Background: This study retrospectively compared the continuous epidural infusion of morphine with a single epidural injection of extended-release morphine for postoperative pain control after arthroplasty. Methods: Medical records were reviewed for subjects who had total knee or hip arthroplasty (THA) under spinal anesthesia and received either a continuous epidural infusion of morphine (Group EPID; n = 101) or an extended-release epidural morphine (Group EREM; n = 109) for postoperative pain. Data were collected for three postoperative days (POD) on: pain scores; supplemental opioids; medications for respiratory depression, nausea, and pruritus, and distance ambulated during physical therapy. Results: Pain scores were similar until subjects were transitioned to another analgesic approach on POD 2; after that time, pain scores increased in Group EPID, although they decreased in Group EREM. Supplemental opioids were used more on POD1 in Group EREM than in Group EPID, although time to first opioid and total daily morphine equivalents were similar. Naloxone and antiemetics, not antipruritics, were used more in Group EREM. Distance ambulated after THA was greater in Group EREM than in Group EPID. Conclusions: These results suggest that EREM is associated with better postoperative ambulation and analgesia during the transition to oral or intravenous analgesics, although a higher incidence of side-effects was evident.

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Background: Different methods of regional anesthesia education have been described in the literature, but none have proven to be superior. The objective of this study was to evaluate the educational value as perceived by the anesthesia resident of a regional anesthesia workshop.Methods: Twenty-eight anesthesia residents participated in a workshop, which reviewed nerve blocks of the upper and lower extremities. Prior to the workshop, each resident completed a survey assessing their confidence in their ability to perform 13 nerve blocks. At the conclusion of the workshop and at 3 months post-workshop, the residents completed similar surveys. Paired sample t-test was used to compare pre-and post-workshop confidence levels.Results: Twenty-eight residents completed the pre-, post-, and 3-month follow-up questionnaires. There was a statistically significant increase in residents" confidence level post-workshop for 11 blocks evaluated. This was sustained in 5 blocks at the 3 month follow-up survey. Senior residents had higher baseline confidence scores when compared to junior residents. When all blocks were considered, junior residents demonstrated a statistically significant increase in confidence level in independently performing nerve blocks immediately post workshop and at 3 month follow-up. Senior residents had a statistically significant increase in confidence level immediately post workshop, but not at the 3 month follow-up. 100% of participants found the workshop to be beneficial. Participants with less prior experience showed sustained increase in comfort levels at 3 months post-workshop (p=0.007). Conclusions:Based on self-reported trainee comfort level, the workshop was an effective teaching tool. Future workshops might be most effective when targeted at learners with less baseline regional anesthesia experience. Peripheral nerve block workshops can provide an important adjunct in the regional anesthesia education of resident anesthesiologists.