Acute Pain

I'm currently on the acute pain service at Stanford. It's a tough rotation. Pain management is not the right thing for most residents, but for those who like it, it can be very rewarding. Our service has several aspects. For the most part, we provide consultation to surgical services post-operatively and manage patients with regional nerve catheters, epidural catheters, and single shot spinal anesthetics. Although the primary operating room anesthesiologist chooses what anesthetic technique to use and implements it, if it is a "neuraxial approach" like an epidural or spinal anesthetic or a regional nerve block, we pick up the patient postoperatively. That makes up the bulk of our service as we get 5-15 patients a day (which means the service hovers around 25 and the turnover is huge). The rest of the service is made up of hospital-wide consultations. Indeed, I consulted pain last year for some of my medicine patients. Any service - psychiatry, medicine, obstetrics, surgery, even emergency medicine - can ask us for advice in managing pain. Sometimes these patients have chronic pain issues and are on high doses of narcotics. Other times, they've exhausted all the common medications and need help with some of the more exotic drugs. We also have a very small primary service of chronic pain patients who are admitted for pain procedures. Overall, it's a really busy rotation, and I feel a lot like I'm an intern again.