A5005228243- Anesthesia and Pain Management
- Pain Management and Opioid Use
- Opioid Use Disorder Treatment
- Nausea and vomiting management
- Cardiac, Anesthesia and Surgical Outcomes
- Pediatric Pain Management Techniques
- Pain Mechanisms and Treatments
- Pain Management and Treatment
- Cardiac Health and Mental Health
- Enhanced Recovery After Surgery
- Musculoskeletal pain and rehabilitation
- Healthcare innovation and challenges
- Pharmaceutical Practices and Patient Outcomes
- Prenatal Substance Exposure Effects
- Pharmaceutical studies and practices
- Intestinal and Peritoneal Adhesions
- Urinary Bladder and Prostate Research
- Diagnosis and Treatment of Venous Diseases
- Nursing Roles and Practices
- Transplantation: Methods and Outcomes
- Diet and metabolism studies
- Spine and Intervertebral Disc Pathology
- Clinical practice guidelines implementation
- Healthcare Quality and Management
- Patient Safety and Medication Errors
Toronto General Hospital
2015-2025
University Health Network
2010-2024
University of Toronto
2010-2022
McMaster University
2016
Scripps Clinic
2016
St. Michael's Hospital
2009
Health Sciences Centre
2009
Sunnybrook Health Science Centre
2009
Health Net
2005
Chronic postsurgical pain (CPSP), an often unanticipated result of necessary and even life-saving procedures, develops in 5-10% patients one-year after major surgery. Substantial advances have been made identifying at elevated risk developing CPSP based on perioperative pain, opioid use, negative affect, including depression, anxiety, catastrophizing, posttraumatic stress disorder-like symptoms. The Transitional Pain Service (TPS) Toronto General Hospital (TGH) is the first to...
To identify the 3-month incidence of chronic postsurgical pain and long-term opioid use in patients at Toronto General Hospital.200 consecutive presenting for elective major surgery completed standardized questionnaires by telephone 3 months after surgery.51 reported a preoperative condition, with 12 taking opioids preoperatively. 35% having surgical site 13.5% continued to relief. Postoperative was associated interference walking work, lower mood.Chronic ongoing are concerns that warrant...
ABSTRACT Background The perioperative period provides a critical window to address opioid use, particularly in patients with history of chronic pain and presurgical use. Toronto General Hospital Transitional Pain Service (TPS) was developed the issues use after surgery. Aims To provide program evaluation results from TPS at highlighting weaning rates management opioid-naïve opioid-experienced surgical patients. Methods Two hundred fifty-one high-risk were dichotomized preoperatively as naïve...
Clinical hypnosis is an effective strategy for managing acute pain in the surgical setting. However, opioid sparing effects of clinical are not as well understood. This pre-registered (NCT03730350) randomized, controlled trial (RCT) examined impact hypnosis, pre- and post-surgery, on consumption during hospitalization measures intensity, interference, depressed mood, anxiety, sleep, catastrophizing. Participants (M = 57.6 years; SD 10.9) awaiting oncologic surgery were randomized to...
Despite the increase in surgical volumes of live liver donation, there has been very little documentation postoperative pain experience. The primary aim this study was to examine difference acute intensity and adverse effects between patients who received intravenous patient-controlled analgesia (IV PCA) or epidural (PCEA) for control after donation surgery. A retrospective chart review performed 226 consecutive underwent right living donor hepatic surgery at Toronto General Hospital,...
Abstract: In an era of growing concern about opioid prescribing, the postsurgical period remains a critical window with risk significant dose escalation, particularly in patients history chronic pain and presurgical use. The purpose this case report is to describe multidisciplinary care complex, patient by innovative transitional service (TPS). A 59-year-old male complex pain, as well escalating long-term use, presented bleeding duodenal ulcer requiring emergency surgery. After surgery, TPS...
This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, teams, pharmacists, allied professionals, and trainees) to (1) use nonopioid therapies reduce opioids so that fewer opioid pills are available diversion (2) educate their families/caregivers about management options after...
With >700 transplant surgeries performed each year, Toronto General Hospital (TGH) is currently one of the largest adult centers in North America. There a lack literature regarding both identification and management chronic postsurgical pain (CPSP) after organ transplantation. Since 2014, TGH Transitional Pain Service (TPS) has helped manage patients who developed CPSP solid transplantation (SOT), including heart, lung, liver, renal transplants.In this retrospective cohort study, we describe...
The present study investigated the associations between smoking, pain, and opioid consumption in 3 months after major surgery patients seen by Transitional Pain Service. Current smoking status lifetime pack-years were expected to be related higher pain intensity, more use, poorer weaning surgery.A total of 239 reported their presurgical assessment (62 smokers, 92 past 85 never smokers). daily use assessed hospital before postsurgical discharge, at first outpatient visit (median 1 month...
Tens of thousands cardiac and vascular surgeries (CaVS) are performed on seniors in Canada the United Kingdom each year to improve survival, relieve disease symptoms, health-related quality life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection hemodynamic compromise, complications, related poor functional status major problems for substantial numbers patients during recovery process. To tackle this problem, we aim refine test effectiveness an eHealth-enabled...
Objective: Conventional management of pain following open liver resection involves intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. The objective this trial was to assess the efficacy a regional technique called Medial Open Transversus Abdominis Plane (MOTAP) catheter compared with IV PCA. Methods: This blinded, randomized, controlled parallel-arm conducted at 2 high-volume centers. Patients undergoing through subcostal incision were enrolled. Using standardized...
Abstract Background The study aims were to model acute pain intensity and opioid consumption trajectories up 72 hr after open hepatic resection, identify predictors of trajectory membership examine the association between memberships 6‐month psychological outcomes. This is a long‐term analysis published randomized controlled trial on impact medial transversus abdominis plane catheters post‐operative Methods A total 152 patients (89 males; mean age 63.0 [range: 54–72]) completed...
Living donor liver resections are associated with significant postoperative pain. Epidural analgesia is the gold standard for pain management, although it often refused or contraindicated. Surgically placed abdominal wall catheters (AWCs) a novel modality that can potentially provide relief those patients who unable to receive an epidural. A retrospective review was performed at single center. Patients were categorized according their modality: intravenous (IV) patient‐controlled (PCA), AWCs...
The current standard for pain control following liver surgery is intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. We have developed a modification of regional technique called medial open transversus abdominis plane (MOTAP) catheter MOTAP involves surgically placed catheters through the surgical site into between internal oblique muscle and transverse superiorly. objective this trial to assess efficacy technique. This protocol describes multicentre, prospective,...
Abstract Background Persistent pain is a common yet debilitating complication after breast cancer surgery. Given the pervasive effects of this disorder on patient and healthcare system, post-mastectomy syndrome (PMPS) becoming larger population health problem, especially as prognosis survivorship increases. Interventions that prevent persistent surgery are needed to improve quality life survivors. An intraoperative intravenous lidocaine infusion has emerged potential intervention decrease...