Colin J L McCartney

University of Toronto, Toronto, Ontario, Canada

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Publications (91)260.94 Total impact

  • Krupa Dighe, Hance Clarke, Colin J McCartney, Camilla L Wong
    Canadian Journal of Anaesthesia 09/2014; · 2.50 Impact Factor
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    ABSTRACT: This study was designed to determine whether a 4 day perioperative regimen of gabapentin added to celecoxib improves in-hospital rehabilitation and physical function on postoperative day 4 and 6 weeks and 3 months after total knee arthroplasty (TKA).
    BJA British Journal of Anaesthesia 06/2014; · 4.24 Impact Factor
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    ABSTRACT: Background: Ontario has introduced strategies over the past decade to reduce wait times and length of stay and improve access to physiotherapy for orthopaedic and other patients. The aim of this study is to explore patients' experiences of joint replacement care during a significant system change in their care setting. Methods: A secondary analysis was done on semi-structured qualitative interviews that were conducted in 2009 with 12 individuals who had undergone at least two hip or knee replacements five years apart at a specialized orthopaedic centre in Ontario, Canada. Interview transcripts were coded and then organized into themes. Results: Although the original study aimed to capture participants' experiences with changes in anaesthetic technique between their first and second joint replacements, the participants described several unrelated differences in the care they received during this period. For example, participants had difficulty obtaining a referral to an orthopaedic surgeon from their family physician. They also noted that the hospital stay and in-hospital physiotherapy they received were shorter after the second joint replacement surgery. They identified guidance from physiotherapists as an important component of their recovery, but sometimes had difficulty arranging physiotherapy after hospital discharge following their most recent surgery. Conclusions: The changes described between the first and second joint replacements provide the participants' perspective on the impact of policy changes on wait times, reduced lengths of hospital stay and physiotherapy access. The impact of these policy changes, often made in an attempt to improve access to care, had an unintended and detrimental effect on participants' perceptions and experiences of the quality of care provided.
    Healthcare policy = Politiques de sante 02/2014; 9(3):55-66.
  • S Choi, R Rodseth, C J L McCartney
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    ABSTRACT: /st>Brachial plexus nerve blocks (BPBs) have analgesic and opioid sparing benefits for upper extremity surgery. Single-injection techniques are limited by the pharmacological duration and therapeutic index of local anaesthetics (LAs). Continuous catheter techniques, while effective can present management challenges. Off-label use of perineural dexamethasone as an LA adjuvant has been utilized to prolong single-injection techniques. The objectives of this systematic review and meta-analysis are to assess the contemporary literature and quantify the effects of dexamethasone on BPB. /st>The authors searched for randomized, placebo-controlled trials that compared BPB performed with LA alone with that performed with LA and perineural dexamethasone. Meta-analysis was performed using a random effects model with subgroup analysis stratified by LA (long vs intermediate). The primary outcome was duration of sensory block or analgesia; the secondary outcomes were motor block duration, opioid consumption, and BPB complications. /st>Nine trials (801 patients) were included with 393 patients receiving dexamethasone (4-10 mg). Dexamethasone prolonged the analgesic duration for long-acting LA from 730 to 1306 min [mean difference 576 min, 95% confidence interval (CI) 522-631] and for intermediate from 168 to 343 min (mean 175, 95% CI 73-277). Motor block was prolonged from 664 to 1102 min (mean 438, 95% CI 89-787). The most recent trial demonstrated equivalent prolongation with perineural or systemic administration of dexamethasone compared with placebo. /st>Perineural administration of dexamethasone with LA prolongs BPB effects with no observed adverse events. The effects of systemic administration of dexamethasone on BPB must be investigated.
