Regional Anesthesia and Acute Pain Management Rotation
The section of Regional Anesthesia and Acute Pain Management (RAAPM) is made up of 5 board certified anesthesiologists with special interest or fellowship training in regional anesthesia and acute pain management who work with four CA-2 or CA-3 residents rotating on service each month. The RAAPM section is responsible for the provision of regional anesthetics and acute pain management throughout our 800 bed hospital and for select ambulatory patients. We perform about 2400 peripheral nerve blocks, 1800 neuraxial blocks, and 550 continuous peripheral nerve blocks yearly in our 40 bed OR suite. Our routine practices include the use of nerve stimulation catheter techniques, ultrasound guidance, sustained release epidural morphine, and ambulatory peripheral nerve block infusions. We currently deliver anesthesia for 8-20 total joint replacements every week using continuous peripheral nerve blockade or combined spinal-epidural sustained release morphine without general anesthesia. Approximately 5000 orthopaedic procedures were performed at WFBMC last year and regional anesthesia was used for most inpatient orthopaedic procedures. Most patients undergoing major thoracic or abdominal general, plastic, urologic, gynecologic, and oncologic surgeries at WFBMC also have their pain managed by RAAPM using thoracic epidural analgesia or sustained release epidural morphine. In addition to providing care for inpatients recovering from surgery, the RAAPM section also maintains an active census of outpatients managed with continuous peripheral nerve blockade at home and patients with chronic pain managed in the hospital. Daily opportunities to practice acute and chronic pain management abound. An active Visiting Clinical Preceptorship for practicing anesthesia providers provides continuing medical education credits for observational visits to our institution after training has been established.
All these types of regional anesthetics are initiated in a dedicated Regional Anesthesia Area staffed by specially trained nurses where medical direction is the responsibility of RAAPM faculty. These same faculty manage these same patients postoperatively using multimodal analgesia based on regional techniques while employing a handheld computer database for tracking patient care and for billing. In addition, members of the section are well versed in managing patients with chronic pain using the same regional analgesic techniques used for acute pain and by providing consultation to medical and surgical services in the medical management of in-patients with chronic pain.
Resident education and hands-on involvement is the cornerstone of patient care in our section. Every month, four residents rotate through RAAPM and each places 40-100 peripheral nerve blocks. RAAPM residents receive one-on-one instruction in the craft of regional anesthesia because they are scheduled to provide patient care in the Regional Anesthesia Area rather than a single operating room. Alternatively, these same RAAPM residents receive instruction in acute and chronic pain management when rounding on the Acute Pain Service and when scheduled to provide coverage through home call of the same patients cared for previously in the Regional Anesthesia Area. Regional anesthesia and acute pain management are a standard part of departmental conferences. Additionally the RAAPM section uses dedicated teaching time for a weekly resident-oriented subspecialty conference, hosts a fresh cadaver anatomy lab twice a year, and has monthly resident in-services for infusion pumps and equipment. Anesthesia residents at WFU have at their disposal the resources necessary to leave their residency capable of providing consultant level patient care in sophisticated techniques for acute pain management such as thoracic epidural analgesia, sustained release epidural morphine, and continuous peripheral nerve blockade.
Additional information can be obtained by calling James Crews, MD, Associate Professor, Regional Anesthesia and Acute Pain Management at (336) 716-4497.
Foundation Training: General OR
Primary Subspecialty Rotations:
Pediatric Anesthesia | Obstetrical Anesthesia | Regional Anesthesia & Acute Pain Management
Advanced Operative Subspecialties: Cardiothoracic Anesthesia | TEE | Anesthesia for Vascular Surgery | Neuroanesthesia | Ambulatory | Safari |
Periopeartive Subspecialty Rotations:
Chronic Pain Management | Preoperative Assessment | Post Anesthesia Care | Critical Care (Neuro ICU and Cardiac ICU) | PICU
Regional Anesthesia and Pain Management Fellowship
Over the course of the 12 month fellowship in regional anesthesia and acute pain management, the fellow will enhance his or her cognitive, psychomotor, and affective skills to safely and effectively administer and teach regional anesthesia as a consultant in anesthesiology. The fellow will be responsible for decisions related to case and block selection to facilitate the smooth flow of OR cases and to enhance patient recovery. The fellow will be expected to have the skills needed to establish regional anesthesia and acute pain management as a primary component of his or her future practice in anesthesiology. LEARN MORE