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August 1997
Volume 61 |
Number 8
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| The Role of ASRA
in Pain Management |
Denise J. Wedel, M.D., President
American Society of Regional Anesthesia
The American Society of Regional Anesthesia (ASRA) has a long
history of involvement in pain management dating back to 1923
when the Society was originally created.
 Louis
Gaston Labat, the first president, was born on the French-owned
island of Mahe and trained in Paris. Based on his reputation as
a regional anesthetist and scholar, he was invited by Charles
H. Mayo and William J. Mayo to come to their clinic in Rochester,
Minnesota, in 1920. During his year at the Mayo Clinic, Labat
lectured to the surgeons on all aspects of regional anesthesia
and worked on his book, Regional Anesthesia: Its Technique
and Clinical Application, which was published in 1922. Labat
left Minnesota for New York in 1921, where he continued to work
and contribute to our specialty until he died in 1934.1
The discovery of the hollow needle and syringe in the latter
part of the 19th century, along with the development of procaine
at the turn of the century, set the stage for development of regional
anesthetic and pain management techniques at this time. Bacon
et al.2 described the interest in regional anesthesia
and pain management in the 1920s and 1930s as small but significant
and steadily growing.
It has been stated that the original ASRA was formed in 1923
to honor Dr. Labat, who modestly declined to have the society
named after him. The initial meetings of this early ASRA were
spent in examining the existing research and technology in regional
anesthesia in order to expand its scope. The original ASRA was
very active in promoting the education of residents in the areas
of regional anesthesia and pain management, defining qualifications
for technical procedures and providing information to assist in
reimbursement of blocks.
In 1939, the Society voted to merge with ASA. During the next
35 years, interest in nerve block techniques continued to grow.
In 1976, a group of dedicated regional anesthesiologists, including
Harold Carron, M.D., Donald L. Bridenbaugh, Jr., M.D., P. Prithvi
Raj, M.D., Alon P. Winnie, M.D., and Jordan Katz, M.D., reactivated
the separate society concept and had the first annual meeting
of the "new" ASRA. This meeting was scheduled to be
held in Las Vegas, Nevada, but due to a strike was moved to Phoenix,
Arizona, at the last minute. In spite of this inauspicious beginning,
ASRA has thrived, with membership growing from 442 in 1977 to
almost 7,000 today. The articles of incorporation clearly state
the purpose of the Society:
"to associate and affiliate into one organization all
anesthesiologists and other physicians and scientists who are
engaged in or interested in the techniques of regional anesthesia
for surgery, obstetrics and pain control; to encourage specialization
and research in these areas; to promote and sponsor courses
and workshops; to disseminate information on regional anesthetic
procedures in all anesthesiology training programs; to edit
and publish articles in these and related subjects; and in all
ways to develop and further the knowledge of safe techniques
for providing surgical and obstetrical anesthesia with local
anesthetic agents and for producing diagnostic and therapeutic
blocks with local and lytic agents for the management of pain."
As ASRA has grown in membership, service and reputation, its
commitment to furthering regional anesthesia and pain management
in the operating room, obstetrical suite, postoperative ward and
pain clinic has grown apace. ASRA provides educational programs
such as its annual meeting and regional workshops, funds research
(Koller and FAER grants) and fellowships (Braun Fellowships),
publishes laboratory and clinical studies (in its journal Regional
Anesthesia) and represents anesthesiologists specializing
in regional anesthesia and pain management at the ASA House of
Delegates.
The Society nurtures anesthesiology residents by providing free
membership for first-year residents, actively involving resident
members in societal functions, funding a resident research award
and publishing a pain fellowship program directory that lists
and describes all pain fellowships accredited by the Accreditation
Council for Graduate Medical Education. ASRA has suggested guidelines
to the American Board of Anesthesiology (ABA) regarding recommended
minimum numbers of regional anesthetic procedures required in
residency programs. In addition, it has provided administrative
services to the Association of Anesthesiology Pain Management
Program Directors, chaired by Stephen Abram, M.D., an organization
that formulates policies and recommendations regarding pain fellowship
training issues.
The treatment of pain has a high profile in the media and in
the mind of the public. Its rapid growth has resulted in the proliferation
of numerous "pain therapists," be they physicians or
nonphysicians, all of whom claim expertise in the management of
pain. The role of ASRA also has expanded to meet this increasing
emphasis on pain management and the attendant need for supportive
technical skills.
This organization is ideally situated to provide the expertise,
education and resources to its members to keep up with this growth
and meet the challenges provided by the ever more complicated
patients and administrative issues facing our specialty. More
importantly, ASRA is an organization of anesthesiologists committed
to advancing well-defined goals for patient evaluation and treatment
and has a history of success. As such, it is unique in the pain
management world.
References:
- Brown DL, Winnie AP. Biography of Louis Gaston Labat, M.D.
Regional Anesth. 1992; 17:249-262.
- Bacon DR, Reddy V, Murphy OT. Regional anesthesia and chronic
pain management in the 1920s and 1930s: The influence of the
American Society of Regional Anesthesia. Regional Anesth.
1995; 20:185-192.
Denise J. Wedel, M.D., is Professor of
Anesthesiology at Mayo Medical School, Rochester, Minnesota.
E-mail the author.
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