Acute Perioperative Interventional Pain Service


Dr. Robert Maniker, Director of the Acute
Perioperative Interventional Pain Service

Management of pain around the time of surgery is one of our top priorities. At Columbia we take an intensive approach to identifying and treating pain, often times even before it arises. Our acute perioperative pain team includes physician specialists and a specialist nurse practitioner working together with the ultimate goals of minimizing pain, minimizing medication side effects, and creating the most comfortable experience for surgical patients. We accomplish this with a state-of-the-art approach, often utilizing procedures such as epidural catheters and peripheral nerve blocks along with a combination of medications and close patient interaction.

 

Treatment of Acute Perioperative Pain, a Multimodal Approach:

In our multimodal approach to acute pain management, we maximize the use of central and peripheral nerve blocks. Nerve blocks are most often placed prior to surgery in order to ensure pain relief as soon as it occurs, and also to minimize the use of pain medications and their side effects.

The procedures we offer include:
Spinal and Epidural Block
Thoracic Paravertebral Block
Lumbar Plexus Block
Brachial Plexus Block
Femoral Nerve Block
Adductor Canal Block
Obturator Nerve Block
Sciatic Nerve Block
Transversus Abdominis Plane (TAP) Block
Rectus Sheath Block

Many of these nerve blocks are also offered as continuous catheters with or without a patient-controlled bolus function.

Patient-Controlled Epidural Analgesia (PCEA) and Patient-Controlled Regional Analgesia (PCRA):
After placement of small catheters in the epidural space or near a peripheral nerve, a specialized infusion pump with physician-programmed parameters and limits allows the patient to tailor the amount of medication infused to their individual level of pain. This allows for a more continuous level of relief, minimum effective medication dosing, and an added level of safety. The limits can be adjusted as needed by the acute perioperative pain team.

In addition to procedures, we utilize a combination of medications including:
Opioids
Non-steroidal anti-inflammatory agents (NSAIDs)
Muscle relaxants
Anticonvulsants
Antidepressants
Topical analgesics

Intravenous Patient-Controlled Analgesia (IV-PCA):
Similar to PCEA and PCRA described above, IV-PCA allows patients to tailor the amount of intravenous opioid pain medication to their individual level of discomfort. Parameters set by the acute perioperative pain team allow for safety and can be adjusted as needed.

A Team Approach:
The acute perioperative pain team conducts daily rounds to follow patients throughout their hospital stay and adjust treatment modalities accordingly. This includes adjustments to PCEA’s, PCRA’s, IV-PCA’s as well as the medications listed above. In addition, we provide dedicated 24-hour coverage by a physician anesthesiologist to provide continuous re-assessment, manage acute issues and make changes accordingly. We also work closely with physicians and specialists from other disciplines to provide the best patient care, including surgeons, physical and occupational therapists, psychiatrists, addiction psychologists, and social workers.

What to expect at the time surgery:
On the morning of surgery, you will meet with an anesthesiologist who will provide care to you in the operating room. If necessary you will consult with an anesthesiologist specialized in performing peripheral nerve block procedures. If a nerve block catheter is placed you will be seen in the recovery room by a member of the acute perioperative pain team. You will then be seen on a daily basis by the acute perioperative pain team while any epidural or peripheral nerve block catheter is in place, or if you have special needs requiring perioperative pain management. If you feel an assessment of your pain and/or an adjustment of any pain medication is needed at any point during your hospitalization, you can ask your nurse to page the acute pain team member on-call.

Our ultimate goal is providing the highest level of patient comfort and affording the greatest opportunity for timely rehabilitation and recovery from surgery.

Acute Perioperative Interventional Pain Team:
A. Robin Brown, MBChB, FFA(SA), Director, Orthopedic and Regional Anesthesia
Robert Maniker, MD, Director, Acute Perioperative Interventional Pain Service
Danielle Ludwin, MD
Connie Chung, MD
Oliver Panzer, MD
Anis Dizdarevic, MD
Leena Matthew, MD
Elsa Wuhrman, DNP, FNP, BC, DCC

EDUCATION/TRAINING
The Pain Medicine Center at Columbia University is under the auspices of the Department of Anesthesiology in the College of Physicians and Surgeons. As a result we have medical students, psychology interns, residents and pain management fellows rotate through the Center and undergo specialized training in Pain Medicine.

Fellowship in Pain Management: we offer a one-year Fellowship in Pain Medicine.

For more information click here.

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Columbia University Medical Center Department of Anesthesiology