Associate Professor of Clinical Anesthesiology New York University School of Medicine
Training and Certification
1996 at MD, Faculté de Médecine Broussais - Hôtel Dieu (Université Pierre et Marie Curie), Paris, France
1996: French Specialty Board Certification in Orthopedic Surgery
2002: Diplomate of the American Board of Anesthesiology; recertified in 2012
2003:Certification in Critical Care Medicine
June 2010 – current: Associate Professor of Clinical Anesthesiology at NYU School of Medicine, New York, NY
Recent significant peer-reviewed articles
Beaussier M, Atchabahian A, Dufeu N. Regional anesthesia and the perioperative period: basics and principles. Tech Reg Anesth Pain Manag 2008; 12(4):171-177
Beaussier M, El’Ayoubi H, Rollin M, Parc Y, Atchabahian A, Chanques G, Capdevila X, Lienhart A, Jaber S. Parietal analgesia decreases postoperative diaphragm dysfunction induced by abdominal surgery: A physiologic study. Reg Anesth Pain Med 2009; 34(5):393-397
Aissou M, Snauwaert A, Dupuis C, Atchabahian A, Aubrun F, Beaussier M. Objective assessment of the immediate postoperative analgesia using pupillary reflex measurement: A prospective and observational study. Anesthesiology 2012;116(5):1006-1012
Atchabahian A, Schwartz G, Hall CB, Lajam CM, Andreae MH. Regional analgesia for improvement of long-term functional outcome after elective large joint replacement. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD010278
Goldblum E, Atchabahian A. The use of 2-chloroprocaine for spinal anesthesia. 2013; Acta Anaesthesiol Scand, 2013; 57(5):545-552
Adams O, Cuff G, Mouzi LK, Lukasiewicz E, Atchabahian A, Champeil E. Liquid chromatography determination of total concentrations of ropivacaine in human plasma during regional anesthesia via the neurostimulation guidance technique or the ultrasound guidance technique. Submitted for publication, 2013
Gupta R, Bhar S, Atchabahian A. Prilocaine spinal anesthesia for ambulatory surgery: A review of the available studies. Submitted for publication, 2013.
Soliman S, Salas F, Mellor A, Atchabahian A. Practice patterns of regional anesthesia for orthopedic surgery: An international survey. Submitted for publication, 2013.
Dufeu N, Marchand-Maillet F, Atchabahian A, Ait Yahia Y, Milan D, Robert C, Coroir M, Beaussier M. Evaluation of ultrasound-guided selective upper-limb distal blocks for postoperative analgesia after ambulatory hand and wrist bone surgery performed under axillary blockade. Submitted for publication, 2013.
Atchabahian A, Gupta R. (Eds.) The Anesthesia Guide. McGraw-Hill, New York, NY, 2013. ISBN 978-0071760492
Comments a recent paper about Continuous femoral block
Continuous femoral nerve blocks: the impact of catheter tip location relative to the femoral nerve (anterior versus posterior) on quadriceps weakness and cutaneous sensory block.
Ilfeld BM, Loland VJ, Sandhu NS, Suresh PJ, Bishop MJ, Donohue MC, Ferguson EJ, Madison SJ.
Anesth Analg. 2012 Sep;115(3):721-7.
