Inpatient Adult Pain Service

acutepainThe Inpatient Adult Pain Service (APS) provides many services for the Comprehensive Pain Center (CPC) as well as for the OHSU hospital as a whole. All attending physicians associated with this service have completed a fellowship in Pain Management and have experience treating both acute and chronic pain. We are available for in-patient consultation to all surgical and medical services regarding any type of pain management issue. This may involve medication recommendations and management, placement and management of neuraxial or peripheral nerve blocks, or performance of neurolytic blocks in cancer patients. Each day the APS is covered by an attending physician and house officer (either a resident or pain management fellow). Coverage is available by pager 24 hours a day. The APS supports regional anesthesia. Whenever neuraxial or peripheral continuous nerve block catheters are placed, the APS will follow these patients post-operatively, manage the catheters, and facilitate transition to oral analgesics. Excellence in regional analgesia is becoming a departmental standard. To facilitate this, the APS attending physician can often assist in placement of regional blocks when challenges are encountered, whether simply to facilitate OR turnover or to provide guidance with more technically challenging procedures.

Occasionally, an epidural will be placed by the APS prior to surgery. This will have been arranged by the surgeons for patients that the surgeons feel will benefit greatly from epidural analgesia but in whom epidural placement was likely to be difficult. Most commonly these patients are morbidly obese and scheduled for Bariatric Surgery. Other patients may have severe scoliosis or other orthopedic challenges. Placement is facilitated by flouroscopy and confirmed with an epidurogram. This ensures that these challenging patients will have a functioning epidural and optimal post-operative analgesia.

For non-surgical specialties our services most commonly involve assistance in medication management. This often involves assisting in conversion between oral and intravenous opioids or in trials of alternative analgesics for neuropathic pain or when opioids are poorly tolerated. Regional anesthesia or performance of neurolytic nerve blocks may play a role in some instances, most commonly in management of cancer pain. For patients whose pain is expected to continue for an extended period even upon discharge, we help facilitate referral to the Comprehensive Pain Center for follow-up.