Background: Epidural analgesia is commonly used for pain control after reconstructive hip surgery, but its use is controversial in the presence of an intrathecal baclofen pump (ITB). The purpose of this retrospective study was to investigate the rate of serious anesthetic and postoperative complications as well as the efficacy of epidural analgesia compared with lumbar plexus blocks (LPBs) for pain management after neuromuscular hip reconstruction in children with cerebral palsy (CP) and ITB. Methods: Pediatric patients with CP and ITB undergoing hip reconstructive surgery from 2010 to 2019 were retrospectively identified. Patients receiving epidural analgesia were compared with those receiving LPB. Morphine milligram equivalents per kilogram were used as a surrogate measure for pain-related outcomes, as pain scores were reported with wide ranges (eg, 0 to 5/10), making it unfeasible to compare them across the cohort. Postoperative complications were graded using the modified Clavien-Dindo classification. Results: Forty-four patients (26/44, 59% male) underwent surgery at an average age of 10.3 years (SD = 3.4 y, range: 4 to 17 y). The majority utilized LPB (28/44, 64%) while the remaining utilized epidural (16/44, 36%). There were no differences in rates of serious complications, including no cases of ITB malfunction, damage, or infection. During the immediate postoperative course, patients who received LPB had higher morphine milligram equivalents per kilogram requirements than patients who received epidural analgesia. Conclusions: In patients with CP undergoing hip reconstruction surgery with an ITB in situ, epidural anesthesia was associated with improved analgesia compared with LPB analgesia, with a similar risk for adverse outcomes. Epidural catheters placed using image-guided insertion techniques can avoid damage to the ITB catheter while providing effective postoperative pain control without increasing rates of complications in this complex patient population. Level of Evidence: Level III.

To improve the quality of our instruction, and to contribute to student success, we designed an instructional development program using peer mentoring and observation grounded in evidence-based practices. We identified three methods of peer observation and mentoring to create an innovative progressively in-depth program that helps librarians understand what is happening in the classroom, and works within a community of practice to identify ways to improve the quality of our instruction. These tools, used in higher education, were then customized to work for information literacy instruction: Teaching Squares, the Teaching Practices Inventory-Information Literacy Instruction, and the Classroom Observation Protocol for Information Literacy. These tools help librarians identify evidence-based practices, understand what occurred in their classrooms, and lead to student-focused teaching. This article discusses the development of these tools and initial findings. teaching (Handelsman, Miller, & Pfund, 2007), increased course structure (Eddy & Hogan, 2014), active learning (Freeman et al., 2014) and flipped classrooms (Arnold-Garza, 2014; Gross et al., 2015) to name a few of the most prevalent terms. For purposes of this paper, we will call all of these methods evidence-based practices. We are not alone in needing to learn how to integrate these approaches into our teaching practice. Many faculty and instructors also need to change to accommodate new evidence about student learning and effective teaching. To help them with these changes, full time faculty and instructors have a culture of peer observation and evaluation that librarians typically do not. We suggest that we adopt programs that build communities of practice, and tools that articulate best practices for effective teaching, so we can form a culture of observation that is responsive to the needs of librarians and students. We can use mentoring and reflection to integrate new teaching methods, and to improve the effectiveness of our