Regional Anesthesiology and Acute Pain Medicine (RAAPM)

Emory provides a great opportunity to learn regional anesthetic techniques in addition to managing acute and chronic pain patients. Residents will rotate between Emory University Hospital, Emory University Hospital Midtown, and Executive Park on their designated acute pain rotations with additional RAAPM exposure while on general service at Grady Memorial Hospital. At the end of residency, residents will become very proficient at performing standard regional techniques and will easily surpass ACGME-required numbers. A fellowship in RAAPM is also offered for those residents who would like to continue to further their skills. At EUH, typical procedures performed include thoracic epidurals for most thoracotomies and large open abdominal cases, thoraco-abdominal blocks including transversus abdominus plane (TAP) and quadratus lumborum (QL) blocks for smaller open abdominal procedures, and upper extremity blocks for vascular procedures. At EUHM, there is a more orthopedic focus with blocks performed for shoulder, knee, and ankle procedures in addition to erector spinae blocks and occasional thoracic epidurals for our thoracic procedures. At Executive Park, residents will gain a strong ambulatory surgery experience with a rapid pace and turnover which will push residents to become extremely efficient at performing blocks.

While on the RAAPM service, residents will round on inpatients who are being followed for pain management. These rounds include follow-up visits with any patients for whom we performed procedures, as well as other post-surgical or chronic pain patients who require our management. Residents on APS have a good amount of autonomy in the management of our patients, including making preparations for adjusting PCA dosages and discontinuing epidural catheters. After collecting data and pre-rounding, (and between performing any additional blocks on the OR schedule), the team will round with the attending. Residents learn more about the clinical examination, neurological evaluation, and managing IV and PO analgesics. The chronic pain patients often become the most interesting because of their difficult-to-control pain requiring a multi-modal approach to therapy. These patients provide an opportunity to learn about pain receptor pharmacology and pain pathways. On occasion, chronic pain patients will require procedures such as celiac plexus or intercostal nerve blocks and residents will have the opportunity to assist with these procedures as well.

The acute pain service can be challenging but is undoubtedly a rewarding experience. Residents will develop a strong knowledge base in both acute post-surgical and chronic pain, and develop technical proficiency with ultrasound-guided as well as neuraxial blocks.