Sunnybrook Bayview/Holland Centre – Acute Pain Service (APS) Primer for Residents
APS Pager: 8210
Goals:
• Achieve adequate/satisfactory pain control for patients post-operatively or patients admitted to hospital with pain (i.e. trauma patients
• Wean intravenous analgesics if appropriate and transition to oral analgesics to facilitate discharge from hospital
• Employ multimodal analgesia and avoid escalation in opioid use
• When appropriate consider regional anesthesia catheters for prolonged acute pain management (2-7 days)
Intraoperative:
• Consultations for APS generally occur for patients with chronic pain, following surgeries with expected severe pain, at surgeon’s request, and for all Holland Centre arthroplasty cases
• Complete a Sunnycare APS consultation note – including details of opioid use prior to hospitalization. Review the patient’s home analgesic regimen and re-order gabapentinoids and long-acting opioids when appropriate
• Complete order on Sunnycare – this will automatically add patients to the APS signout list. If a paper orderset is completed, please add patients manually to the APS signout list
Resident APS coverage:
Tue-Fri 10pm-8am; Mondays 4pm-8am
**Note that after hours and weekend coverage also includes answering pages from the Holland Centre. If your 4 digit call back number is invalid, consider calling locating and asking to be transferred to the 4 digit extension as it may originate from the Holland Centre.
Catheters:
• No changes to anticoagulation/DVT prophylaxis needed when removing peripheral nerve catheters. Ward nurses can typically remove peripheral nerve catheters with written/verbal order.
• Epidural catheters require timing the removal to DVT prophylaxis. Epidural catheters must be removed by APS/Anesthesia team
o If called by MRP/ICU about patient with epidural in situ for full anticoagulation due to PE/ACS, please remove epidural catheter ASAP before loading with anticoagulant
Tips and tricks:
• Do not order IV PCA and PCEA at the same time as it offers two buttons to push for the patient
• ED does not accept IV PCA. As of Jan 2024, admitted patients who are in ED can have their ESP catheters infused using programmable pumps
• When responding to page, call 416-480-(extension number) or 416-480-4244 (locating)
• Patients should be seen within 24 hrs of being consulted
• When signing off of HPB patients from APS, nerve catheter infusions can continue and will be managed by HPB
• Ketamine infusions can be started by other service and are not exclusive to APS
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