    BJA British Journal of Anaesthesia 01/2014; · 4.24 Impact Factor
  • Colin J L McCartney, Kathleen Nelligan
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    ABSTRACT: Total knee arthroplasty (TKA) is a common surgical procedure in the elderly and is associated with severe pain after surgery and a high incidence of chronic pain. Several factors are associated with severe acute pain after surgery, including psychological factors and severe preoperative pain. Good acute pain control can be provided with multimodal analgesia, including regional anesthesia techniques. Studies have demonstrated that poor acute pain control after TKA is strongly associated with development of chronic pain, and this emphasizes the importance of attention to good acute pain control after TKA. Pain after discharge from hospital after TKA is currently poorly managed, and this is an area where increased resources need to be focused to improve early pain control. This is particularly as patients are often discharged home within 4-5 days after surgery. Chronic pain after TKA in the elderly can be managed with both pharmacological and non-pharmacological techniques. After excluding treatable causes of pain, the simplest approach is with the use of acetaminophen combined with a short course of non-steroidal anti-inflammatory drugs (NSAIDs). Careful titration of opioid analgesics can also be helpful with other adjuvants such as the antidepressants or antiepileptic medications used especially for patients with neuropathic pain. Topical agents may provide benefit and are associated with fewer systemic side effects than oral administration. Complementary or psychological therapies may be beneficial for those patients who have failed other options or have depression associated with chronic pain.
    Drugs & Aging 01/2014; 31(2). · 2.50 Impact Factor
  • Ben Safa, Jeffrey Gollish, Lynn Haslam, Colin J L McCartney
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    ABSTRACT: Peripheral nerve blocks appear to provide effective analgesia for patients undergoing total knee arthroplasty. Although the literature supports the use of femoral nerve block, addition of sciatic nerve block is controversial. In this study we investigated the value of sciatic nerve block and an alternative technique of posterior capsule local anesthetic infiltration analgesia. 100 patients were prospectively randomized into three groups. Group 1: sciatic nerve block; Group 2: posterior local anesthetic infiltration; Group 3: control. All patients received a femoral nerve block and spinal anesthesia. There were no differences in pain scores between groups. Sciatic nerve block provided a brief clinically insignificant opioid sparing effect. We conclude that sciatic nerve block and posterior local anesthetic infiltration do not provide significant analgesic benefits.
    The Journal of arthroplasty 12/2013; · 2.37 Impact Factor
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    ABSTRACT: A scoping review was performed to assess published evidence regarding how best to teach ultrasound-guided regional anesthesia (UGRA). The literature search yielded 205 articles, of which 35 met the inclusion criteria. Current literature on the topic can be divided into 3 main themes: the development of motor skills, learning and teaching sonoanatomy, and understanding of the requirements for establishing a UGRA education program and evaluation. We discuss the current status and future direction of research on UGRA training.
    Regional anesthesia and pain medicine 10/2013; · 4.16 Impact Factor
  • C J L McCartney, S Choi
    BJA British Journal of Anaesthesia 09/2013; 111(3):331-3. · 4.24 Impact Factor
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    ABSTRACT: Persistent pain and psychological distress are common after traumatic musculoskeletal injury (TMsI). Individuals sustaining a TMsI are often young, do not recover quickly, and place a large economic burden on society. The aim of this systematic review is to determine (1) the incidence of persistent pain following TMsI, (2) the characteristics of pain, characterized by injury severity and type, and (3) risk and protective factors associated with persistent pain following TMsI. A systematic search of electronic databases (MEDLINE(®), PubMed(®), Embase, and PsycINFO(®)) was conducted for prospective, interventional, or noninterventional studies measuring the incidence of pain associated with TMsI. The search revealed 4388 studies. Eleven studies examined persistent pain and met inclusion criteria. Pain was assessed using a validated measure of pain intensity or pain presence in six studies. Persistent pain was reported by all studies at variable time points up to 84 months postinjury, with wide variation among studies in pain intensity (ie, from mild to very severe) and pain incidence at each time point. The incidence of pain decreased over time within each study. Two studies found significant relationships between injury severity and persistent pain. Frequently cited predictive factors for persistent pain included: symptoms of anxiety and depression, patient perception that the injury was attributable to external sources (ie, they were not at fault), cognitive avoidance of distressing thoughts, alcohol consumption prior to trauma, lower educational status, being injured at work, eligibility for compensation, pain at initial assessment, and older age. The evidence from the eleven studies included in this review indicates that persistent pain is prevalent up to 84 months following traumatic injury. Further research is needed to better evaluate persistent pain and other long-term posttraumatic outcomes.
