Dr. Karen Boretsky is director of the Perioperative Regional Anesthesia Program at Boston Children’s Hospital and a lecturer in Anesthesia at Harvard Medical School. She is also a valued BK Ultrasound key opinion leader, and has recently shared her expertise in the development of a forthcoming, small-footprint pediatric transducer.
As a pediatric anesthetist, Dr. Boretsky’s role is to identify children at risk of moderate-to-severe post-operative pain, and to administer the appropriate nerve blocks for a pain-free recovery. Although there is a long and varied list of procedures that benefit from pediatric regional anesthesia, it is still a relatively new and underused specialty in the United States, and only 10 to 20 pediatric tertiary care facilities are able to provide similar services.
Dr. Boretsky will typically assist in procedures including anterior cruciate ligament repairs of the knee, and a complex hip repair called a periacetabular osteotomy (PAO) – an operation for patients too young for hip replacement surgery. These are characteristically painful procedures that benefit from ultrasound-guided regional anesthesia to neutralize post-operative pain, which can be particularly distressing for the pediatric patient population. Pediatric regional anesthesia is also valuable in minor procedures including the fitting of gastric feeding tubes on high-risk babies. As Dr. Boretsky says, “Although it’s just a little surgery, when they breathe against the incision it hurts. To have them be more comfortable and not stressed out and using a lot of oxygen is just better patient care for them.”
Dr. Boretsky’s work has made a significant impact on the comfort of children, both operatively and during recovery. Of the anterior cruciate ligament repair population, “We were able to decrease the unanticipated hospital admit rate for that one diagnosis from 18% down to 5.6%. Not only were these children not having pain afterwards or vomiting, we also got them home with their own families, in their own beds, and it was just a wonderful thing.”
The evident benefits of ultrasound-guided regional anesthesia continue to drive its worldwide growth in popularity. How does Dr. Boretsky feel about the challenges of using ultrasound to guide nerve blocks?
“You start with the simple blocks – the easy ones. You do a couple of easy blocks, then you can advance up to something a little bit more complicated. It’s a progression, a spiral progression of revisiting the basic concept and building bigger ideas onto it. It’s fairly easy.”
For Dr. Boretsky, there is clearly great satisfaction in improving the quality of post-operative life for children: “I tell people I have the best job in the hospital, because I get to see kids wake up after surgery, and be comfortable, and have parents look at me and say, “This is the best surgery he or she has ever had,” or “We thought she was going to hurt more,” says Dr. Boretsky. “Here they are after major surgery, and I walk in, and they look like they had nothing done.”