Becker’s Healthcare Podcast – Episode Summary

Guest: Armen Voskeridjian, Director of Anesthesia Services, Jefferson Surgery Center at The Navy Yard
Host: Francesca Matthews
Date: September 21, 2025

Episode Overview

In this episode, Armen Voskeridjian returns to the Becker’s Healthcare Podcast to update listeners on groundbreaking outcomes in postoperative pain management following orthopedic surgery at his ambulatory surgery center. He shares hard data from two studies (ACL, foot & ankle) demonstrating dramatically reduced narcotic use, discusses implications for anesthesia practice and ASC economics, and reflects on industry trends amid changing reimbursement landscapes. His candor and enthusiasm offer listeners a firsthand look at innovation in regional anesthesia and its ripple effects across patient care and ASC operations.

Guest Introduction and Background [00:51–02:59]

• Education & Career Path:
  • Double board-certified in Internal Medicine and Anesthesiology.
  • Trained in New York (notably at Bronx High School of Science, SUNY Downstate, Staten Island, and NY Hospital Cornell).
  • Extensive practice at Albert Einstein Medical Center before current role at Jefferson Surgery Center.
  • Director of Anesthesia Services for three years.
• Scope of Practice:
  • Small ASC focused on outpatient orthopedic cases—shoulder/clavicle, elbow, wrists, hips, knees, foot and ankle (excluding joint replacements).
  • “We do everything except for joint replacements unfortunately. But everything else, we do.” [01:43—B]

Key Study Updates: ACL and Foot/Ankle Outcomes [03:16–10:56]

Study #1: ACL Repair

• Published Results

  • 131 patients, split into two groups:
    1. Liposomal bupivacaine + aqueous bupivacaine
    2. Same as above + preservative-free dexamethasone
  • Dexamethasone was theorized to prolong block effect; did not significantly do so in ACL cases.

• Impactful Findings:

  • 77% of patients needed zero narcotics post ACL surgery.
  • Allograft patients had the least post-op pain, reporting 0–1/10, while typical ACL patients reported average 3–4/10.
  • For the 23% using any oxycodone, average pills used was <2 (2.5 mg per ACL case).
  • “I think any orthopedic surgeon would be hard pressed to deny that. So we're very proud of these results.” [04:30—B]

Study #2: Foot & Ankle Surgeries

• Patient Cohort

  • ~129 patients, same two-group design as above.
  • Surgeries included Lisfranc fractures, complex bunionectomies, Achilles ruptures, trimalleolar fractures.

• Notable Findings:

  • Narcotic use among patients receiving dexamethasone: 0.7%. “That just means that out of every 100 patients, only seven people took narcotics.” [06:56—B]
  • Block duration extended by ~36–40 hours with dexamethasone.
  • “This is unheard of right now. The only thing that comes close to these kinds of results was when we were placing catheters…” [07:23—B]

Practice Modifications and Generalization

• Traditional catheters had weaknesses—good popliteal coverage, but saphenous nerve pain would rebound after 1–1.5 days.
• The new protocol enables 6–7 days of effective pain control without catheters or significant motor blockade.
• Feedback from colleagues: most institutions restrict access to (costly) liposomal bupivacaine; prompted Voskeridjian to further reduce his dosing with sustained clinical results.

Technical and Practical Innovations [10:56–15:35]

• Dosing Adjustments:
  • ACL: From 30cc to 20cc of liposomal bupivacaine
  • Foot/Ankle: From 20cc to 10cc
• Mixing Additives:
  • Demonstrated that preservative-free dexamethasone can be mixed with liposomal bupivacaine and aqueous bupivacaine without compromising block.
  • “We’ve shown at the Navy Yard that you can actually add preservative free dexamethasone without compromising the liposomes.” [12:09—B]
• Expansion to Other Blocks:
  • Supraclavicular, interscalene, and other nerve blocks.
  • Ongoing and future studies will broaden evidence base.
• Novel Technique:
  • Addition of a third infiltration (“suprasartorial infiltration”) for ACL/knee cases, achieving “superior coverage” in conjunction with the standard adductor canal and IPAC blocks.
  • “By doing these three infiltrations you can truly get superior coverage of blocking the knee...narcotic use was basically eliminated postoperatively.” [14:06—B]