    Journal of Pain Research 01/2013; 6:39-51.
  • Stephen Choi, Amy Trang, Colin J McCartney
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    ABSTRACT: The introduction of ultrasound guidance for regional anesthesia has resulted in an explosion of interest in its use for postoperative analgesia, particularly for orthopedic surgery. Regional anesthesia demonstrates unequivocal superiority compared with systemic opioids with respect to analgesia, reduced opioid consumption, increased patient satisfaction, and earlier achievement of discharge criteria. Improved acute postoperative analgesia can facilitate effective rehabilitation. Investigators are in the early stages of reporting the effects of regional anesthesia on functional outcome. Recent studies reporting functional outcomes have been plagued with sample sizes of inadequate power to generate meaningful results. Furthermore, the functional outcome measures are used inappropriately in terms of clinically meaningful difference, assessment intervals, and/or duration of follow-up. This report aims to address these issues by discussing functional outcomes used in the physiotherapy or orthopedic literature and their appropriate utilization, so that future research into the effects of regional anesthesia can be methodologically sound. Outcomes discussed include those that are physical-performance-based (ie, range of motion, quadriceps strength, Timed Up and Go test, 6-Minute Walk Test, Stair Time, and Self-paced Walk Test) and those that are self-reported (ie,Western Ontario and McMaster Universities Osteoarthritis Index, Knee Osteoarthritis Severity Score, Lower Extremity Function Scale).
    Regional anesthesia and pain medicine 01/2013; 38(4):340-349. · 4.16 Impact Factor
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    ABSTRACT: PURPOSE: Regional anesthesia is the preferred technique for total knee arthroplasty to provide a bridge for early postoperative analgesia, reduce opioid consumption, and improve mobility and rehabilitation. Multiple patient and process factors must be weighed when choosing the appropriate technique to reduce morbidity and facilitate discharge. We hypothesized that a low-dose of intrathecal bupivicaine combined with regional block would facilitate discharge from the postanesthesia care unit (PACU) and reduce postoperative morbidity. METHODS: Patients undergoing total knee arthroplasty under spinal anesthesia received either 5 mg (low-dose group) or 10 mg (standard-dose group) isobaric bupivacaine in a double-blind randomized controlled trial. The primary outcome measure was time to achieve eligibility for PACU discharge. Secondary outcome measures included time to recovery of S2 dermatome sensation, time to voiding, rate of bladder catheterization, and time required for nursing intervention in the PACU and after discharge to the surgical ward. RESULTS: Forty-five of the 49 recruited patients completed the study. Patients receiving low-dose spinal anesthesia were eligible for PACU discharge earlier than those receiving the standard dose (P = 0.0036). Patients receiving the standard dose had significantly delayed recovery of S2 dermatome sensation (P = 0.0035). There was no difference between groups in the amount of time required for nursing intervention in the PACU, but patients receiving low-dose spinal anesthesia required more time for nursing intervention within the first four hours of their arrival on the ward (P = 0.009). None of the patients required intraoperative analgesic supplementation. CONCLUSIONS: In patients undergoing total knee arthroplasty, low-dose intrathecal bupivacaine (5 mg) combined with regional block is associated with a reduced time to achieve eligibility for discharge from the PACU.
