The Regional and Acute Pain Division at the University of Virginia (UVA) comprises eleven faculty whose primary passions include treating our patients’ acute pain needs with peripheral nerve blocks, continuous peripheral nerve catheters, neuraxial procedures, and multimodal medication therapies. The Regional and Acute Pain Division provides care at the University of Virginia’s Main Hospital’s thirty-three Operating Rooms as well as in the Outpatient Surgical Center’s twelve operating rooms.
Additionally, UVA’s Ivy Mountain Musculoskeletal Center has four operating rooms and one procedure room. Our busy clinical division provides consultation and care for both surgical and medical patients. The Division performs more than 8,000 peripheral nerve blocks and continuous catheters annually, more than 2,500 neuraxial techniques annually, and participates in perioperative consults daily.
Our Acute Pain Service cares for our medical and surgical patients within the roughly 800 bed hospital and provides services to patients every day of the year. The Division works closely with all surgical and medical services, providing a high volume of procedures for the departments of Orthopedics, Plastics, Vascular and General Surgery. We provide a multidisciplinary approach to optimize patient care and patient outcomes.
Our Division has an enduring commitment to teaching and prides itself on educating fellows, residents, and medical students. There are currently two accredited Regional and Acute Pain Medicine (RAAPM) fellows and two non-accredited fellowship positions. In addition to learning regional and acute pain, we emphasize modern Point of Care Ultrasound (POCUS) education throughout the hospital.
A Message from the Division Chief
Having trained in the days of nerve stimulation and transarterial axillary blocks, I am constantly enthralled by the progress and changes within the specialty of Regional Anesthesia and Acute Pain Medicine (RAAPM). We now carry ultrasounds that fit easily into our pockets. We watch our patients walk with minimal to no pain or motor block on the same day as their total knee replacements. We can replace joints in their entirety and send patients home only hours after surgery. With a complete evolution of our specialty, we continue to discover additional indications and benefits of regional procedures and pain management techniques almost daily.
What I most like about working within UVA’s Regional Anesthesia and Acute Pain Division are the connections we are able to create within our division and department, with our surgical and medical colleagues, and most critically, with our patients. We focus on the optimization of pain and the improvement in patient outcomes to provide care for every type of patient.
We may provide care for a collegiate athlete with a torn ACL, and the same day, place a spinal in an elderly patient suffering a pathologic fracture. Our division is unique in frequently caring intraoperatively for awake patients who provide us with feedback, gratitude, and conversation. We currently have 11 faculty with diverse training and experiences. Our faculty hold positions within ASA, ASRA and SAMBA, have won teaching awards, and teach international courses.Read More
Acute Pain Service (APS)
The Acute Pain Service (APS) care team is here to help navigate patients through their hospitalization more comfortably. Our experienced team is able to add specialized medications or nerve blocks to improve patient pain control. We can also aid the surgical or medical team in utilizing existing pain medications more effectively.
Our physicians are anesthesiologists and/or full-time pain physicians. All have completed additional fellowship training in regional anesthesia and/or pain medicine and are board certified in their fields. Our physicians teach regional anesthesia and pain medicine to residents, fellows, and students who learn to actively manage the service. Many of our doctors are actively involved in pain-related research projects and national societies. Our nurse practitioner and nurse coordinator have many years of experience specific to acute pain management and are empathetic to patient concerns.
Ashley M. Shilling, MD
Ashley M. Shilling, MD, Regional Anesthesia Division Chief
Dr. Ashley Shilling is an Associate Professor of Anesthesiology and Orthopedic Surgery at the University of Virginia Medical Center. Her interests include Regional Anesthesia, Ambulatory Anesthesia, Orthopedic Anesthesia and Mentorship development. She enjoys providing care for patients in both inpatient and ambulatory settings, and is passionate about the use regional techniques in the peri-operative period to improve patient care and patient experiences.
