While I have a deep love for the practices of surgery and anesthesiology, I am excited to offer patients an alternative to surgery … a means to repair and restore themselves back to the life they want, doing what they love to do, without the pain and trauma of surgery. This is the direction all of medicine should be going … to help the body heal itself

Dr. Hostetter is a nationally-recognized board certified, fellowship-trained anesthesiologist who built her career specializing in orthopedic and spine surgery with an expertise in regional anesthesia. She brings her expert needling techniques, along with her passion for innovative pain treatment strategies to the field of regenerative medicine.

After earning her MD from the UCLA School of Medicine, Dr. Hostetter completed her anesthesiology residency at Virginia Mason Medical Center. After residency, she was awarded the Moore-Bridenbaugh Regional Anesthesia Research Fellowship, where she honed her interest and skill in pain management through training anesthesia residents and researching alternate ways to treat acute pain.

Following fellowship, Dr. Hostetter joined a private practice group at Swedish Medical Center where she initiated the adductor canal nerve block program for postoperative pain management, leading to shorter hospital stays, decreased opioid use and improved pain scores in patients following total knee surgery. In 2014, building on the success of this program, Dr. Hostetter went on to establish the first ever regional anesthesia nerve block program for orthopedics and podiatry at St. Francis Hospital. There, she also founded the multimodal pain program for joints and spine patients, significantly improving postoperative pain outcomes.

She has published several research papers, and co-authored the Spinal and Epidural Anesthesia chapter in a leading Clinical Anesthesia textbook. She is also enthusiastic about teaching, and as an avid lecturer and educator, she routinely teaches ultrasound and regional anesthesia to anesthesiologists nationwide.

Dr. Hostetter’s dedication to optimizing the patient experience through minimally invasive strategies drove her interest in regenerative medicines such as stem cell therapy. She is committed to its ability to restore orthopedic function, rejuvenate mental and emotional vitality, and relieve pain without relying on opioid drugs.

Evaluation of Ultrasound-Assisted Thoracic Epidural Placement in Patients Undergoing Upper Abdominal and Thoracic Surgery: A Randomized, Double-Blind Study
Continuous Ultrasound-Guided Adductor Canal Block for Total Knee Arthroplasty: A Randomized, Double-Blind Trial
Ultrasound Refraction Artifact Is Unlikely: A Response to Duplication of Brachial Plexus, A Letter to the Editor
Clinical Anesthesia, 7th Edition; Chapter 34: Epidural and Spinal Anesthesia
Evaluation of Ultrasound-Assisted Thoracic Epidural Placement in Patients Undergoing Upper Abdominal and Thoracic Surgery: A Randomized, Double-Blind Study

Auyong, DB, Hostetter LS, Yuan SC, Slee AE, Hanson NA ABSTRACT BACKGROUND: The placement of thoracic epidurals can be technically challenging and requires a thorough understanding of neuraxial anatomy. Although ultrasound imaging of the thoracic spine has been described, no outcome studies on the use of this imaging have been performed. We evaluated whether preprocedural ultrasound of the thoracic spine would facilitate the process of epidural catheterization. METHODS: Subjects undergoing thoracic or upper abdominal surgery with planned thoracic epidural placement at T10 or higher were enrolled in this randomized double-blind study. Subjects were allocated into 1 of 2 groups for preoperative epidural placement: ultrasound guidance (group US) or palpation (group Palp). Subjects randomized to group US had a preprocedural ultrasound examination to identify pertinent spinal anatomy and make appropriate marks on the skin identifying midline and interlaminar spaces for targeted Tuohy needle insertion. Subjects in group Palp had a skin marking performed by palpation alone. Using the skin markings, all epidurals were performed using a loss of resistance to saline technique. Block levels were assessed with ice and pain scores obtained by a blinded nurse in the postanesthesia care unit. The primary outcome was procedural time from needle insertion to loss of resistance in the epidural space. RESULTS: Seventy subjects were recruited and completed the study protocol. The median time for epidural needle placement to achieve loss of resistance in group US and group Palp was 188.5 seconds (interquartile range [IQR], 79.0-515.0) and 242.0 seconds (IQR, 87.0-627.0), respectively (P = 0.188). Using ultrasound to mark the skin overlying the targeted epidural space took a median time of 85 seconds (IQR, 69-113) for group US and 35 seconds (IQR, 27-51) for group Palp (P < 0.001). The number of needle passes was not significantly different between the 2 groups (P = 0.31). The use of ultrasound assistance resulted in a decreased number of needle skin punctures to achieve loss of resistance (P = 0.005). Mean pain scores after surgery were lower in group US compared to group Palp: 3.0 versus 4.7, respectively (P = 0.015). CONCLUSIONS: This is the first randomized study to evaluate the efficacy of preprocedural ultrasound marking for placement of thoracic epidural catheters. We observed that preprocedural ultrasound did not significantly reduce the time required to identify the thoracic epidural space via loss of resistance. Full Article


