Project Details
About the Project
Two Victoria anesthesiologists have initiated highly complimentary projects around the use of regional anesthesia for certain procedures, including hernia repair, rib fracture, hip fracture, and breast surgery. Dr. Gus Chan and Dr. Jacques Smit and their colleagues in Anesthesia and Surgery developed an ambitious plan to expand the use of regional anesthesia alongside the planning for a VGH block room for parallel processing of patients, alongside related initiatives to improve the patient experience and outcomes from various surgeries.
A specific aim of Dr. Smit’s project is to improve patient experience of major breast surgery. Those involved in performing this type of surgery recognize its association with a high risk of post operative nausea, vomiting, pain, opioid requirements and chronic pain. These post-operative symptoms often necessitate admissions to the hospital in excess of 24 hours. Excessive post-operative pain is also associated with opioid use and over-sedation, which can further delay discharge, and possibly risk prolonged opioid usage.
To mitigate these impacts on patients and their caregivers, a team of clinicians including Dr. Smit and Dr. Chan from Anesthesia, Surgeons Dr. Heather Emmerton-Coughlin and Dr. Elaine Lam, and related clinical and allied health supports from the Breast Health Program and Home Care Nursing aimed to develop an Enhanced Recovery After Surgery (ERAS) approach for major breast surgery. Part of the ERAS approach involves the use of regional anesthesia, and a focused pre-operative screening, counselling, and optimization process, as well as multimodal analgesia and nausea prophylaxis. This model has been used successfully at Mount St. Joseph hospital, and needed local champions to operationalize it within Island Health.
To inform the planning, Dr. Smit conducted a data review of all breast surgery cases he worked on (>110 cases), and grouped them according to whether they involved general versus regional anesthesia. Comparing these cases with length of stay data indicate increased efficiency and lower pain and nausea incidence in the regional anesthesia group. Sharing these results with the broader surgical team helped to build consensus for the importance of a regional block room at VGH to help advance the ERAS approach to major breast surgery.
These dual initiatives have just received an additional one year of funding to pursue these objectives. The project leads thank their project team members: Dr. Jo Bleakley, Garrett Barry, Andrew Tyrell, Ryan Truant, Adrian Vethanayagam, Pooya Kazemi, Heather Emmerton-Coughlin, Elaine Lam, and Surgical Services Director, Alison Dormuth.