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Edward R. Mariano, MD, MAS

Academic Appointments

  • Associate Professor of Anesthesiology, Perioperative and Pain Medicine at the Palo Alto Veterans Affairs Health Care System

Key Documents

Contact Information

  • Clinical Offices
    VA Palo Alto Health Care System 3801 Miranda Ave 112A Anesthesiology and Peroperative Care Palo Alto, CA 94304
    Tel Work (650) 849-0254 Fax (650) 852-3423
  • Academic Offices
    Alternate Contact
    Ana Hammons Administrative Officer Tel Work (650) 858-3938

Professional Overview

Bio

After graduating from Georgetown University School of Medicine, I completed my anesthesiology residency and pediatric anesthesiology fellowship at Stanford University Medical Center and Lucile Packard Children's Hospital with emphases on clinical investigation and regional anesthesia and perioperative pain management for children.

I joined the Department of Anesthesiology at the University of California, San Diego, in 2004, where I started UCSD’s current training program in Regional Anesthesia and earned my Masters Degree in clinical research. I served as Division Chief of Regional Anesthesia and Acute Pain Medicine until 2010. The UCSD Regional Anesthesia Fellowship that I founded was the first fellowship in this subspecialty in California recognized by the American Society of Regional Anesthesia and Pain Medicine.

In 2010, I returned to the Stanford community to serve as Chief of the Anesthesiology and Perioperative Care Service at the Veterans Affairs Palo Alto Health Care System.

My clinical research interests include the development of techniques and patient care pathways to improve postoperative pain control and other surgical outcomes in adults and children. I am particularly interested in regional anesthesia, the specific application of local anesthetics and adjuvants at the site of peripheral nerves, in the context of producing target-specific pain relief.

Clinical Focus

  • Anesthesia

Academic Appointments

Administrative Appointments

  • Associate Chief of Staff, Inpatient Surgical Services, VA Palo Alto Health Care System (2013 - present)
  • Chief, Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System (2010 - present)

Honors and Awards

  • Resident of the Year, Department of Anesthesia; Stanford University (2003)
  • Teacher of the Year, Department of Anesthesiology; University of California, San Diego (2005)
  • Health Care Champion, San Diego Business Journal (2007)
  • Top "40 Under 40" in San Diego, San Diego Metropolitan Magazine (2007)
  • Special Service Award, Department of Anesthesiology; University of California, San Diego (2010)
  • 2012 Distinguished Visiting Professor in Anesthesiology, Hospital for Special Surgery (2012)
View All 9honors and awards of Edward Mariano

Boards, Advisory Committees, Professional Organizations

  • Editorial Board, Journal of Cardiothoracic and Vascular Anesthesia (2008 - present)
  • Editorial Board, Regional Anesthesia and Pain Medicine (2009 - present)
  • Editorial Board, Seminars in Cardiothoracic and Vascular Anesthesia (2011 - present)
  • Editor-in-Chief, American Society of Regional Anesthesia and Pain Medicine News (2012 - present)

Professional Education

Board Certification: Pediatric Anesthesia, American Osteo Board of Anesthesiology (2013)
Board Certification: Anesthesia, American Board of Anesthesiology (2004)
Medical Education: Georgetown University DC (1999)
Fellowship: Stanford University CA (2004)
Residency: Stanford Medical Center - Anesthesia CA (2003)
Internship: Georgetown/NOVA Fairfax Hospital VA (2000)
View All 11

Community and International Work

Courses

2013-14

Graduate and Fellowship Program Affiliations

Scientific Focus

Current Research and Scholarly Interests

My clinical research interests include the development of techniques and patient care pathways to improve postoperative pain control and other surgical outcomes for patients of all ages. I have published over 60 peer-reviewed articles and multiple book chapters primarily in these research areas. Most of my work has centered around the application of continuous peripheral nerve blocks (also known as "perineural catheters") to provide target-specific pain relief after surgery in the form of extended-duration local anesthetic infusions. In 2007, I published a case-control study investigating the use of continuous femoral nerve blocks on an outpatient basis compared to the same therapy performed in-hospital in terms of hospitalization costs. This study is widely-referenced by other investigators interested in perioperative management and health-care cost-containment. In the subsequent years, I have either led, as principal investigator, or participated in, as co-investigator, multiple randomized clinical trials involving orthopedic patients. For joint arthroplasty in particular, I have been a co-investigator on 3 randomized clinical trials, including one multi-center study, evaluating the use of local anesthetic perineural infusion in knee and hip arthroplasty patients to decrease time to discharge eligibility. In these 3 studies, discharge eligibility was determined by pain scores, need for intravenous opioids for analgesia, and ambulation distance achieved; in all 3 studies, continuous local anesthetic was found to be superior to placebo infusion. More recently, I have investigated variations in local anesthetic regimen for perineural infusion and innovative catheter placement techniques, such as the use of ultrasound guidance. My studies on local anesthetic infusion concentration have shown that dose is the predominant factor influencing perineural infusion effects, and the resulting numbness (motor block) varies among anatomic sites. I have published several randomized clinical trials and case series establishing ultrasound guidance as an effective and efficient technique for perineural catheter insertion in adults and children. In 5 clinical studies, I have shown that ultrasound facilitates faster perineural catheter insertion with higher success rates compared to traditional techniques (e.g., electrical stimulation). The application of ultrasound to identify anatomic variability is critical to accurate placement of these catheters and their subsequent infusion effects.

My current ongoing research projects involve simulation-based training of practicing anesthesiologists in ultrasound-guided perineural catheter techniques (funded by a grant from the Foundation for Anesthesia Education and Research), the use of perineural infusion in the treatment of intractable phantom limb pain (a multi-center grant awarded by the Department of Defense), preclinical and clinical studies evaluating perineural catheter equipment and placement methods, and the analyses of large databases within VA to maximize the benefits and minimize the side effects of anesthetic and surgical interventions in the acute care setting.

Publications

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Publication Topics

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