Eskenazi Acute Pain Service (APS)

The Acute Pain Service (APS) at Eskenazi is a consistent favorite among residents.  This service exceeded 3000 regional blocks last year and is on pace to grow significantly this year.  During this month, a resident’s primary responsibility is providing regional blocks for patients undergoing surgery.  All blocks are conducted under the direct supervision of a dedicated APS faculty anesthesiologist.  Given that Eskenazi does not have any regional anesthesia fellows, all of these blocks are performed by residents.  Residents complete this month-long rotation twice during their anesthesia training, typically surpassing 100 regional blocks on this rotation alone.  Eskenazi APS staff teach a vast array of regional anesthesia techniques including both cutting-edge and time-tested regional anesthesia procedures.  These include both single shot and catheter techniques.  Daily rounding on pain service patients also facilitates training in post operative pain control and managing an acute pain service.

 

The vast array of regional blocks currently being taught includes but is not limited to the following:

Upper Extremity

  • Interscalene (nerve stimulator and ultrasound-guided)
  • Supraclavicular (ultrasound-guided)
  • Infraclavicular (nerve stimulator and ultrasound-guided)
  • Axillary (transarterial, nerve stimulator, and ultrasound-guided)

 

Lower Extremity

  • Lumbar plexus (nerve stimulator)
  • Fascia iliaca (ultrasound-guided)
  • Femoral (nerve stimulator and ultrasound-guided)
  • Sciatic (nerve stimulator and ultrasound-guided
     -parasacral, classic, subgluteal, and popliteal approaches
  • Lateral Femoral Cutaneous (landmark and ultrasound-guided)
  • Saphenous (landmark and ultrasound-guided)
  • Intraarticular blocks
  • Ankle block
Trunk
  • Intrathecal
  • Epidural (lumbar and thoracic, midline and paramedian approaches)
  • Paravertebral (nerve stimulator and ultrasound-guided)
  • Transversus Abdominis Plane (ultrasound-guided)

 

In adhering to the Eskenazi anesthesia theme of resident autonomy, regional blocks are usually resident-directed.  Specific regional techniques are chosen based primarily on the combination of surgical type, patient comorbidities, block side effect profile, and resident training preference.  APS faculty are committed to flexibility and intense resident instruction.  Eskenazi Hospital is currently in the process of becoming a regional anesthesia Center of Excellence.

 

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