Surgery

The Acute Pain Service is a multidisciplinary team comprised of anesthesiologist, anesthesia assistants trained in acute pain management, in-patient nurses and pharmacists. The goal of the Acute Pain Service is to assist patients through their surgical recovery by minimizing pain and reducing post-operative complications.

The type of pain management employed is determined by a number of factors, including type of surgery, type of anesthetic and most importantly, specific patient’s needs. The specific therapies employed to manage pain may include: oral medication, intravenous self-controlled pain pumps, regional anesthetic blocks or epidural infusions. The Acute Pain Service team will work with each patient to develop the best strategy to optimize their post-operative recovery with your surgeon and other health care providers.

Post-operative Pain Management Education for Patients

The management of post-operative pain begins at home with the development of reasonable expectations and goals for pain relief. Although absolute avoidance of pain following surgery would be ideal, the reality is that some discomfort is likely unavoidable. However, with the use “multi-modal” (medications from different classifications) therapy and non-pharmacologic techniques, the Acute Pain Service will ensure that our patients have level of pain that is manageable and allows for a safer and quicker recovery.

Each patient within the Acute Pain Service will have the opportunity to discuss their individualized pain management plan with a dedicated anesthesiologist or anesthesia assistant in their pre-surgery appointment or the day of surgery. Part of that discussion will include the type of anesthetic utilized, such as spinal, neuraxial anesthesia, general anesthesia, regional anesthesia or epidural anesthesia/analgesia.

Immediately prior to surgery, Acute Pain Service patients will be provided with several oral medications. This “multi-modal” therapy will be continued throughout the perioperative period and works to minimize narcotic (opioid) use.

Advantages of Multi-Modal Pain Management include:

• Reduces the dependency on narcotic (opioid) drugs to achieve adequate pain management
• Reduces the overall side effects of the medications (i.e., drowsiness, nausea)
• Allows patients to feel more alert following surgery
• Allows for earlier ambulation
• Allow for earlier progression of diet (i.e., clear fluids to full diet)
• Allows for earlier return of normal bowel and bladder function
• Decreased incidence of confusion post-operatively
• Earlier recovery and discharge home

Although each patient’s medications will be tailored to their particular surgery, anesthetic and pre-existing medical condition(s), patients will be provided with around the clock medications for a number of classifications (multi-modal) including: anti-inflammatories, acetaminophen, long acting capsules and stronger tablets used for “breakthrough” pain. “Breakthrough” pain is pain that is not effectively managed with scheduled medications alone. Typically this type of pain may be associated with an increase in activity, such as physiotherapy or ambulation. Patients are encouraged to speak with their nursing staff and take additional medications as needed to promote optimum comfort. By providing these medications around the clock, pain is managed and side effects are minimized. Although it may seem strange to have nursing staff wake patients to take medications, the regular dosing has been proven to be more effective and well tolerated.

Medications provided by intravenous or epidural routes are often used in conjunction with oral tablets to provide additional analgesia for patients requiring them. Patient Controlled Analgesia pumps and Patient Controlled Epidural Analgesia pumps are an option that allow the patient to push a button that is attached to the intravenous line or epidural, which then delivers a small effective dose of medication. These devices have multiple pre-set, safe limits and are used exclusively by the patient. Nursing staff and family are not allowed to touch the pump control button. Patient Controlled Epidural Analgesia is a method often used for patients undergoing large abdominal, urologic or vascular surgeries, as well as for mothers in the birthing unit. The anesthesiologist, anesthesia assistant and nursing staff will provide additional education for patients with these systems to ensure that patients understand how to effectively use them.

There are also a number of other pain management techniques to improve patient comfort. These can include application of cold or heat packs, relaxation techniques, distraction (television, music and games) or activities that patients find relaxing and therapeutic.

Assessing Your Pain

Pain is not easy to measure. Each patient room is equipped with a “white board” that your nurse will explain on arrival to the area. There are a number of “faces” at the bottom of the board, which help in assigning a numeric value or pain score (0-10) to your discomfort. Your pain score will help the nursing staff determine the most effective medications to administer to improve your comfort. These pain scores will also be used by the Acute Pain Service team to evaluate how effective any changes to your multi-modal therapy have been. Staff will be asking you with each visit how comfortable you are and how effective your pain medications are. It is important that patients communicate with the nursing staff to ensure that comfort is achieved.