Industry and Economic Implications [15:35–22:57]

• Challenge: Decreasing government and private insurer reimbursement; rising clinician salaries create unsustainable pressure for ASCs and anesthesia groups.
• Emerging Trend: Anesthesia groups increasingly require direct payment from ASCs (separate from collections), cutting ASC profitability.
• Clinical Value:
  • The ability to offer “top of the line, cutting edge anesthesia nerve blockade” with minimal to no narcotic use is a new value proposition.
  • Surgeons curtail or eliminate narcotic prescribing (“sometimes switching to...tramadol versus using oxycodone...some are not even taking that” [17:48—B]).
  • This has weight under patient satisfaction–linked payment models and in light of the opioid crisis and NO PAIN Act (2025).
• Quote:
  • “This is a big deal when it comes to advocating for the group. The surgeons will be the first person to advocate for them. Any anesthesia group that adopts this...this will work for tap blocks...OBGYNs, if they add preservative free dexamethasone...it’s going to make their blocks last longer.” [17:09—B]

Current Trends and Concerns for ASCs [20:10–22:57]

• Primary Issues Impacting ASCs:
  1. Shrinking reimbursement for anesthesia.
  2. Rising costs and changing demographics impacting ASC finances.
• Prediction:
  • Fewer new ASC startups, stress on sustainability for existing centers.
  • "I think we're going to see a slowing down, if not already in the upstart of new openings of ASCs around the country." [22:46—B]
• Warning: “This is an alarm. Sort of a canary in a coal mine.” [22:52—B]

Memorable Quotes

• “77% of those 131 patients took zero narcotics after their ACL repair surgery. ...These are in my opinion incredible results.” [04:06—B]
• “This is unheard of right now. The only thing that comes close...was when we were placing catheters.” [07:23—B]
• “We’ve shown at the Navy Yard that you can actually add preservative free dexamethasone without compromising the liposomes.” [12:09—B]
• “Narcotic use was basically eliminated postoperatively by the patients….the physical therapists were pretty impressed at the results they were getting.” [14:09—B]
• “This is a big deal when it comes to advocating for the group…the surgeons will be the first person to advocate for them.” [17:11—B]
• “All of this...becomes one big box present with a bow tie on top. And you give that to the anesthesia ASC provider, the administrator, and hopefully...they see the benefit in that.” [19:43—B]
• “This is an alarm. Sort of a canary in a coal mine.” [22:52—B]

Closing Thoughts and Contact [23:37–24:45]

• Voskeridjian encourages peers interested in adopting these protocols or reviewing his data to reach out via LinkedIn or through Becker’s platform.
• Further studies on different nerve blocks and in various surgical specialties are ongoing.
• Expressed pleasure at sharing results and collaborating to improve patient care:
  • “I would love to share my data, anecdotal or otherwise, with anybody interested in bringing this type of cutting edge regional...anesthesia to their ASC. It would be my pleasure.” [24:14—B]

Timestamps for Major Segments

• Background and practice scope: 00:51–02:59
• ACL and foot/ankle study design and results: 03:16–10:56
• Technique refinements (dosing, mixing): 10:56–15:35
• Industry implications for anesthesia and ASCs: 15:35–22:57
• Trends & warnings for ASCs: 20:10–22:57
• Closing and contact: 23:37–24:45

This summary captures the clinical excitement, technical rigor, and economic realities explored in the conversation. Armenia Voskeridjian’s results represent a promising step forward in post-op pain control and demonstrate how innovation in anesthesia can reverberate through patient care and ambulatory surgery center operations.