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Annual Reports

Regional Anesthesia and Acute Pain Services 

Dr. Kevin Armstrong, Program Director

2015 marks the end of an era for the regional program at Western. Su Ganapathy, who was instrumental in a number of endeavours, retired. Since completing her regional anesthesia fellowship training in 1993, she has been prominent on the national and international stage. Her contributions include numerous publications, the establishment and development of a training program for residents and fellows, multiple learning workshops, the introduction of advanced clinical care for a large number of patients. Two more important contributions are her foresight into the use of ultrasound (US) for regional anesthesia, and her collaborative work beyond the department. Under her guidance we became early adopters of this US technology, which is state of the art. 

Together with the Department of Anatomy and Cellular Biology and the Robarts Research Institute, many fruitful collaborative projects resulted. Obviously this paragraph cannot do justice to her career here at Western; however together with George Varkey, Su is someone to whom all who practice regional anesthesia owe a debt of gratitude. 

As we enter 2016, the regional anesthesia and acute pain service continue to be busy environments regarding patient care. These services provide care for a large number of patients at the three acute care hospitals in London. Regarding education, residents and fellows gain exposure, experience, knowledge and skill in the practice of regional anesthesia at the SJHC and UH sites. Residents and to limited degree fellows, have educational opportunities at the VH site. The regional anesthesia groups have been quite productive in the area of research over the past year.

For a number of years there has been a vision to harness the expertise of services with know-how in pain management and apply this to pain management in the perioperative period. The identified services are Chronic Pain, Acute Pain, Palliative Care, and Regional Anesthesia. With the support of the CPMP, three programs were initiated and showed great promise for the future. Under the leadership of Collin Clarke, the intrathecal catheter placement and management for palliative pain management is well underway with a projected growth for 2016. Under the leadership of Raju Poolacherla the pediatric chronic pain management program has been implemented at the VH site. 

Qutaiba Tawfic, one of our newer physicians has initiated the Acute Pain Management Fellowship. For 2016, we are expecting to enhance the academic deliverables for such a program. 

Our support from nursing includes our Nurse Clinician Heather Fisher and our Nurse Practitioners Heather Whittle (VH) and Charlotte McCallum (UH). As the roles of the programs expand, these individuals will play a significant role in both clinical care, as well as education. 

Regional Anesthesia 

Regional anesthesia and analgesia, in the form of peripheral nerve block, is well established in the clinical care of perioperative patients at SJHC and UH. There continues to be interest in introducing regional anesthesia to the VH site. At this time, Dr. Gopa Nair and his pediatric colleagues are working towards the expanded use of regional anesthesia for pediatric patients. With the retirement of of Su Ganapathy and John Parkin, and the lost of Rakesh Vijayashankar, we currently have eight faculty members who provide clinical care, educational opportunities and participate in research at the SJ and UH sites. This creates a number of challenges. In the coming months we will be actively recruiting consultants with the skill set to fulfill the academic mission of the department.

At SJHC, the clinical load of the Hand and Upper Limb Centre (HULC), results in a high volume of clinical work, educational opportunities, and research involving the brachial plexus. The presence of the breast care program is an opportunity to increase our activity in trunchal blockade, namely paravertebral blocks. At UH the general surgery, orthopedic and plastic surgery populations provide a high volume of clinical work, educational opportunities, and research involving truchal blockade and lower limb regional analgesia. The UH block room continues to evolve. We continue to work towards an effective model in these financially challenging times.

Acute Pain Management

The clinical load at both UH and VH sites continue to be highly subscribed. There are 100 to 150 primary clinical visits per week by the APS team at both sites. Additionally there are supplemental visits by of nurse clinicians and on call residents. At SJHC, the numbers are much smaller and often involve regional analgesia. “CPOE” (computer provider order entry) has been in place for over a year at this point, and I believe that the workflow for APS consultants is working reasonably well.

Complex Pain Management Program 

There is an ever increasing need for innovative strategies to manage the pain of patients presenting for surgery. Some patients have generalized chronic pain, others have pre-existing chronic pain at the site of surgery, and others develop chronic post surgical pain. The extent of these problems are variable and difficult to predict. We continue to work towards pain management pathways that draw on the expertise of those who work in regional anesthesia, acute pain management and chronic pain. These pathways are expected to improve the care for all patients but especially those higher risk for chronic post- surgical pain. Such changes have the potential to improve patient care, offer learning opportunity for our trainees, and opportunities for research and audit activity. Involvement of the chronic pain residency will add positively to this program.