The 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 inpatient consultation to all surgical and medical services regarding any type of pain management issue. Our consultations may involve:

• Medication recommendations and management
• Placement and management of neuraxial or peripheral nerve blocks
• Performance of neurolytic blocks in cancer patients

Each day, an attending physician and house officer (either a resident or pain management fellow) cover the APS. Coverage is available by pager 24 hours a day. The APS supports regional anesthesia. Whenever we place neuraxial or peripheral continuous nerve block catheters, the APS will follow these patients postoperatively, 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 placing regional blocks when you encounter challenges. We can offer help simply to facilitate, turn over or guide you through more technically challenging procedures.

Occasionally, the APS will place an epidural before surgery. In these cases, surgeons have made arrangements for patients they 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. We facilitate placement by fluoroscopy and confirm it with an epidurogram. This ensures that every patient has a functioning epidural and optimal post-operative analgesia.

For non-surgical specialties, we most commonly help with medication management. We often assist in:

• Conversion between oral and intravenous opioids
• Trials of alternative analgesics for neuropathic pain
• Cases when opioids are poorly tolerated

In some instances, we assist with regional anesthesia or neurolytic nerve block performance, most commonly in managing cancer pain.

If you expect a patient's pain to continue for an extended period, even upon discharge, we help facilitate referral to the OHSU Comprehensive Pain Center for follow-up.