Her roles include Regional Anesthesia Division Chief and Acute Pain Medicine and Co-Medical Director of UVA’s Ambulatory Surgical Center. Dr. Shilling serves on American Society of Anesthesiologists’ (ASA) Committee on Regional Anesthesia and Acute Pain Medicine and ASA’s Committee on Ambulatory Surgical Care. Dr. Shilling is also involved with the Society of Ambulatory Anesthesia (SAMBA) Regional and Education Committees.
Read Dr. Shilling’s Full Bio
Link to Dr. Shilling’s Publications
Peter Amato, MD
Peter Amato, MD
Dr. Amato is an Associate Professor of Anesthesiology and Pain Medicine Fellow. He specializes in regional anesthesia and acute pain medicine and frequently cares for patients undergoing orthopedic, trauma, and outpatient surgery.
Dr. Amato is active in resident and medical student education. He received a Dean’s Award for Excellence in Education in 2019. Dr. Amato is interested in non-narcotic methods to improve pain control and has active clinical research projects studying nerve blocks for hip arthroscopy, and ketamine infusions for acute pain management.
He has served on committees and special interest groups for the American Society of Regional Anesthesia and Pain Medicine and the Society for Ambulatory Anesthesia.
Paul C. DeMarco, MD
Paul C. DeMarco, MD
Dr. DeMarco is an Assistant Professor of Anesthesiology at the University of Virginia. His work encompasses anesthesia care for patients undergoing orthopedic surgery, general surgery, and multiple other surgical subspecialties. He specializes in regional anesthesia, peripheral nerve blocks, and acute pain care.
Dr. DeMarco is interested in education and is active in the Simulation Center at UVA working with and teaching Fourth Year medical students. He is a founding member of the Wellness Special Interest Group through the American Society of Regional Anesthesia and Pain Medicine. He is also involved in Acute Pain Medicine ERAS protocols.
Brittany L. Deiling, DO
Brittany L. Deiling, DO
Dr. Brittany Deiling is an Assistant Professor of Anesthesiology at the University of Virginia. She is one of the faculty members of the Regional Anesthesia and Acute Pain Medicine divisions.
She has particular interest in point-of-care ultrasound. Dr. Deiling is an active member of the American Society of Regional Anesthesia and Pain Medicine.
Read Dr. Deiling’s Full Bio
Link to Dr. Deiling’s Publications
Nabil Elkassabany, MD
Nabil Elkassabny, MD
Dr. Elkassabany is the Vice-Chair of Clinical Operations for the UVA Department of Anesthesiology. He is a Professor of Anesthesiology, specializing in Regional and Acute Pain Medicine. Prior to joining the UVA Anesthesiology Nabil Elkassabany was an Associate Professor in the Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania in Philadelphia. He was the Director of the sections of Regional and Orthopedic Anesthesiology. He was also the Director of the Anesthesia Service at the ambulatory surgery facility at Penn Medicine at University City.
Dr. Elkassabany did his undergraduate and medical education at Alexandria University, Egypt. He completed his anesthesia residency training at Cleveland Clinic, Cleveland, Ohio and his regional anesthesia subspecialty training at the University of Florida at Gainesville, Florida. He earned a Master Degree in Clinical Epidemiology and Biostatistics in December 2012 from the Perelman School of Medicine at the University of Pennsylvania and his MBA in December 2021 from the Fox School of Business, Temple University in Philadelphia. Dr. Elkassabany is also the Fellowship Program Director for Regional Anesthesia and Acute Pain Medicine at the University of Pennsylvania.
He was inducted to the Academy of Master Clinicians at the University of Pennsylvania in 2018. His research interest focuses on patients’ outcomes after orthopedic surgery, specifically patients who receive regional anesthesia in different clinical settings. He is especially interested in improving patient outcomes after major joint arthroplasty and defining the value added by regional anesthesia and acute pain medicine to patients’ perioperative experience. Nabil is a member of the Board of Directors for the American Society of Regional Anesthesia and Pain Medicine (ASRA). He also Chairs the Educational Track Subcommittee on Regional Anesthesia and Acute Pain Medicine at the American Society of Anesthesiologists (ASA). Dr. Elkassabany will be starting on July 1st, 2022.
