthesia techniques for surgery and acute pain management. Space is limited, so register today!

2022 Workshop Schedule:

February 27 — Basic Course [SOLD OUT]
March 20 — Basic Course
July 24 — Advanced Course
October 2 — Basic Course
November 13 — Advanced Course

For more information, contact Bill Johnson at (615) 732-7846 or

Advanced Physiologic Foundations Class

Taught by Brett Clay, DNAP, CRNA, this course discusses advanced human physiologic concepts at the system, organ, cellular, and subcellular levels, with the overall goal to enhance the learner’s foundation for nursing practice. This year, a new summer course is available: May 2 – Aug. 11. Application deadline: March 31.

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News Notes

Service in Action: Fall 2021 Service Week

MTSA students, faculty, staff and friends participated in Service Week in November, volunteering for numerous special projects, including:

  • packaging 25,000 meals for those in need with Rise Against Hunger;
  • cleaning, organizing and more at King’s Daughters Child Development Center;
  • giving blood during the Red Cross Blood Drive; and
  • crafting cards for FiftyForward Meals on Wheels.

The week culminated with a night of music and worship featuring Christian recording artist Mark Shultz. Special thanks to all who volunteered and helped promote the spirit of service for which MTSA is known!

Honduras Mission Trip

MTSA 2021 graduates Ashley Stokes and Lucas Urbi (pictured) recently took their talents overseas by providing anesthesia and regional anesthesia to patients in Honduras. They traveled with Baptist Medical and Dental Mission International. The trip was sponsored by Ray Alonge, CRNA.

Students’ Scholarly Projects Accepted for Publication

The following scholarly projects have been submitted by MTSA students and approved for publication by professional journals.

Efficacy and Safety of Buprenorphine in a Single Shot Peripheral Nerve Block: A Systematic Review and Meta-Analysis of Randomized Controlled Trials April Cook AANA
Assessment Tools for the Evaluation of Simulation-Based Competency In Ultrasound Guided Regional Anesthesia: An Integrative Review Gail Crawford AANA
Compliance with Opioid Disposal Following Opioid Disposal Education in Surgical Patients: A Systematic Review Stace Dollar Journal of PeriAnesthesia Nursing
Surgical Patient Compliance with Healthcare Facility Provided In-home Opioid Disposal Products: A Systematic Review John Edwards Journal of Nursing Administration


Sporting Clay Tournament

MTSA hosted its 5th Annual Sporting Clay Tournament at the Nashville Gun Club on Nov. 5, with participants aiming to help reduce opioid abuse. All proceeds from the event funded MTSA’s opioid reduction initiative.

Brad Koss Named President of TANA

MTSA Alumnus Brad Koss, DNAP, CRNA, was recently named the 2021-22 president of the Tennessee Association of Nurse Anesthetists (TANA). Koss, who is the CRNA Manager of Education at Vanderbilt University Medical Center in Nashville, took office as TANA president in October.

“It is an honor to have been elected by my peers to represent them in this position,” said Koss. “Getting to know my fellow board members, I am perpetually amazed by their dedication to their profession and patients. I’m excited to take on this role in anticipation of what the year ahead will bring for TANA’s 2,400 members.”

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MTSA Calendar

Feb. 27 – Basic Cadaveric Ultrasound-Guided Regional Anesthesia Workshop [SOLD OUT]
March 20 – Basic Cadaveric Ultrasound-Guided Regional Anesthesia Workshop
March 31 – Application deadline for Advanced Physiologic Foundations Class
April 12 – MTSA Career Fair
May 5 – 8th Annual MTSA Mission & Awards Gala
May 31 – Application deadline for Practice Doctorate Program
June 1 – Application deadline for Nurse Educator Certificate Program, DNAP Completion Program, and Acute Surgical Pain Management Fellowship
July 24 – Advanced Cadaveric Ultrasound-Guided Regional Anesthesia Workshop
Sept. 15 – 19th Annual MTSA Golf Classic
Oct. 2 – Basic Cadaveric Ultrasound-Guided Regional Anesthesia Workshop
Nov. 4 – 6th Annual MTSA Sporting Clay Tournament
Nov. 13 – Advanced Cadaveric Ultrasound-Guided Regional Anesthesia Workshop

For additional details, visit

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Gowns, Golf, and Guns


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New Learning Resource Center

Students and faculty will soon have access to the new Learning Resource Center in the Magan Building after renovations are complete. A part of the facility will be dedicated for research, including faculty offices. The front portion will be open for students to use for studying or small group meetings. The entire facility was envisioned and designed with MTSA students in mind, using various sound-canceling equipment and structures as well as common areas for gathering.

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