Continuous Ultrasound-Guided Adductor Canal Block for Total Knee Arthroplasty: A Randomized, Double-Blind Trial

Hanson NA, Allen CJ, Hostetter LS, Nagy R, Derby RE, Slee AE, Arslan A, Auyong DB ABSTRACT BACKGROUND: Adductor canal blocks have shown promise in reducing postoperative pain in total knee arthroplasty patients. No randomized, controlled studies, however, evaluate the opioid-sparing benefits of a continuous 0.2% ropivacaine infusion at the adductor canal. We hypothesized that a continuous adductor canal block would decrease postoperative opioid consumption. METHODS: Eighty subjects presenting for primary unilateral total knee arthroplasty were randomized to receive either a continuous ultrasound-guided adductor canal block with 0.2% ropivacaine or a sham catheter. All subjects received a preoperative single-injection femoral nerve block with spinal anesthesia as is standard of care at our institution. Cumulative IV morphine consumption 48 hours after surgery was evaluated with analysis of covariance, adjusted for baseline characteristics. Secondary outcomes included resting pain scores (numeric rating scale), peak pain scores during physical therapy on postoperative days 1 and 2, quadriceps maximum voluntary isometric contraction, distance ambulated during physical therapy, postoperative nausea and vomiting, and satisfaction with analgesia. RESULTS: Eighty subjects were randomized, and 76 completed the study per-protocol. The least-square mean difference in cumulative morphine consumption over 48 hours (block-sham) was–16.68 mg (95% confidence interval, -29.78 to -3.59, P = 0.013). Total morphine use between 24 and 48 hours (after predicted femoral nerve block resolution) also differed by least-square mean -11.17 mg (95% confidence interval,: -19.93 to -2.42, P = 0.013). Intention-to-treat analysis was similar to the per-protocol results. Functional outcomes revealed subjects in the adductor canal catheter group had better quadriceps strength (P = 0.010) and further distance ambulated (P = 0.034) on postoperative day 2. CONCLUSIONS: A continuous adductor canal block for total knee arthroplasty reduces opioid consumption compared with that of placebo in the first 48 hours after surgery. Other outcomes including quadriceps strength, distance ambulated, and pain scores all show benefit from an adductor canal catheter after total knee arthroplasty but require further study before being interpreted as conclusive. Full Article


Clinical Anesthesia, 7th Edition; Chapter 34: Epidural and Spinal Anesthesia

CHAPTER 34: EPIDURAL AND SPINAL ANESTHESIA Christopher M. Bernards, Lucy S. Hostetter KEY POINTS 1. Clinicians must develop a three-dimensional mental picture of the spinal anatomy so that when they contact bony structures during attempted epidural or spinal needle placement, they can redirect the needle in a reasoned and systematic manner and not subject the patient to random needle “pokes” in an effort to place the block. 2. The epidural fat and the epidural venous plexus do not form a continuous cylinder surrounding the spinal cord, as is often depicted. Rather, the epidural fat lies in discrete pockets in the posterior and lateral epidural space and the epidural veins travel primarily in the anterior and lateral epidural space and are normally absent in the posterior epidural space. 3. Serious systemic toxicity during attempted epidural block is almost always the result of inadvertent local anesthetic injection directly into the vasculature. Consequently, an appropriate test dose designed to identify intravascular injection is critical. 4. Physical characteristics (e.g., height, weight, cerebrospinal fluid volume) and age do have an effect on spinal and epidural block characteristics. However, the magnitude of the effects is relatively small and of such low predictive power that these characteristics are not useful predictors of local anesthetic dose in any individual patient. 5. The risk of hemodynamic complications of epidural and spinal anesthesia increases with increasing block height. 6. Lidocaine appears to be worse than other local anesthetics in terms of the risk of neurologic toxicity (i.e., cauda equina syndrome and transient neurologic symptoms). 7. Human studies suggest that the preservative-free formulation of chloroprocaine may offer a viable alternative to lidocaine for short-duration spinal anesthesia. 8. Administration of drugs that impair coagulation can put patients at increased risk of spinal hematoma. Our understanding of the relative risk of different classes of drugs affecting the clotting system is constantly evolving. Clinicians are directed to the consensus statement from the American Society for Regional Anesthesia and Pain Medicine for the most recent recommendations. Clinical Anesthesia, 7th edition, by Paul G. Barash, Bruce F. Cullen, Robert K. Stoelting, Michael K. Cahalan, M. Christine Stock, and Rafael Ortega