The femoral nerve block (FNB) is typically one of the first blocks regional anesthesia trainees learn. It is used to provide postoperative analgesia for a variety of procedures on the anterior thigh and the knee, especially total knee arthroplasty (TKA) and ACL reconstruction. It is also used following hip surgery, although the effectiveness of the FNB is more questionable in that setting.One of the drawbacks of the FNB is quadriceps motor blockade, which can impair rehabilitation and possibly lead to falls. An ideal technique would block mostly sensory rather than motor components of the femoral nerve, possibly by placing the local anesthetic (and/or the catheter in the case of a continu ous block) in a specific location near the nerve. The branches to the quadriceps seem to be mainly located on the posterior aspect of the nerve.In this study, Brian Ilfeld and coll. tested the hypothesis that placing a perineural catheter superficial (anterior) or deep (posterior) to the femoral nerve would alter the degree of motor and sensory blockade. Seventeen healthy volunteers acted as their own controls, and catheters were placed near both femoral nerves. The dominant side was randomized to having the catheter placed in the superficial or deep position, and the catheter on the non-dominant side was placed in the other position. Ultrasound guidance was used, and 4 mL/h of 0.1% ropivacaine was infused for 6 hours, after an initial priming bolus of 2 mL. Quadriceps strength and tolerance of TENS as a measure of sensory blockade were measured at baseline then every hour for 9 hours, then at 22 hours. They found that while quadriceps strength did not differ between the groups, maximum tolerance of TENS was higher when the catheter was placed anterior than when it was posterior to the nerve. The authors suggest that anterior placement might provide improved analgesia and allow using less local anesthetic, thus limiting the motor block.As the authors acknowledge, the main limitation of this study is that the sensory block that is evaluated is purely cutaneous and does not predict whether the sensory block of the deep tissues and bone would be different between the groups. Performing this study in patients undergoing TKA would have given results that are more useful clinically. Providing analgesia for major knee surgery is challenging, and the fact that so many different techniques are being used bears witness to the fact that there is no ideal approach. While the FNB, single-injection or continuous, is very widely used, two new approaches have been gaining ground: local anesthetic infiltration analgesia (LIA) and the adductor canal block (ACB). The ACB blocks only motor branches of the femoral nerve, including the saphenous nerve, and probably the posterior branch of the obturator nerve. While the analgesia provided is not as intense as that following a FNB, it is effective enough to allow the patient to ambulate early on and participate in physical therapy. Some studies suggest that combining LIA and ACB might yield the best results, providing excellent analgesia with little or no motor block.An important concept is that the block is only one component of a multimodal and multidisciplinary management that should include multimodal pharmacological analgesia, physical means (compressive dressing, icing), local anesthetic infiltration by the surgeon, adapted physical therapy and a well-defined clinical pathway.
Arthur Atchabahian MD
Interview with the expert
1- Are you a defender of the continuous femoral block for total knee replacement surgery? Do you prefer any alternative regional technique?
In my experience, the adductor canal block provides almost as good analgesia as the femoral nerve block, without causing motor blockade of the quadriceps muscle. I will use it preferentially in patients who are candidates for rapid rehabilitation; on the other hand, I will use a femoral nerve block for an elderly, morbidly obese patient who is obviously not going to do physical on the day of surgery. Whether a single-injection or a continuous block is preferable is not quite clear yet. While it makes sense intuitively that a continuous block would provide better analgesia, this has not been confirmed by the literature.
2- Are we responsible for the number of falls and late deambulation after lower limb blocks?
Some patients indeed fall because of impaired motor or proprioceptive function after a nerve block. However, patients can also fall when they have not received
any block. Surgery by itself causes alterations in motor strength and proprioception. Physical therapists do not always take into account the fact that the patient is blocked, and several articles reporting falls after nerve blocks basically describe physiotherapists getting patients out of bed and watching them fall without doing anything to prevent it.
As far as delayed ambulation is concerned, we need to strike a balance between analgesia and motor and sensory blockade. Again, using an adductor canal block rather than a femoral nerve block might allow earlier ambulation with a lower risk of fall.
3- Please, share with us 2 intense moments in your career: the best and the worst.
One of the best moments in my career was when the book I co-edited, The Anesthesia Guide, published by McGraw-Hill, came out. It was born out of my idea that a more practical approach was needed for handbooks, that tend to be smaller versions of large textbooks. Publishing a book is a bit like having a child: once it is out, it has a life of its own and must fend by itself. It remains to be seen whether it will be successful.
Each time one of my patients dies or has a bad outcome, that could qualify as the worst time in my career. This happens more rarely now that I only provide anesthesia for elective orthopaedic surgery. But perhaps the worst time emotionally was when the hospital I was working at, St Vincent, located in Greenwich Village in Manhattan, went bankrupt and closed. St Vincent was part of the history of the neighbourhood. It had received the survivors of the Titanic wreckage, and the wounded following the attacks of September 11, 2001. Yet it closed like a grocery store that cannot pay its bills, and people who had worked there for years or decades, as well as patients who felt it was to a certain extent their home, were left stranded. I still live nearby and I sometimes walk by and watch the progress of the construction work to turn the building into multi-million-dollar condos.