D. Arik Elmer, MD
D. Aric Elmer, MD
Dr. D. Aric Elmer is an Assistant Professor of Anesthesiology. He completed medical school, residency and fellowship at the University of Virginia. He specializes in regional anesthesia and acute pain medicine.
Dr. Elmer was honored as an outstanding educator in 2019 with the Department of Anesthesiology Resident Physician Teaching award. He has developed curriculum for our ACGME training programs on regional ultrasound. His area of expertise focuses on the upper extremities, where he also serves on the Head and Breast Enhanced
Recovery after Surgery (ERAS) Committee for UVA Health.
Dr. Elmer is Board certified by the American Board of Anesthesiology. He also presented at the Virginia Society of Plastic Surgeons and the 65th Annual Plastic Surgery Research Council Meeting in Canada.
Brett Elmore, MD
Brett Elmore, MD
Dr. Elmore is an Associate Professor of Anesthesiology and an Associate Professor of Orthopedic Surgery at the University of Virginia. Within the Department of Anesthesiology, he serves as the Regional Anesthesia and Acute Pain Medicine Fellowship Director and the Certified Registered Nurse Anesthetist Faculty Liaison.
He is a founding member of the American Society of Regional Anesthesia Physician Mentoring and Leadership Special Interest Group and serves as a Pain Fellowship Committee member of the American Association of Pain Medicine. Dr. Elmore is also a question writer for the American Board of Anesthesiology Basic Examination. His interests within anesthesiology include regional anesthesia and acute pain medicine, clinical anatomy, orthopedic anesthesia, mentorship, education, and multidisciplinary relationships.
Read Dr. Elmore’s Full Bio
Link to Dr. Elmore’s Publications
William C. Manson, MD, Assistant Professor
William C. Manson, MD
Dr. Manson is the Medical Director of Perioperative Medicine at UVA Health. He specializes in regional anesthesiology as well as perioperative medicine. He teaches and performs point-of-care ultrasound (POCUS) at the local and national level.
Dr. Manson serves on the American Society of Anesthesiology (ASA) Editorial Board for Point-of-Care Ultrasound, and is the Vice-Chair for the American Society of Regional Anesthesia Pain Medicine (ASRA) POCUS Special Interest Group. He is the Co-Director for the ASRA POCUS Course. Dr. Manson is currently pursuing a Physician Executive Masters in Business Administration (MBA).
Read Dr. Manson’s Full Bio
Link to Dr. Manson’s Publications
Kenneth R Mullen, MD
Dr. Kenneth Mullen is an Assistant Professor of Anesthesiology. He completed medical school at the University of Kentucky and his anesthesiology residency at the University of Virginia, where he served as a Chief his final year of training. He finished his advanced training with a regional and acute pain fellowship at Duke University.
Dr. Mullen works at the UVA Outpatient Surgery Center and the Main OR on the regional service. He lectures on regional anesthesia to both residents and fellows. He recently gave a departmental Grand Rounds presentation on “Hip Fractures.”
Christopher M. Sharrow, MD
Christopher M. Sharrow, MD
Dr. Sharrow is an Assistant Professor in the Department of Anesthesiology at the University of Virginia. His clinical work focuses on the care of patients undergoing elective and trauma orthopedic surgery, as well as performing and teaching perioperative regional anesthetic techniques.
Prior to joining UVA, Dr. Sharrow served in the roles of president and vice president in a private practice anesthesia group for a total of 8 years. He has an interest in anesthesia practice management and educates residents on the business aspects of anesthesiology. He serves on the clinical compensation and resident selection Department committees.
