The 30th annual Navy Medicine East Academic Research Competition Oral Phase recognized two anesthesia-based studies as the winners April 23, one in the resident category and one in the staff category.

Lt. Cmdr. Chris Call, an anesthesia resident at Naval Medical Center Portsmouth, placed first with his presentation of "A Comparison of Epidural Infusion Strategies for Labor Analgesia."

Capt. Greg Nezat, an anesthesiologist at Naval Hospital Camp Lejeune, North Carolina, was the first place winner in the staff category with his study "Optimizing Postoperative Pain Management and Staff Workload by Comparing a Single Dose of Intrathecal Morphine to Intravenous Patient Controlled Analgesia in Hysterectomy Patients: A Randomized Control Trial."

During the award ceremony, NMCP's executive officer, Capt. Bradford L. Smith, spoke about the importance of focusing research on ways to better serve and protect the lives of patients.

Call's research did just that. His study determined whether a particular epidural technique could provide the necessary amount of pain relief for the patient, while simultaneously decreasing the amount of medication used. This would lead to a decreased risk of potential side effects and make epidurals safer for the patient and baby.

"As a medical community, we are constantly striving to improve the safety of our techniques while still maintaining the overall satisfaction for the patient," Call said. "The study's goal is to improve patient safety and reduce the risk of a potential adverse event as a result of receiving epidural analgesia."

The number of women receiving epidurals for pain relief during the labor and delivery process has more than tripled in the past 20-30 years, according to Call. Epidurals are used by up to 70 percent of women in labor at large facilities such as NMCP. They have a high safety profile, yet there are still potential risks involved with the procedure.

"The most common complaint associated with epidurals is that they simply don't provide the degree of pain relief that the patient desires," Call said. "This represents the fine balance between relieving pain and putting the patient at a higher risk of adverse effects by using additional medication."

Call and his team observed the use of several different infusion techniques at NMCP and other institutions, and then focused their research on answering the question of which epidural infusion strategy was the best. The study was developed in 2012, and after protocol approval in late 2012, the study's patient enrollment began in February 2013 and lasted until May 2014. The data analysis continued through late 2014.

The study included healthy women who received an epidural during the delivery of their first pregnancy and were without complications, since that could lead to unpredictable variations in the study results.

"When we compared epidural techniques among three commonly used programs, we found that a lower continuous rate combined with a larger bolus (single dose of medication) option reduced the amount of local anesthetic required to maintain the same level of pain relief," Call explained. "We also checked the degree of lower extremity weakness and how many patients required cesarean delivery to ensure that our technique did not increase these factors. We found no increase in lower extremity weakness or cesarean delivery using this particular technique."

As a first-place award winner and primary presenter in this competition, Call will advance to the Navywide ARC in May. He and his team will present their research at the annual Society for Obstetric Anesthesia and Perinatology meeting, also in May.

"Our study has the potential to improve the healthcare value provided at NMCP by increasing the quality of the pain care offered to our laboring patients," Call said. "This will also improve safety while simultaneously decrease health care cost by decreasing the volume of medication consumed. We plan to share this information through further presentation and publication in an effort to improve patient health and safety outside of NMCP."

During the award ceremony, special awards were also given for presentations that fell within the Navy Surgeon General's goals of Readiness and Value.

Readiness: Lt. Michael Eliason for "Incidence and Prevalence of Sleep Disordered Breathing in the Active Duty Population."

Value: Lt. Jennifer Ottino for "Complication Rates and Operative Times for Endoloop Versus Endoscopic Stapler Techniques for Laparoscopic Appendectomy."

For more news from Naval Medical Center Portsmouth, visit www.navy.mil/local/NMCP/.