Nursing staff will also be focusing on the type of pain that patients are experiencing and may ask questions about the “quality” of the pain. Is it burning, sharp, throbbing, and aching? Where is the pain? Does it travel to other parts of your body? Is there a certain position that makes you feel better or worse? How effective are the pain medications when you take them? All of these questions will assist the nursing staff to effectively manage your post-operative pain.

Patients are encouraged to speak to the anesthesiologist, the anesthesia assistant and nursing staff about any questions related to their pain and treatment while at RVH.

References

RVH – Information for Patients Having Surgery – Spinal / Epidural Anesthesia
RVH – Information for Patients Having Surgery – Regional Anesthesia, Upper and Lower Extremities
RVH – Pain Management – Patient Controlled Analgesia
RVH Department of Anesthesia
Pasero, C., McCaffrey, M. Pain Assessment and Pharmacologic Management. Mosby. St. Louis. (2011)

The Department of Anesthesia provide Anesthesia care for patients undergoing surgical procedures and carefully assess patients preoperatively and educate them about their surgeries

The Department also runs a comprehensive Acute Pain Service to ensure that patients have appropriate pain management during their post-operative stay. The care of postoperative pain also includes regional anesthesia (Nerve Blocks for acute pain) where an anesthesiologist, using ultrasound guidance, delivers local anesthetic close to a nerve to provide hours of relief after certain surgeries.

Anesthesiologists play an important role in the birthing unit, providing pain control during labour and surgical anesthesia during caesarean sections.

They also provide relief for patients with chronic spinal pain through Fluoroscopy (X-Ray) guided and Ultrasound guided nerve block and epidural injections.

You may also encounter anesthesiologists caring for patients in areas like the Imaging Department, Emergency Room, Cardiac Care Unit (CCU) and Intensive Care Unit (ICU).

Currently, there are 24 dedicated anesthesiologists on staff at the hospital providing 24 hour coverage for both elective and emergency care throughout the hospital. You may also encounter our excellent anesthesia assistants who work under the supervision of the physicians to provide high quality care for our patients.

Musculoskeletal Central Intake / Musculoskeletal Rapid Access Clinic
The North Simcoe Muskoka LHIN (region) has introduced the Musculoskeletal (MSK) Central Intake and Rapid Access Clinics (RAC) as part of a provincial initiative to improve timely access to quality care.

Rapid Access Clinics locations:

• Collingwood General and Marine Hospital
• Orillia Soldiers’ Memorial Hospital
  •Royal Victoria Regional Health Centre

​Contact Us
Phone: 705-728-9090 Ext. 46950
Fax: 705-792-3329
Toll Free Fax: 1-866-449-0994

The MSK Central Intake acts as one point of contact for all referrals related to hip and knee arthritis across the region. Patients will be assessed by an Advanced Practice Physiotherapist (APP) at one of three RACs in our region. Patients deemed ready for surgery will then go on to see the orthopaedic surgeon.

What to Bring to Your Appointment:
· Health Card and/or applicable insurance (ie WSIB, etc)
· X-rays or Diagnostic Imaging Films or CDs
· Please wear/bring loose fitting clothes for the joint being assessed
· Medication list

The APP is a specially trained physiotherapist that works collaboratively with the orthopaedic surgeons. This model focuses on providing quicker access for patients while maintaining thorough patient education and treatment recommendations. This streamlined process has improved access and quality of care for patients with hip and knee arthritis including reduced wait times for both assessment and surgery.

Prior to referral, primary care practitioners should discuss with their patients if they would prefer their assessment to take place at the location closest to their home, or if they would prefer to attend the first available assessment within the LHIN (region).

Joint Assessment Referral Process
All patients require a referral from a referring practitioner.

Referral Forms that are not complete will be returned to the referring practitioner and a new referral will be required. Complete referrals facilitate having patients seen in a timely manner and allows accurate provincial wait times to be captured for our LHIN (region).

Once a patient has been booked for a consultation appointment at the clinic, they are contacted directly and/or by their referring practitioner with appointment information and any specific instructions required (paperwork and x-ray requirements).

Fax:
Referring practitioner can fax the completed referral form with an attached x-ray report (within the past 6 months) to 705-792-3329

Equipped with the latest technology, our three room endoscopy suites and one room cystoscopy (OR 11) suite provides a comprehensive range of diagnostic and therapeutic procedures on a scheduled or emergency basis. After hours, the Surgical Suite provides coverage.

Referral Instructions
The Surgeon/Specialist offices book procedures directly with the OR scheduling Staff.

RVH Endoscopy Patient Survey
If you have been a recent RVH Endoscopy patient, the Endoscopy Department kindly requests that you complete this short survey to help us improve the patient experience.