Interview with a Leader in the Field: Brian Ilfeld – 2022 Gaston Labat Award Recipient
Cite as: Machi A. Interview with a leader in the field: Brian Ilfeld – the 2022 Labat Award recipient. ASRA Pain Medicine News 2022;47. https://doi.org/10.52211/asra080122.029
Brian Ilfeld, MD, received the Gaston Labat Award on April 2, 2022, in conjunction with the 47th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in Las Vegas, NV. Dr. Ilfeld is a professor of anesthesiology,
in residence, in the division of Regional Anesthesia and Acute Pain Medicine, Department of Anesthesiology, at the University of California San Diego.
ASRA Pain Medicine News Special Projects Associate Editor Anthony Machi, MD, sat down with Dr. Ilfeld recently to discuss his career trajectory, reminisce, and drop some equally impressive names.
Anthony Machi: Can you outline your journey?
Brian Ilfeld: If you mapped my professional journey, it would look like a squiggly line that surprised everyone—most of all myself—by delivering me to where I am today. In college I wanted to be a federal attorney, took the law school entry test (LSAT), and was prepared to apply to law schools until I actually worked with a district attorney in my senior year and subsequently changed my mind. So, I went back to school after graduation to take pre-veterinary school classes, until I actually worked with a veterinarian and changed my mind. So, I took my pre-vet classes and applied to medical school. I did an internship in OB-GYN, but—you guessed it (is there a pattern here?)—changed my mind and switched to anesthesiology. Hey, as my wife says, I’m an experiential learner…
The first case on my first day of residency I did a transarterial axillary block and told my attending that day (Dr. Jeffrey Swisher) I wanted to do a fellowship in regional anesthesia. I never wavered in that decision, but if there had been a vote upon residency graduation, I would have been voted LEAST likely to go into research.
I arrived at the University of Florida to start my regional fellowship with Dr. Kayser Enneking and found an IRB-approval letter on my desk for a study that Kayser had designed and was ready for me to execute. Well, I had little interest in research (so I thought), and so I promptly ignored the letter and instead tried to read every published article I could find involving regional anesthesia. Well, that took longer than originally anticipated, and, by my second month, Kayser informed me that while she encouraged my reading, it was time to start the research study. By the second day I was completely hooked (I never did finish reading every regional-anesthesia article ever published…).
Since that day, I never wavered in my passion for or pursuit of regional anesthesia and pain-related clinical research. So, I earned a master’s degree in clinical research, had a National Institute of Health (NIH) -mentored career development award funded with Drs. Daniel Sessler and Tony Yaksh as my mentors, began designing multicenter studies, and started looking for investigators who were interested in collaboration.
A mutual friend introduced me to Dr. Edward Mariano who had just started the regional anesthesia program and fellowship at the University of California, San Diego, and Ed enrolled as many participants at U.C. San Diego as we did at the University of Florida. He subsequently “recruited” me to U.C. San Diego (recruited is in quotes because I was raised in California, I wanted to return to be closer to my family, and I had always wanted to live in San Diego; so, at the time I thought I was “recruiting” Ed to offer me a position!). I have pursued federal grants over the last 15 years at U.C. San Diego since the multicenter clinical trials I want to complete require millions of dollars to execute.
I’m not sure where or when it ends for me, but my grandfather was an academic orthopedic surgeon who published his last manuscript at age 86 (search: “Ilfeld FW”). I’m 55 now, so by that measure, I’m just getting started!
AM: What personal qualities or skill sets have been most important along the way?
BI: Of the many classes of my medical school and master’s degree training in research, I believe that it was the scientific writing class from my MS degree that has benefited me most (when my 7-year-old son asked me what I actually did as a doctor, I answered him honestly: mostly write… protocols, grant proposals, manuscripts, endless emails, etc… he wasn’t impressed and instead chose his mother’s job—a clinical pediatrician—for his class presentation).
I’ve found that scientific writing is of paramount importance for a research-based career. I review grant proposals for the NIH and Department of Defense. There are so many investigators infinitely smarter than I, with fantastic ideas/projects, but they often have a hard time conveying their meaning and intentions due to a lack of writing skills. If one cannot clearly and concisely convey intent in grant proposals and manuscripts, the results are rarely favorable, and, without funding and publications, a career in research is very challenging.
AM: In your view, which of your studies has had the most impact on the practice of regional anesthesia and why?
BI: I believe the first three randomized, placebo-controlled studies I started during my fellowship with Kayser. They helped reveal the potent analgesia and opioid-sparing offered by continuous peripheral nerve blocks (and use for ambulatory patients).
AM: How do you define professional success for yourself?
BI: For me, professional success is being able to perform the research that I believe is most important to pursue and, I hope, helping to relieve the most pain with the fewest risks and side effects.
AM: What has been your most rewarding accomplishment?
BI: Without a doubt, receiving the 2022 ASRA Pain Medicine Labat Award was the most rewarding moment of my professional career. To receive such an honor from my friends and colleagues was truly the honor of a (my) lifetime.
Regarding an accomplishment, receiving federal grants that enable multicenter clinical trials ranks very high. There is a great deal of satisfaction in executing a pilot study and then putting the definitive trial and grant proposal together. They often run over 300 pages and involve up to 100 individuals at more than 10 different centers. Putting these projects together with my coinvestigators, having them reviewed favorably by my peers, and then ultimately having them funded by the federal government enables us to provide answers to important clinical questions and is immensely challenging and satisfying.
