Clinical Services

Operating Room

Under the leadership of Dr. Tim Stanley, the Durham VA HCS operating room platform consists of nine operating rooms (three new ORs including a hybrid room are currently under construction and are projected to be completed by July 2021). We perform about 5,500 cases per year, with a significant number of high-risk cardiac (including circulatory arrest cases), thoracic, general, vascular, neurosurgery, urology, ENT, orthopedics, and plastics procedures.

Non-OR Locations (NORA)

We provide anesthetic services for our hospital-based GI Endoscopy Unit, and procedures in the Electrophysiology and Vascular and Interventional Radiology suites.

Surgical Critical Care Unit

A multidisciplinary team of Anesthesiology and Surgery faculty, physician assistants, nurses, trainees, nutritionist, pharmacist, physical therapy, and respiratory therapy round daily on our 12-bed surgical intensive care unit. On any given day, approximately 30% of our patients are post-cardiothoracic surgery patients, with the rest a mix of high-risk general, vascular, urology and neurosurgery patients. The unit provides advanced therapies such as inhaled nitric oxide, continuous renal replacement therapy, and invasive hemodynamic support. Our team is also capable of placing peripherally-inserted central catheters, nasoenteral feeding tubes, and percutaneous tracheostomy procedures. The unit is directed by Dr. John Lemm.

Pain Program

Under the leadership of Dr. Thomas Van de Ven, our Pain Program is focused on providing cutting-edge, multidisciplinary care to patients suffering both chronic and acute pain in multiple settings from home to the hospital.

Pain Clinic

The Durham VA pain clinic is one of the oldest in the VA system, founded by Dr. Joel Goldberg in 1988. The clinic, currently led by Dr. David Lindsay, has been providing intensive pain therapy, including advanced image-guided interventional techniques, for over three decades. It has also provided clinical education to pain medicine fellows for over twenty years where they learn in a truly multidisciplinary environment, with a group that now includes dedicated pain-focused psychology, physical therapy, and pharmacy providers in addition to Physical Medicine and Rehabilitation physicians, advanced practice providers, nurses and Anesthesiology pain specialists.

Inpatient Pain Services

In addition to providing outpatient chronic pain care, our clinic practitioners also provide pain medicine services for patients in the hospital suffering from severe pain exacerbations of ongoing medical conditions. We also offer services to veterans in VA long-term care and hospice facilities who require end-of-life treatment for cancer pain and pain resulting from other terminal conditions.

Regional Anesthesia Services

Regional anesthesia, targeting surgical, medical or traumatic pain in a specific area of the body, not only reduces pain and suffering for patients in the hospital but has also been shown to improve many other important patient outcome measures following surgery or trauma. Under the direction of Dr. Harika Nagavelli and Dr. Juliann Hobbs we have created an inpatient acute pain service offering advanced regional anesthesia techniques and acute pain care coordination with surgical and medical inpatient services.

Transitional Pain Service

As our ability to identify patients who are at risk of uncontrolled pain around the time of surgery improves, and as we have become more and more aware of the dangers of long-term opioid use, our group, led by Dr. Srinivas Pyati, has developed a service that provides support, advice, information and care for patients at high risk of severe post-operative pain. This transitional pain service meets with patients before and after surgery, optimizes pain medication regimens, provides alternative pain therapies and offers complementary and behavioral-based approaches to pain mitigation after surgery and beyond.

Pain Research

Our research group continues to study multiple aspects of pain medicine in the VA environment. We have a long track record of running both therapeutic and diagnostic clinic trials in veterans suffering from post-traumatic or post-operative nerve damage related pain and our group has been at the forefront of research investigating how to reduce the burden of opioid use and opioid-related adverse events. We have also evaluated the role of complementary medicine techniques for reduction of perioperative pain (including music therapy and acupuncture) with the goal of creating a perioperative environment that provides quality care, improves patient satisfaction, reduces pain and reduces the negative consequences of opioid therapy.

Perioperative Medicine Program

Pre-Anesthesia Evaluation Clinic (PAEC)

The PAEC evaluates about 6,000 patients per year prior to surgical or other invasive procedures either in-person or by phone. The clinic also provides comprehensive assessments of physical function and nutrition prior to high-risk surgery, and is involved in other preoperative optimization efforts in coordination with our Duke PASS Clinic. Staffed by a talented group of advanced practice providers, and under the leadership of Dr. Karthik Raghunathan, the program is continuously growing to develop prehabilitation pathways and postoperative follow up protocols.

Preoperative Optimization of Senior Health Program (POSH)

The POSH Program was created in 2015 by Drs. Sandhya Lagoo and Mitch Heflin as a specialized clinic for older adults with high comorbidity burden who are contemplating high-risk surgery. Older veterans undergo a thorough evaluation by a multidisciplinary team and optimization strategies are implemented as needed. The Duke Anesthesiology team has been part of this team since its inception. The POSH inpatient team is involved in the postoperative follow-up of these patients.

Transesophageal Echocardiography Service

Our group performs all TEEs for the Durham VAHCS, both intraprocedurally during cardiac and other non-cardiac high-risk procedures, but also for other medical conditions such as during evaluation of thromboembolism or infective endocarditis. Dr. Eric JohnBull is the clinical lead for this service.