Figure 1. ASRA LAST 2.0 is available for download from the App/iTunes store for iOS devices.

One of the most serious but rare adverse events associated with using local anesthetics is local anesthetic systemic toxicity (LAST). As readers know, local anesthetics aren’t just delivered by anesthesiologists; they may be administered by a variety of medical and surgical specialists as well as dentists and paramedical personnel. Therefore, education must be easily available to all professionals who administer the agents. Wouldn’t it be great if all health care providers could use a simple tool to access instructions on what to do in case of a LAST event? As you likely already know, we have such a tool. And an app (Figure 1).

All of that came out of an ASRA research grant. In 2004, Dr. Guy Weinberg was awarded the Carl Koller Memorial Research Grant, which he and his colleagues used to conduct a study of lipid infusion in the removal of bupivacaine and bupivacaine toxicity in the isolated rat heart to determine a mechanism of action related to bupivacaine cardiac toxicity. Today, ASRA consistently receives inquiries and requests to reprint the LAST checklist from across the healthcare spectrum. The LAST guidelines were updated in April 2018, and the updated app, LAST 2.0, was made available almost immediately thereafter.

“The impact of the program is, as just described, wide reaching and affects all of us in our daily practice. Studies conducted today may one day turn into the seminal works that guide practice beyond just our specialty.”

ASRA’s mission is to advance the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy. Given that not all ASRA members may be interested in conducting research, ASRA’s research grants program can be an overlooked benefit. However, the impact of the program is, as just described, wide reaching and affects all of us in our daily practice. Studies conducted today may one day turn into the seminal works that guide practice beyond just our specialty.

Figure 2. Gina Votta-Velis, MD, PhD

 The 2018 ASRA Carl Koller Memorial Research Grant recipient is Dr. Gina (Effrossyni) Votta-Velis, MD, PhD. Dr. Votta-Velis and colleagues are studying “Lidocaine Infusions in Pancreatic Cancer: Translational Studies in a Preclinical Model and Human Subjects" (Figure 2). This study is expected to elucidate the effect of lidocaine infusions in the perioperative period on the biology of circulating tumor cells, signaling mechanisms and gene expression related to metastasis. 

Dr. Votta-Velis and her co-investigators hypothesized that lidocaine infusion might control metastasis or recurrence by inhibiting specific enzymatic activities, signaling pathways and gene expression that are associated with the metastatic process, in circulating cancer cells. If their hypothesis proves to be correct, it would provide a sound rationale for conducting a prospective, randomized, controlled clinical trial evaluating the effect of perioperative lidocaine infusions in preventing pancreatic cancer metastasis. Results of such a study could potentially have an impact on the anesthetic management of cancer patients.

ASRA’s last Chronic Pain Research Grant recipient, Shalini Shah, MD, who was awarded the grant in 2016, is currently investigating the effectiveness of onabotulinumtoxin A (Botox®) in the treatment of pediatric migraines. She provided an encouraging update at the 16^th Annual Pain Medicine Meeting in November 2017.

Figure 3. Delara Brandal, MD

 Two newer grants just implemented this year are the Young Investigator Award and the Graduate Student Award, which provide opportunities to those newer to the research field. Delara Brandal, MD, received the first Young Investigator Award at the 2018 World Congress on Regional Anesthesia and Pain Medicine for her project on development of a clinical decision support tool for prescribing opioids (Figure 3). Dr. Brandal will work with mentor Maxime Cannesson, MD, PhD, and Siamak Rahman, MD, all from the UCLA Department of Anesthesiology and Perioperative Medicine. The project is timely, given the current opioid epidemic in the United States. Someone dies from an opioid overdose every 12.5 minutes, with more than half happening at home. Some of these victims had their initial exposure to opioids with surgery or an acute injury. I believe that regional anesthesia and analgesia can play in integral role in combating the crisis by reducing opioid use in the acute pain setting. If each of us succeeds in decreasing the number of opioids being prescribed at discharge, the impact of saving lives will be tremendous.

Figure 4. Desmond H. Fung, BSc

Desmond H. Fung, BSc, was the first-ever recipient of the Graduate Student Award, and he will be looking at lidocaine derivatives in his mentored grant (Figure 4). Take note: letters of intent for the next grant cycle for the Young Investigator Award are due August 15 and letters of intent for the Graduate Student Award are due September 15.

These are just a few examples of the many exciting projects that have come out of ASRA research grants and demonstrate the value of the program beyond our organization. ASRA members have access to $240,000 in research funding each year through the program. This includes:

• Chronic Pain Medicine Grant (up to $200,000 awarded biannually)
• Carl Koller Memorial Research Grant (up to $200,000 awarded biannually)
• Young Investigator Award (up to $30,000 awarded annually)
• Graduate Student Award (up to $10,000 awarded annually)

The two new research grants started this year will no doubt lead to some promising results for future investigators and will shape the way we, as regional anesthesiologist and pain physicians, practice in the world.

So even if you are not actively engaged in research, be proud of the role that your membership organization is playing in advancing our specialty!

Share these upcoming letter of intent deadlines with your colleagues and students:

• Young Investigator : August 15, 2018
• Graduate Student: September 15, 2018

Visit www.asra.com/research to learn more.