I started my CA-2 year with the MD Anderson Acute Pain Service rotation. My time at MD Anderson provided excellent training in the use of ultrasound, performing a variety of regional nerve blocks, and the management of complex post-surgical pain on their Acute Pain service. 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 treat patients with acute postoperative pain, and often patients with acute on chronic pain postoperatively.
The structure of this rotation is divided into two weeks of covering the service during the day and two weeks of covering the service during night shifts. During your week of days, the morning starts at 6 a.m., receiving sign out from your co-resident on the night shift, discussing the morning blocks for the day, and then preparing for those blocks. 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. As a resident you will get great exposure to truncal blocks in these morning cases, and a variety of peripheral nerve blocks post-operatively or often pre-operatively. 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 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 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 prior to sign-out, you’ll help set up ORs with first case start for blocks for the day resident. Sign out between the night and day resident usually happens around 6:30 a.m.
Throughout your whole rotation, the Acute Pain Service team is wonderfully collaborative and supportive of this experience for residents. Residents will come to this rotation with a variety of experience in regional techniques and the faculty are all eager to train and help improve your skills. The nurse practitioners and block nurses are excellent resources during your rotation as well, providing tips on writing orders, coordinating care, and systems-learning that comes with rotating at a new center.
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!
