Neurosurgical residency adaptations for the residency application cycle amid the COVID-19 pandemic: Acute on chronic sequelae

Background: The COVID-19 pandemic has transformed medical education, including the upcoming residency application cycle. External rotations have been restricted, but virtual opportunities for applicants have not yet been assessed. Objective(s): To describe how neurosurgical residency programs are adapting to the 2021 application cycle through augmented social media usage and establishment of virtual sub-I’s and open houses. Methods: One hundred fifteen separate programs were identified on ERAS. Twitter, Facebook, Instagram, residency websites, and the Visiting Student Application Service (VSAS) were reviewed for virtual open house and sub-I opportunities. Professional neurosurgery society websites were also reviewed. All data is updated as of February 14 th, 2021. Results: Eighty-eight (77%) programs had some social media presence. Fourty-three (30%) departmental accounts were created in 2020. Twenty-four (57%) of the residency program accounts were created in 2020. Programs offered 35 (18%) open house opportunities on Twitter, 19 (17%) on Facebook, and 23 (20%) on Instagram. Nineteen (17%) virtual sub-I opportunities were on Twitter, 9 (8%) on Facebook, and 10 (9%) on Instagram.Virtual opportunities were updated on 13 (12%) residency websites. The National Neurosurgery MedEd website had the most website listings of virtual opportunities with 34 (30%) programs listing open houses and 18 (16%) programs listing virtual sub-I’s. No program specific virtual opportunities were found on the AANS or CNS websites. VSAS identified only 4 (4%) virtual sub-internships. Conclusion: Many neurosurgical residency programs increased their virtual presence amid the COVID-19 pandemic. More programs could utilize these platforms to mitigate applicant restriction in upcoming neurosurgery residency application cycles

Analgesic Efficacy of Quadratus Lumborum Block in Infants Undergoing Pyeloplasty

Post-operative analgesic management is challenging in infants and opioids have been the standard of care. However, they are associated with adverse effects which may negatively impact infants. In this retrospective cohort study, we sought to explore the postoperative analgesic efficacy of quadratus lumborum (QL) block in the infant population undergoing dorsal lumbotomy pyeloplasty. Chart review of 34 infants (≤12 months) who underwent dorsal lumbotomy pyeloplasty between 2016–2020 was performed. Post-operative pain was assessed using externally validated pain scales (CRIES & FLACC) and monitored hemodynamics (pulse and blood pressure). Opioid doses were standardized by using morphine milligram equivalency (MME). The Prescription Database Monitoring Program (PDMP) was utilized to determine if discharge opioid prescriptions were filled. Of 34 patients, 13 received the QL block. Mean age at the time of surgery was 6.2 months ± 3.2 months. The QL group received 0.8 MME postoperatively, whereas the non-QL group received 0.9 MME (p = 0.82). The QL group (20%) filled their discharge opioid prescription less frequently compared to non-QL group (100%) (p = 0.002). There were no observed differences between pain scale or hemodynamic variables. Further studies are warranted to explore QL block’s efficacy for post-operative infant pain management