Matthew R Thames, MD, MBA
Matthew R Thames, MD, MBA
Dr. Thames is a regional anesthesiologist specializing in peripheral nerve blocks for pain control before, during and after surgery. He completed most of his training at UVA including residency and a fellowship in Regional Anesthesia and Perioperative Management.
He is an Assistant Professor at UVA where his practice includes a mix of inpatient and outpatient anesthesia services as well as coverage of the Acute Pain Service. His clinical interests include all areas of regional anesthesiology as well as operating room efficiency. He currently serves on the Practice Management committee of ASRA.
James L. White, MD
James L. White, MD
Dr. James White is an Associate Professor of Anesthesiology. He graduated from Bowman Gray School of Medicine in Winston-Salem, NC. He completed his internship and residency at Georgetown University Medical Center in Washington, D.C. where he also became Chief Resident.
Dr. White served in the US Navy as a medical officer for many years and was recalled to active duty numerous times throughout his prestigious career. He began in academics at Georgetown as a Clinical Instructor, became an Assistant Professor, and was promoted to Associate Professor before coming to UVA. He served as the Division Director of Regional Anesthesia at UVA for a number of years in the past and now works primarily in ambulatory medicine at the Outpatient Surgery Center.
Acute Pain Service
The Acute Pain Service, under the direction of Peter E. Amato, MD, is a consult team that seeks to improve patient comfort and satisfaction through the use of multiple pharmacologic and interventional therapies. We understand how difficult it can be to deal with longstanding pain or new and severe pain associated with illness or surgery. We are comfortable working with patients who have chronic pain conditions and those who have been taking opioid pain medications for years. Treatment can involve regional anesthesia (the use of local anesthetics to numb pain), oral, intravenous, and topical medications.
We try to limit the use of narcotic pain medications whenever possible, and to recommend appropriate dosing strategies when they are needed. Our patients are those who have just had surgery, those with recent physical trauma, or others with medical problems leading to pain that is hard to control. Most of our patients are adults, but we treat children as well.
Our team is made up of multiple physicians with acute and chronic pain management expertise, anesthesia residents, acute and chronic pain fellows, a skilled nurse practitioner, and an experienced acute pain nurse coordinator. APS Services Include:
We use local anesthesia to numb part or all areas of pain. We work hand in hand with our regional anesthesia team to block nerves specific to surgical pain. Techniques include epidural and spinal anesthesia, as well as peripheral and truncal nerve blocks. Some of these techniques utilize continuous infusions of local anesthesia through a catheter inserted near nerves.
Multimodal Pain Management
We use various medications that, in combination, will reduce patients’ pain levels. Frequently used medications include acetaminophen, non-steroidal anti-inflammatory medications, muscle relaxants and antispasmodics, nerve pain medications, infusions of local anesthetics and ketamine, and opioids when needed.
Enhanced Recovery After Surgery (ERAS) protocols are standardized surgical and perioperative care plans specific to many common surgeries at UVA. They are designed to improve pain and function and get patients home sooner. The Acute Pain Service is responsible for providing regional nerve blocks and spinal injections that are part and parcel of many ERAS protocols. We will continue to see many ERAS patients postoperatively as we help to manage their multimodal pain therapies.
Perioperative Pain Consult
Our team can be a resource to the surgical team BEFORE patients undergo surgery. Patients with existing chronic pain, substance abuse disorder (SAD), or who
currently take higher dose opioids to manage their pain, are candidates for a more specialized pain plan. Through a telemedicine visit with patients, we can design a plan for patient care before the surgery date.
Point of Care Ultrasound (POCUS)
The UVA Regional Anesthesia and Acute Pain Medicine program is a leader in Point-of-Care Ultrasound (POCUS). Multiple faculty members have taught at the ASRA POCUS Course, which has been attended by many of our faculty and fellows. This year, all of our RAAPM fellows attended the ASRA POCUS course in the fall of 2021, and one of our current fellows is planning to lead an international POCUS course prior to the end of his fellowship.
