A Day Managing Acute Pain

Acute Pain Service

The Acute Pain Service (APS) is a well-organized rotation at UVA with a nice blend of developing leadership skills, technical skills, and teaching from some of the leaders in the field of pain medicine. Primarily responsible for placing and managing perioperative thoracic epidural catheters for various abdominal and thoracic surgeries, APS is a busy service, with never a dull moment. We are fortunate to have a large volume of complex thoracic surgical procedures at UVA.  The APS rotation is a 7-day rotation and we typically do one week as a CA-1, two weeks as a CA-2, and have the option of doing more weeks as a CA-3 with elective time.


A Day Managing Inpatient Pain

The Acute Pain Service at UVA is an opportunity for residents to get comfortable with neuraxial anesthesia in the operative setting. 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 postoperative epidurals on the floor as well as the Lidocaine 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 attendings. With our high operative volume and increasing Early Recovery After Surgery (ERAS) program, the APS rotation is a busy service and residents become comfortable with neuraxial anesthesia and postoperative pain management.

Daniel Smith, CA-1

The day usually begins around 7am, when the daily schedule is reviewed for potential preoperative epidurals and spinals. The team – pain 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 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 3-6 epidurals and spinals daily. CA-1s do one week of APS, usually prior to doing OB anesthesia to hone their epidural skills and CA-2s do two weeks. 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.    Acute Pain Service Update provided by Dan Smith, CA-1