Research Report 2018

Dr. Richard Brull | Senior Scientist and Anesthesiologist

Pushing the boundaries of anesthesia in ambulatory surgery

Despite advancements in safety and technology that have revolutionized the practice of anesthesia, pain and nausea remain the two leading obstacles to timely discharge from hospital after surgery. Conventional narcotic-based analgesic strategies create a vicious circle of pain and nausea that keep patients in hospital beds, creating further delays for operations and costing the health system thousands of dollars per hospital stay. Dr. Richard Brull’s research is focused on developing strategies that prolong the duration of regional anesthesia to push the boundaries of ambulatory surgery and facilitate same-day discharge from the hospital.

Total knee replacement (TKR) surgery is one of the most commonly performed, yet painful surgeries worldwide. In Canada, only 69 per cent of patients receive TKR surgery within the recommended time frame and creating a backlog in our already strained healthcare system. Using his research on prolonging the effects of nerve blocks, Dr. Brull, Evelyn Bateman Cara Operations Chair in Ambulatory Anesthesia and Women’s Health, has played an instrumental role in developing, implementing and launching Canada’s first outpatient TKR program building on the success of Women’s College Hospital (WCH)’s Outpatient Thyroid Surgery program. By avoiding opioids and using sensory nerve blocks and short-acting spinal anesthesia to preserve muscle strength, patients undergoing TKR surgery at WCH are able to go home the same day.

Dr. Brull’s research has also been used to reduce severe acute postoperative pain following breast cancer surgery, which affects nearly 60 per cent of patients. As a result of postoperative pain, up to 50 per cent of women undergoing breast cancer surgery will develop chronic pain with long-term health impacts. To reduce pain following surgery, Dr. Brull evaluated the effectiveness of using novel nerve blocks. Based on evidence from Dr. Brull’s research over the past year, using nerve blocks during breast cancer surgery is now routine practice at WCH.