Pain and its management are important components of medical care. The Department of Anesthesia and Perioperative Medicine at the Medical University of South Carolina (MUSC) recognizes the importance of pain management. In an effort to better serve our patients’ pain needs and provide quality patient care, the Regional Acute Pain Service (RAPS) was created. Our goal is not only to provide intraoperative anesthesia, but also to decrease postoperative pain (pain after surgery) through advanced regional anesthesia techniques and multimodal analgesia pain management. We use cutting edge technology and techniques to place peripheral nerve blocks including ultrasound guidance and nerve stimulation; thus striving to improve safety and efficacy.
RAPS provides coverage and management of patients with postoperative, post-traumatic, and other types of acute pain requiring specialized interventions such as epidural analgesia and continuous peripheral nerve blockade. The service is staffed by board certified anesthesiologists and anesthesia residents. RAPS is a consult service that does not provide routine management for patients receiving intravenous opioid pain medicine. However, RAPS may be consulted for assistance with pain management at the request of the patients’ primary service.
RAPS is available to assist the anesthesia department and surgical teams to devise a post-operative pain management strategy tailored for the individual patient. This includes a full perioperative assessment which evaluates the patient’s pre-surgical pain and function, the proposed surgery, the anesthetic plan, and post-operative course. Recommendations can then be made regarding preoperative pain adjuvants, regional anesthetic techniques, anticoagulation if applicable, and post-operative pain management. Some patients may only need a single injection of local anesthetic (numbing medicine) to make a part of their body numb for surgery or decrease their pain after surgery for many hours. These injections are usually called spinal anesthesia or a peripheral nerve block (PDF). Patients requiring only a single injection of local anesthetic will be evaluated through the recovery room but will not be visited daily.
Patients followed on our service daily typically have a peripheral nerve block catheter or epidural catheter (“pain catheter”) in place through which local anesthetic is administered. This catheter is usually placed prior to surgery. This facilitates early assessment of catheter function, decreases pain prior to surgery, decreases anesthetic requirements during surgery and possibly decreases the stress response of surgery. All patients are evaluated in the recovery room and their pain and catheter function is re-assessed. RAPS will visit patients at least daily and more if necessary while the pain catheter is in place.
Sometimes patients having outpatient surgical procedures may be offered an outpatient peripheral nerve block catheter with a continuous infusion of local anesthetic to go home with. In this case, patients are called daily to check on their comfort. They are given information on how to contact someone if they have additional needs or questions. These peripheral nerve block catheters are removed by patients and their families at home two to five days after their procedure.
The Orthopedic Anesthesia Division at the Medical University of South Carolina performs over 3,400 anesthetics a year for a variety of orthopedic surgeries. As a Level 1 trauma center and major orthopedic referral center for the state, our cases include a wide variety of emergency trauma, sports medicine, spine, total joint replacement, hand, and pediatric surgeries.
We provide anesthesia at both the main hospital and our Rutledge Tower ambulatory surgery center. The Orthopedic Anesthesia Division operates in concert with MUSC’s Regional Anesthesia Pain Service (RAPS) and Bone & Joint Center. This arrangement offers patients a team approach to anesthesia, surgery and postoperative pain management. Our group employs a variety of intraoperative anesthetic techniques including spinals, epidurals and peripheral nerve blocks.
Regional Anesthesia Pain Service Faculty
Ryan Gunselman, M.D.
Director, Regional Anesthesia Pain Service