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As a researcher in pain management at the clinical research unit in the Department of Anaesthesiology at Zealand University Hospital, Maagaard Blem is on a mission to ensure that patients benefit from the best possible pain control after surgery. Because there is definitely room for improvement.

“We know that the better we are at managing postoperative pain, the better the patients recover from surgery. However, studies show that we are undermedicating patients for postoperative pain,” he says.

The standard procedure today for a broken ankle or wrist is to inject a nerve block, which works for about 15 hours. When the nerve block wears off, the patients will be in pain, typically by the evening or night after their surgery, when they then need pain-relieving medication.

“And they often suffer extreme pain because bone surgery is among the most painful procedures. As a result, they fare worse and leave hospital later, and are at greater risk of chronic pain and other complications,” says Maagaard Blem,

However, this does not have to be the case. In his PhD thesis, he demonstrates that it is possible and very straightforward to give patients an additional ten hours of full pain relief by giving them dexamethasone, which prolongs the numbing effect of the nerve block injected for the surgical procedure.

“If this medicine were given as standard, then there’s no doubt that patients generally would do better after surgery,” he explains. 

Maagaard Blem has been awarded the Lundbeck Foundation’s Talent Prize 2024 for his research, his dedication to instructing and inspiring other clinicians, and for his special expertise in statistics and methods.

Too good to be true

The inspiration for the part of his PhD concerned with prolonged postoperative pain control was an article by another group of researchers.

This demonstrated that by administering a combination of two drugs – dexamethasone and dexmedetomidine – to bone-fracture patients before surgery, the effect of a nerve block was prolonged by 14 to 70 hours.

“This sounded too good to be true, so I had to investigate for myself,” says Maagaard Blem.

As part of his PhD, he tested this outcome in a randomised trial involving 120 patients scheduled for below-knee bone surgery.

His results confirmed that complete pain control could be prolonged by ten hours; not for as long as in the other study, but still a significant improvement. But he also made the astonishing discovery that one of the two therapeutic drugs, dexmedetomidine, could be left out altogether. In fact, this is the costliest of the two drugs, and also the one that causes the most side effects.

This discovery has not yet been put to use in operating theatres.

“I’ve had many positive reactions, internationally too, but there's a long way from a study to clinical procedure. And there are many habitual practices and conventions in play,” he says.

To the best of Maagaard Blem’s knowledge, no Danish hospitals have guidelines on the use of these adjuvants (‘add-on’ therapies) to nerve blocks.

“But some hospitals are now developing local guidelines on which patients can or cannot be given this adjuvant,” he says.

He is convinced that this is a good idea.

“If you’re only operating on a little-finger nail, you don’t need a numb arm for 24 hours. Conversely, for a fractured wrist, which is extremely painful, it’s good to keep a patient’s arm numbed for a long time.

Maagaard Blem believes that the best approach would be a national position paper on the use of adjuvants to prolong the effect of a nerve block.

Anaesthesiology tends to be overlooked

Maagaard Blem has ideas for many more research projects, such as following up on how research discoveries are implemented, and determining whether the results are as effective in the real world as they are in an experimental setup. But securing funding is generally a challenge.

“Anaesthesiology is a crucial branch of medicine, but tends to get overlooked in the big picture. In some senses it tends to be seen as a medical ‘service’. After all, tumours are removed by surgeons and thrombosis is treated by a specialist in internal medicine, and that’s all too apparent when applying for funding,” he explains.

However, competition for research funding is not likely to stop Maagaard Blem, who already has a long list of publications to his name, and is involved in many studies.

He is deeply committed to encouraging medical students and doctors with other specialties to conduct research in pain management, and is active as a supervisor and mentor to a great many students. And the motivation is a given:

“Pain management is a specialty in which doctors can really make a difference for patients,” he says.

In addition, Maagaard Blem juggles figures, tables and charts, and instructs and assists other doctors at all levels to avoid slip-ups in data analysis. This know-how does not come out of thin air.

“When you study medicine, you only get a couple of weeks’ statistics teaching, but at my first research location I learnt about the importance of being meticulous and using the right methods. That was at Copenhagen Trial Unit,” he explains.

He consequently took the necessary courses.

“As I see it, if you can’t do it yourself, then you don’t really understand it. Plus, analysing data to see the bigger picture is quite thrilling.”

Maagaard Blem has maintained his special skill set and is invited to join many projects on account of his expertise in methods and statistics.

However, this multifaceted researcher actually has another distinct ability: he is an inventor, too. He is currently developing a device to make it easier to anaesthetise patients. So that one day, when his research discovery becomes standard clinical practice, it will be easy to provide better pain control for patients.