Fellows rotate through the Stanford Hospital sites including 300 Pasteur Drive (300P), 500 Pasteur Drive (500P) and Lane Surgery Center (LSC) for 6 blocks of dedicated out-of-OR regional anesthesia.
The Stanford rotation consists of 2 fellows: one fellow leads the team and manages the schedule, while the other focuses on clinical care and resident education. The team also consists of 2 regional attendings, 3-4 residents, anesthesia technicians and nurse practitioners.
Educational objectives focus on safety, efficacy, efficiency, education and communication. Fellows train to become experts at choosing, placing and managing a wide range of peripheral nerve blocks, most of which include catheter placement. Ongoing clinical protocols include:
- Hip fracture femoral or fascia iliaca catheter placement
- Rib fracture and lung transplant consults for potential epidural or paravertebral blocks
- Myocardial bridge patients for preoperative paravertebral catheter placement
The orthopedic anesthesia rotation (2-weeks) is at 500P. Fellows are scheduled for trauma cases and joint replacement cases that involve neuraxial anesthesia
Palo Alto VA Medical Center
Fellows rotate at the Palo Alto VA for 3 blocks of dedicated out-of-OR regional anesthesia. During the VA rotation, the fellow runs the RAAPM team. The team consists of 1 fellow, 1-2 RAAPM NPs, and 1 regional anesthesia attending. The fellow role is to manage all regional and acute pain care for perioperative patients from preop until pain is well managed and stable postoperatively. The team provides primary pain care for all orthopedic surgery and neurosurgery spine patients, as well as most operative patients with chronic pain, including those taking methadone or buprenorphine as outpatients.
A typical day consists of first case blocks, followed by breakfast with teaching, acute pain rounds, and setting up/performing blocks throughout the rest of the day, while managing floor patients and addressing consults as they arise. The team calls all patients with home nerve catheters until the catheters are safely removed by the patient.
The team performs buprenorphine inductions for applicable inpatients and offers Battlefield Acupuncture to patients as part of multimodal pain treatment.
Stanford Outpatient Surgery Center
During the blocks at the Stanford main hospital, fellows will spend days at the Outpatient Surgery Center (OSC) which is 5 miles north in Redwood City. The OSC focuses on same-day orthopedic surgeries including arthroscopes and foot/ ankle procedures. The team consists of one attending, one NP and 1-2 residents. Fellows help perform blocks and supervise residents.
Lucille Packard Children's Hospital
The fellows rotate at the Lucille Packard Children’s Hospital (LPCH) during their 4-week pediatric pain rotation and 2-week neuraxial/ obstetric rotation. The pediatric rotation is split into inpatient acute pain and outpatient chronic pain.
Fellows also have an opportunity to do a pediatric regional anesthesia elective with the Stanford University Pediatric Perioperative Pain and Regional Anesthesia (SUPRA) team.