    Canadian Anaesthetists? Society Journal 12/2012; · 2.31 Impact Factor
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    ABSTRACT: The ability to identify and focus care to patients at higher risk of moderate to severe postoperative pain should improve analgesia and patient satisfaction, and may affect reimbursement. We undertook this multi-centre cross-sectional study to identify preoperative risk factors for moderate to severe pain after total hip (THR) and knee (TKR) replacement. A total of 897 patients were identified from electronic medical records. Preoperative information and anaesthetic technique was gained by retrospective chart review. The primary outcomes were moderate to severe pain (pain score ≥ 4/10) at rest and with activity on postoperative day one. Logistic regression was performed to identify predictors for moderate to severe pain. Moderate to severe pain was reported by 20 % at rest and 33 % with activity. Predictors for pain at rest were female gender (OR 1.10 with 95 % CI 1.01-1.20), younger age (0.96, 0.94-0.99), increased BMI (1.02, 1.01-1.03), TKR vs. THR (3.21, 2.73-3.78), increased severity of preoperative pain at the surgical site (1.15, 1.03-1.30), preoperative use of opioids (1.63, 1.32-2.01), and general anaesthesia (8.51, 2.13-33.98). Predictors for pain with activity were TKR vs. THR (1.42, 1.28-1.57), increased severity of preoperative pain at the surgical site (1.11, 1.04-1.19), general anaesthesia (9.02, 3.68-22.07), preoperative use of anti-convulsants (1.78, 1.32-2.40) and anti-depressants (1.50, 1.08-2.80), and prior surgery at the surgical site (1.28, 1.05-1.57). Our findings provide clinical guidance for preoperative stratification of patients for more intensive management potentially including education, nursing staffing, and referral to specialised pain management.
    International Orthopaedics 07/2012; 36(11):2261-7. · 2.02 Impact Factor
  • Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 06/2012; 21(8):e16-7. · 1.93 Impact Factor
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    ABSTRACT: There is a paucity of large multi-institutional surveys to determine the prevalence of and risk factors for persistent pain after total hip (THR) and knee (TKR) replacements. We surveyed a variety of practices and patients and also correlated persistent pain with health-related quality-of-life outcomes. From October 10, 2007, to March 15, 2010, patients who had undergone primary THR or TKR with a minimum follow-up of 1 year were identified. A previously published questionnaire to identify persistent postsurgical pain that included a 36-item Short Form Health Survey was mailed to this group. Independent risk factors for persistent pain were identified with logistic regression. Responses from 1030 patients who underwent surgery at some point in time between June 13, 2006, and June 24, 2009, were analyzed (32% response rate). Forty-six percent of patients reported persistent pain (38% after THR and 53% after TKR) with a median average pain score of 3 of 10 and worst pain score of 5. Independent risk factors for persistent pain were female sex (odds ratio [OR], 1.23), younger age (OR, 0.97), prior surgery on hip or knee (OR, 1.39), knee versus hip replacement (OR, 1.65), lower-quality postsurgical pain control (OR, 0.9), and presence of pain in other areas of the body (OR, 2.09). All scores in the 36-item Short Form Health Survey were worse (8%-28% decrease) in patients with persistent postsurgical pain (P < 0.001). Persistent postsurgical pain is common after THR and TKR and is associated with reduced health-related quality of life, although our survey may be biased by the low response rate and retrospective recall bias. Nonmodifiable risk factors may lead to risk stratification. Severity of acute postoperative pain may be a modifiable risk factor.
    Regional anesthesia and pain medicine 05/2012; 37(4):415-22. · 4.16 Impact Factor
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    ABSTRACT: Most total knee arthroplasty (TKA) recipients experience pain following the procedure. Patients are provided with medications to manage pain but there is little information regarding their usage of analgesics after hospital discharge. This study investigated analgesic usage in recent TKA recipients. A qualitative descriptive approach was taken to produce a summary of the experiences of 14 participants. Purposive sampling methods were used during recruitment. One semistructured interview was conducted with each participant. Interviewing continued until theoretical saturation was reached. Most participants used less medication than was prescribed and stopped taking prescription analgesics before requiring a renewal. Participants adjusted their usage in response to pain, adverse effects, advice from their family and healthcare providers, fears of becoming "hooked," and a general dislike of taking medications. Patient modifications to medication regimens are often labeled as patient nonadherence; however, participants in this study considered their actions to be adaptive. This conceptual distinction has practical implications for healthcare providers. These findings emphasize the importance of having TKA patients develop their pain management regimen in conjunction with healthcare providers so that regimens can be tailored to individual needs.