AM: What drives your professional curiosity?
BI: The clinical needs of our patients, I don’t have to tell anyone reading these words how terrible and destructive pain can be for people’s lives and how appreciative patients are if one can relieve that pain.
AM: Can you describe one or more of the most difficult professional challenges you have had in your career?
BI: Acquiring federal research funding. The first NIH grant proposal I wrote took me 6 months to complete and proposed the use of ambulatory continuous peripheral nerve blocks to treat pain following major joint arthroplasty. The reviews were not, shall we say, glowing. The score was so low that the NIH scientific officer told me that she had never seen a revision result in a score improvement that would permit funding.
I was devastated—my hopes of pursuing clinical research as a career was grounded in attaining the nonclinical time and education only a federal grant could provide. But my mentors, Kayser, Krista Vandenborne, Pamela Duncan, and Daniel Sessler, all
encouraged me to get back on the proverbial horse: if at first you don’t succeed, just keep trying. And, thank heaven for their support as the revised proposal was ultimately funded.
AM: As you look back, has there been a defining moment in your career?
BI: Without a doubt, receiving the ASRA Pain Medicine 2022 Labat Award at the Spring Conference in Las Vegas.
AM: Where do you see the most potential for future research in regional anesthesia?
BI: Anesthetics and analgesics that are not based on local anesthetics. Some promising modalities include electrical nerve stimulation, cryoneurolysis, and pulsed electromagnetic field therapy.
AM: Do you have advice to offer current trainees or early career professionals who seek to do research in regional anesthesia?
BI: Find a mentor who shares your research interests and has a proven track record doing what it is you want to do. There certainly have been world-renowned researchers who “did it on their own,” but that path is usually far
more difficult and time consuming, and it comes with a greatly decreased chance of success.
AM: How much of your success would you attribute to hard work and how much would you attribute to luck or other circumstances?
BI: I don’t think one can succeed in research without hard work; but, there are, unfortunately, many who work hard and yet are not ultimately successful. So, I attribute my ability to do the research I want to do since finishing residency to those who have mentored and supported me: Dr. Joe Neal guided me to my regional anesthesia fellowship with Kayser at the University of Florida; Kayser introduced me to clinical research, trained me clinically, and supported my request for nonclinical time following my fellowship year; the department chair, Dr. Nikolaus Gravenstein, provided the funding enabling me to earn my master’s degree in clinical research, which was critical in securing my NIH career development award, which would never have been possible without the research training and mentoring of Daniel Sessler who continues to work with me on every multicenter trial I run to this day. Edward Mariano enabled my move to U.C. San Diego and the pilot work that eventually led to the funding of multiple federal grants, which enabled me to work with other extraordinary investigators who continue to mentor me on every multicenter project: Drs. James Eisenach, Steven Cohen, and Paul Pasquina (among SO many others).
And, without the literally hundreds of investigators I have had the honor of working with over the past two decades, we could not have completed a single trial. Over the past decade, my friends and colleagues in the division of Regional Anesthesia and Acute Pain Medicine at U.C. San Diego have helped to implement every study, perform every clinical procedure, and run many of the trials on nights, weekends, and holidays: Drs. John Finneran, Engy Said, Rodney Gabriel, Matthew Swisher, among many others.
And last—but certainly not least—our program manager, Baharin Abdullah, makes everything work. She is an organizing genius who keeps every center for every clinical trial running smoothly. I couldn’t do half of what she accomplishes and am always in awe of how she never misses a single detail. It is the many mentors who dedicated so much of their time and effort to teach and guide me, the plethora of individuals who supported me and my work, and the countless colleagues who help design and implement our clinical research who have enabled what some view as “my” work (when it is always “our” work).
AM: How has involvement in ASRA Pain Medicine contributed to your success?
BI: ASRA Pain Medicine has been so integral to my career that it is hard to even know where to begin in answering that question. I knew that I wanted to do a regional anesthesia fellowship after my first case on my first day of residence (transarterial axillary block: I don’t recommend them), but my residency director only knew of one regional fellowship. I met Joe Neal at an ASRA conference, and Joe introduced me to Kayser at the University of Florida who was developing ambulatory continuous peripheral nerve blocks—exactly what I was most interested in learning.
During my fellowship, ASRA Pain Medicine gave me the opportunity to present my research and meet so many people who advanced my knowledge of regional techniques. At my first presentation, there was a person who was quite hostile during the Q&A, and when I was too nervous to answer his question, two members—Drs. Denise Wedel and Eugene Viscusi—stepped in, supported me, and let the guy know exactly what they thought of his attitude. Their reassurance really helped me in returning to speak the following year. I ran my first multicenter clinical trial soon after finishing my fellowship, and nearly everyone I work with from all over the world I met through ASRA Pain Medicine. So, ASRA Pain Medicine has been instrumental in making my research career possible.
AM: What do you love about your job?
BI: So many things, but the two that stand out most are (1) helping to take away people’s pain—that never, ever gets old—and (2) the people I get to work with who not only make our research possible, but inspire me with their inquisitiveness, knowledge, clinical skill, dedication, and enthusiasm.
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