A Day Managing Acute Pain

Rotation description provided by Scott Heller, Class of 2022

The Acute Pain Service at UVA is an opportunity for residents to become comfortable with neuraxial anesthesia in the operative setting and managing acute pain consults. The APS team is responsible for placing the majority of thoracic and lumbar epidurals as well as spinals for the operative anesthesia teams. On top of this, they manage all of the pain consults, postoperative epidurals on the floor, as well as any lidocaine or ketamine infusions. It is a unique anesthesia experience in that it is half procedural and half clinical, with lots of one on one hand-on instruction with one of our chronic pain or regional attendings. With our high operative volume and robust Early Recovery After Surgery (ERAS) program, the APS rotation is a busy service and residents become comfortable with neuraxial anesthesia and postoperative pain management.

The day usually begins around 7am, when the daily schedule is reviewed for potential preoperative epidurals and spinals. The team – pain/regional attending, nurse coordinator, resident, and medical student – will then perform any necessary first start procedures and then begin rounding on postoperative patients. Rounds will focus on multimodal analgesic methods ranging from epidurals, blocks, lidocaine/ketamine infusions, opioids, neuromodulators as well as various other modalities. The team will work closely with the surgical teams and nursing staff to troubleshoot any issues and come up with an optimal pain control plan. Epidural and spinal placements will occur throughout the morning and early afternoon. The day also includes lots of teaching from our skilled faculty. Great one on one experience in performing procedures or discussing mechanisms of action constantly occurs throughout the day making it a great learning rotation for everyone from CA-1s to CA-3s. Around 5pm, the APS resident signs out to the night OB call resident who will cover any overnight needs. On average, most residents will do around 2-4 epidurals and spinals daily. CA-1s spend one week on APS, usually prior to doing OB anesthesia to hone their epidural skills. Our CA-2s spend two weeks on APS. CA-3 can do an elective rotation through APS, which is a useful refresher prior to graduating and a nice change from the operating room.

updated 2020