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Using ambulatory anesthesia to improve the patient experience

May 7, 2018

By Atifa Hamir

This article is the last part of a four-part series about Women's College Hospital's new ambulatory (outpatient) joint replacement surgery program. Read parts one, two and three

Opioids are a vital component of many surgeries, allowing patients to undergo important procedures while minimizing pain during the process. However, they often come with unwanted side effects, such as nausea, which can delay discharge from hospital. Women’s College Hospital’s new ambulatory joint replacement surgery program is addressing this issue by using a unique combination of regional anesthesia, comprised of a local anesthetic-based nerve blockers, to give patients long-lasting pain relief with a reduced risk for adverse effects, allowing them to return home faster and improving their surgical experience.

"A lot of people go through this unfortunate cycle of pain and nausea after surgery, where the anesthetic and the pain medication they are on can cause them to feel nauseated, but stopping the medication causes them to be in pain," says Dr. Richard Brull, the inaugural Evelyn Bateman Cara Operations Chair in Ambulatory Anesthesia and Women’s Health at WCH. "By moving from opioid-based pain control to local anesthetics, we’re breaking the vicious circle of pain-nausea-pain, and it can be vicious indeed."

The ambulatory surgery program aims to send patients home within four hours of completing their surgery. This means that patients need to be awake, mobile and comfortable before being discharged. To keep patients comfortable, an anesthesiologist uses a local anesthetic that is administered to the procedure area that lasts for up to 24 hours, giving the patient pain relief well into their first full day of recovery. To do this, the anesthesiologist will use an ultrasound machine to locate the sensory nerves and then use nerve blockers to stop the nerve’s ability to send messages of pain to the brain. 

"What makes our method of ambulatory anesthesia unique is the way in which we’re targeting specific types of nerves in a particular area, and essentially tricking the brain into thinking that there’s nothing happening," notes Dr. Brull. "This puts less strain on a patient’s body in a lot of ways, one them being that the patient doesn’t experience the normal physiological and psychological reactions to pain both during and after the procedure."

To keep the patient still during the short surgery, the anesthesiologist also gives the patient a spinal anesthetic to freeze the lower half of the body for roughly 75 minutes. Since the surgery is done within an hour, the freezing is completely worn off by the time the patient is ready to go home. This is important for the patient’s recovery process as it allows them to practice walking using their crutches and climbing stairs with the assistance of a physiotherapist in the hospital, giving them the confidence to use them independently at home.

"This transition from traditional inpatient to ambulatory surgery may seem like a small change, but it has really positively impacted our patients in so many ways," reflects Dr. Brull. "Using regional anesthesia to facilitate an ambulatory procedure with minimal pain, nausea and sedation changes the landscape for joint replacement surgery in Canada and improves the overall patient experience."

To learn more, see the recent news coverage about the program from the Toronto Star and CTV National News

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