POCUS has become an integral component of the practice of regional anesthesiology and pain medicine. Incorporating the familiarity with ultrasound with diagnostic imaging skills creates the ideal adjunct to the procedural focus of regional anesthesiology. Symptomatic patients can be immediately diagnosed with the aid of POCUS, shifting the clinical focus to patient treatment. This is a key field for anesthesiologists of all specialties.
We encourage the UVA RAAPM fellows to attend the ASRA POCUS Course to develop a strong foundation in these skills. Once the strong foundation has been established, regional anesthesiology fellows further develop their POCUS skills through regular imaging of patients in the pre-operative and post-operative arenas. The fellows also have the opportunity to coordinate acquisition and interpretation skills through joint education sessions with the critical care fellows. The Regional Anesthesiology division is developing a joint program with the Emergency Medicine Department to further augment opportunities to learn POCUS in the Emergency Department.
Lastly, the regional anesthesiology fellows have the option to complete their ASA certificate in POCUS during their fellowship. William Manson serves on the ASA’s Editorial Board for POCUS and he can directly mentor the fellows in POCUS. The fellow can complete all aspects of the certificate during the fellowship year. This certificate is the recognized marker of competency in POCUS in Anesthesiology.
Total Joint Arthroplasty Enhanced Recovery After Surgery (ERAS)
In collaboration with the Department of Orthopedic surgery, we have created an Orthopedic Surgery Total Joint Arthroplasty (TJA) Enhanced Recovery After Surgery (ERAS) Pathway. The protocol was instituted in 2017 after a thorough review of the literature on best clinical practices. Utilizing data-proven regional, neuraxial, and multimodal analgesic and anesthetic techniques, we provide our patients with comprehensive pain control while still allowing maximal participation in the postoperative rehabilitation process and in an effort to hasten safe and appropriate discharge from the hospital.
We are collecting data on this process and plan to assess patient outcomes in hopes of further improving our patient care at UVA, then publishing the results to influence care on patients globally.
Mariano ER, Dickerson DM, Szokol JW, Harned M, Mueller JT, Philip BK, Baratta JL, Gulur P, Robles J, Schroeder KM, Wyatt KEK, Schwalb JM, Schwenk ES, Wardhan R, Kim TS, Higdon KK, Krishnan DG, Shilling AM, Schwartz G, Wiechmann L, Doan LV, Elkassabany NM, Yang SC, Muse IO, Eloy JD, Mehta V, Shah S, Johnson RL, Englesbe MJ, Kallen A, Mukkamala SB, Walton A, Buvanendran A. “A multisociety organizational consensus process to define guiding principles for acute perioperative pain management.” Reg Anesth Pain Med. 2022 Feb;47(2):118-127. doi:10.1136/rapm-2021-103083. Epub 2021 Sep 22. PMID: 34552003.
Thiele RH, Sarosiek BM, Modesitt SC, McMurry TL, Tiouririne M, Martin LW, Blank RS, Shilling A, Browne JA, Bogdonoff DL, Bauer TW, Hedrick TL. “Development and Impact of an Institutional Enhanced Recovery Program on Opioid Use, Length of Stay, and Hospital Costs Within an Academic Medical Center: A Cohort Analysis of 7774 Patients.” Anesth Analg. 2021. Feb1;132(2):442455.doi:10.1213/ANE.0000000000005182. PMID: 33105279.
Manson WC, Blank RS, Martin LW, Alpert SB, Dobrzanski TP, Schneider EB, Ratcliffe SJ, Durieux ME. “An Observational Study of the Pharmacokinetics of Surgeon-Performed Intercostal Nerve Blockade With Liposomal Bupivacaine for Posterior-Lateral Thoracotomy Analgesia.” Anesth Analg. 2020. Dec;131(6):1843-1849. doi:10.1213/ANE.0000000000005115. PMID: 32833710.
