As my first rotation in CA-2 year, this rotation was instrumental in strengthening my confidence in ultrasound-guided blocks and developing multimodal regimens to manage post-op surgical pain. MD Anderson is a phenomenal cancer institution with a very busy surgical service with over 40 ORs and a strong collaboration amongst the anesthesia and surgical departments. On the acute pain service, you’ll be responsible for caring for patients who often have acute pain overlaying chronic pain. The rotation is split into weeks of days and nights with one weekend of coverage.
During your week of days, the morning starts at 6 a.m., receiving sign out from your co-resident on the night shift and switching into a pair of MD Anderson scrubs to head to the ORs for first-case blocks. MD Anderson cases start at 7 a.m. compared to the classic 7:30 a.m. starts at other pavilions. Pathology varies widely ranging for massive abdominal resections, hemipelvectomies, amputations, and spinal surgeries. To match the variety of cases, there’s an equal diversity of blocks including transversus abdominis plane (TAP), quadratus lumborum (QL), erector spinae plane (ESP), paravertebral, interscalene, supraclavicular, sciatic/popliteal, and femoral/adductor blocks. If you’re running ahead of schedule, epidurals and certain blocks can be done in the pre-op holding area. More often, epidurals are done pre-induction in the OR and all other blocks are typically done post-induction. Depending on the caseload, there are often multiple first-cases that require blocks. After completing blocks for these cases with your attending, you’ll meet with the nurse practitioner to split the list to round on floor patients and field new consults for the day (typically one-two per day). You’ll be able to follow your block and consult patients and assess the effectiveness of your interventions, monitor for complications and side effects, and craft personalized pain regimens. You’ll continue to follow the OR schedule for blocks for cases to follow later in the day. You’ll sign out at 6:30-7 p.m. to the night residents during one week of days and leave at 3 p.m. on the other week of days.
During your week of nights, sign out for the night resident is at 6:30-7 p.m. from your co-resident or the nurse practitioner. You’ll be responsible for covering the patient list and seeing patients who come out of the OR late for post-block assessments. Occasionally, you’ll split the list with the night nurse. After rounding on your patients for the night and checking your orders, you’ll head to your call room! Often the nights are calm, but you will be paged based on patient needs. In the morning around 5-6 a.m., you’ll check on your patients and help set up ORs with first case start for blocks for the day resident. Sign out between the night and day resident usually happens between 6:30-7 a.m.
Overall, this is a great rotation that equips you with an invaluable arsenal of pain management tools for any anesthesiologist including nerve blocks, epidurals, multimodal regimens, narcotics, and patient-controlled analgesia setups!
