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Department of Anesthesiology

A Day the Life: CA-2 at MD Anderson Acute Pain Service

Master
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Wendy

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By Wendy Tsai, M.D.

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This rotation was a great way to practice muscle memory and to get more confident with ultrasound-guided regional blocks. I enjoyed this rotation for the variety and number of blocks we got to do-- transversus abdominis plane (TAP), quadratus lumborum (QL), supraclavicular, infraclavicular, femoral, popliteal, erector spinae, pectoral, epidurals, and the list goes on. MD Anderson has a huge number (more than forty!) of robust and bustling ORs and many surgeons request blocks for their patients. The patients here often have complex or long surgeries to debulk tumor burden or deal with chronic pain, so there’s an additional level of learning too. The attendings will supervise us while we are placing blocks (usually after the patient is induced), guiding us and stepping in to help out if needed. 

We also get to see the same patients post-op to assess how well the blocks work, look for any complications, check on the pumps for our epidurals or peripheral block catheters, and of course, optimize each patient’s tailored pain regimen. Outside the OR, we follow in-house patients to continually assess their pain management and take new consults as well. The nurse practioners help split the list and hold the fort while we are in the OR performing procedures, and they help set things up when there are procedures on the floors. One of them also always leaves little surprise snacks on our desks-- yay!)

Even for residents not planning to specialize in pain medicine, practicing regional techniques is useful for pretty much all anesthesia specialties— doing a primarily regional anesthetic for super sick patients, minimizing the risks of opioid adverse effects, getting comfortable with the ultrasound (useful for things like IVs and A-lines)—I’m glad I got to do this rotation and am pumped to have some more techniques to use for my patients!