Haskins SC, Bronshteyn Y, Perlas A, El-Boghdadly K, Zimmerman J, Silva M, Boretsky K, Chan V, Kruisselbrink R, Byrne M, Hernandez N, Boublik J, Manson WC, Hogg R, Wilkinson JN, Kalagara H, Nejim J, Ramsingh D, Shankar H, Nader A, Souza D, Narouze S. “American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part I: clinical indications.” Reg Anesth Pain Med. 2021 Dec;46(12):1031-1047. doi:10.1136/rapm-2021-102560. Epub 2021 Feb 24. PMID: 33632778.
Haskins SC, Bronshteyn Y, Perlas A, El-Boghdadly K, Zimmerman J, Silva M, Boretsky K, Chan V, Kruisselbrink R, Byrne M, Hernandez N, Boublik J, Manson WC, Hogg R, Wilkinson JN, Kalagara H, Nejim J, Ramsingh D, Shankar H, Nader A, Souza D, Narouze S. “American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part II: recommendations.” Reg Anesth Pain Med. 2021 Dec;46(12):1048-1060. doi: 10.1136/rapm-2021-102561. Epub 2021 Feb 24. PMID: 33632777.
“Comparison of Liposomal Bupivacaine Versus Non-liposomal Bupivacaine for Total Shoulder Arthroplasty: A Prospective, Double-blinded, Noninferiority Trial.” Enrolling. UVA IRB HSR210190. ClinicalTrials.gov identifier NCT04974385.
“Pericapsular Nerve Group Block for Arthroscopic Hip Surgery: A randomized, placebo-controlled trial. Enrollment completed.” UVA IRB HSR200214. ClinicalTrials.gov identifier NCT04508504.
“Ketamine infusions for acute pain and bladder-related complications. Multi-center retrospective chart review studying rare ketamine induced uropathy.” UVA IRB-exempt study HSR220005.
“Impact of an automated text messaging platform on patient response rates following perioperative single-shot peripheral nerve blockade.” Quality Improvement project. UVA IRB- HSR tracking #23646.
“ERAS for Cervical Brachytherapy. In the process of developing a protocol for epidural anesthesia/analgesia from the surgical procedure involving insertion of implants, through subsequent radiation treatments over the ensuing three-day admission.” Ongoing.
“ERAS for Donor Nephrectomy. Development of a perioperative protocol involving TAP blocks with liposomal bupivacaine to reduce pain and length of stay. Hip fractures quality improvement project.” Collaboration with ED and orthopedic surgery to develop an improved protocol for pain control utilizing regional nerve blocks, as well as improved perioperative optimization and risk stratification for surgery.
“Brachial plexus versus forearm block for endoscopic carpal tunnel release: comparison of efficacy, safety, patient and surgeon satisfaction.” IRB# HSR # 19094. 2018-present.
“Risk factors for rescue peripheral nerve block after hip arthroscopy.” Active IRB Exempt Study #22633. 2020-present.
“Total joint arthroplasty Enhanced Recovery After Surgery (ERAS) Project.” Ongoing.
Regional Anesthesia and Acute Pain Medicine Fellowship
We pride ourselves on our strong and collegial relationships in our Regional Anesthesia and Acute Pain Medicine Fellowship (RAPM) within the Anesthesia Department, and with our surgical and medical colleagues. Learn more about our ACGME-accredited Regional Anesthesia and Acute Pain Medicine (RAPM) Fellowship here.
Clinical experience within the one-year fellowship will include rotations focusing on regional techniques at our 32 bed operating room main hospital campus, our 12 operating room Outpatient Surgical Center (OPSC), and our new Orthopedic Hospital opening summer of 2022.
Our busy division performs more than 8,500 regional blocks and catheters annually for our patients, more than 2,500 neuraxial techniques, and more than 2,100 consults. Through these experiences, our fellows become proficient, confident, and capable of running a prolific service.
Acute Pain Service & POCUS
Our Acute Pain Service provides care for our medical and surgical patients within our 800-bed hospital. Additionally, our fellows provide Point of Care Ultrasound (POCUS) throughout the hospital.