    Journal of opioid management 05/2012; 8(3):145-52.
  • Colin J L McCartney, Sanjiv Patel
    Regional anesthesia and pain medicine 04/2012; 37(3):239-41. · 4.16 Impact Factor
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    ABSTRACT: The assessment of technical skills in ultrasound-guided regional anesthesia is currently subjective and relies largely on observations of the trainer. The objective of this study was to develop a checklist to assess training progress and to detect training gaps in ultrasound-guided regional anesthesia using the Delphi method. A 30-item checklist was developed and then e-mailed to 18 reviewers for feedback. The checklist was modified on the basis of their feedback. This process of iteration was repeated until no further feedback was received, and a consensus was reached on the final composition of the checklist. A global rating scale (GRS) was introduced as a result of the feedback. Three rounds of feedback were required to reach consensus on the composition of the checklist and the GRS. The final checklist contains 22 items, and the GRS contains 9 categories. Using the Delphi method, a checklist and GRS were developed. These tools can serve as an objective means of assessing progress in ultrasound technical skills acquisition.
    Regional anesthesia and pain medicine 02/2012; 37(3):329-33. · 4.16 Impact Factor
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    C J L McCartney, G A McLeod
    BJA British Journal of Anaesthesia 10/2011; 107(4):487-9. · 4.24 Impact Factor
  • Fiona Webster, Samantha Bremner, Colin J L McCartney
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    ABSTRACT: It is reported that patients continue to have misgivings about regional anesthesia (RA) despite strong evidence to support its use for hip and knee replacement surgery. To date, no one has had an opportunity to study the experiences of patients who have undergone both types of anesthesia for these procedures. Using descriptive qualitative methods, 12 patients who had hip or knee replacements under both RA and GA at two different time points (excluding revisions) were interviewed using purposeful sampling until saturation had been reached. Following transcription of each tape, a small study team met over the course of several months to read and discuss each transcript. A coding template was developed, and emerging themes noted. For the majority of patients, RA was either well tolerated or preferred. Having a previous negative experience with general anesthesia was common and was strongly associated with a patient's satisfaction with RA. Patients also described being highly influenced by the preference of their surgeon. These findings have important implications. First, many patients were surprisingly neutral about the procedure and seemed more fearful of anesthesia in general rather than of either technique specifically. This finding, combined with patient's influence by clinician preference, underscores the importance of physician support for RA. Some participants identified one of their misgivings about RA as being fear of being awake, which is consistent with the medical literature. Our findings also support the idea that from a patient's perspective, appropriate sedation while undergoing RA may be important.
    Regional anesthesia and pain medicine 08/2011; 36(5):461-5. · 4.16 Impact Factor
  • C J L McCartney, A McNaught, U Shastri, M Columb
    BJA British Journal of Anaesthesia 07/2011; 107(1):103-4. · 4.24 Impact Factor

Publication Stats

2k Citations
260.94 Total Impact Points


  • 2003–2014
    • University of Toronto
      • • Department of Anesthesia
      • • Institute of Medical Sciences
      • • Department of Surgery
      Toronto, Ontario, Canada
  • 2007–2013
    • Sunnybrook Health Sciences Centre
      • Department of Anesthesia
      Toronto, Ontario, Canada
    • University Health Network
      Toronto, Ontario, Canada
    • Radboud University Medical Centre (Radboudumc)
      Nymegen, Gelderland, Netherlands
  • 2000–2007
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 2004
    • SickKids
      Toronto, Ontario, Canada