Pain and Palliative Medicine Department

The Pain and Palliative Medicine Department started off as a pain clinic in Basavatarakam Indo American Cancer Hospital & Research Institute. We are currently managing cancer patients with pain and palliative needs in an outpatient setting, in-hospital consultation, palliative ward services, and patients requiring home care. Our team comprises 2 physicians: Dr. Praneeth Suvvari M.D, D.M Onco-Anaesthesia AIIMS, CCEPC, NFPM, and Dr. Praveen Kumar Kodisharapu, DNB, CCEPC, NFPM, working as full-time Consultants. We also have one dedicated social worker and 7 dedicated nurses working under the department.

Dr. Praneeth and Dr. Shyam have participated in the CTC-4 (Cancer Treatment Centers Palliative care provider) foundation course in January 2020. This course was jointly conducted by Lien Collaborative foundation, Singapore and AIIMS, New Delhi. As part of this training, they underwent observership in the department of palliative medicine at Kasturba Medical College, Manipal under the supervision of Dr. Naveen Salins. Dr. Praneeth and Dr. Praveen are currently pursuing National Fellowship in Palliative Medicine (NFPM) from the Institute of Palliative Medicine (IPM), Kozhikode, Kerala.

We run a Cancer Pain Palliative Medicine clinic which operates 6 days a week and yearly for more than 1000 new outpatients. We also liaise with the lymphedema clinic and stoma clinic for continuity of care.

We are running a 12-bedded dedicated palliative care ward and providing a variety of palliative services such as management of acute pain crisis with patient-controlled infusion pumps, interventional pain management with various nerve blocks, management of acute breathlessness, sub-acute intestinal obstructions, end-of-life care, psychosocial support, and other services. Additionally, we provide round-the-clock inpatient services to patients who are admitted to various other wards on-call basis followed by a daily review. We liaise with various government and private-run Palliative and Hospice centres within the area of the patient’s home for the continuity of palliative care and assist them with home care needs.

The department regularly conducts orientation classes to doctors of other specialties in the hospital and nurses about palliative care and its importance. We are proud to announce that the National Board of Examinations has granted us permission to start a formal degree in “DNB Palliative Medicine” from the year 2022 with 2 seats annually. We are one of the first 5 institutes in India that were given this opportunity to offer this training course.

Long-Term Vascular Access

Most cancer treatments run over months or years. Patients who have limited venous access, may face difficulties in getting venous access for every treatment cycle. We provide services for long-term vascular access, which helps patients take their treatments without the trouble of repeated difficult cannulations.

There are various types of long-term vascular access devices. The commonly used are – chemoport, PICC line and Hickman catheter. Your oncologist would suggest an appropriate vascular access for you. Some procedures can be done under local anaesthesia but some may need general anaesthetic during insertion. If a general anaesthetic is required, they are done as day-care procedures. You would require to visit us one week after the procedure for wound assessment and dressing change as required.

Chemoport:

Information for the Patient and Family

Chemoport is an advanced vascular device used to ease your chemotherapy experience. It protects your veins, is less painful than routine methods and aesthetically better option for delivering chemotherapy medicines.

What is Chemoport?

Chemoport is an implantable device placed under the patient’s skin to allow easy access to your central veins. It allows healthcare professionals to draw blood as well as deliver chemotherapy drugs directly into veins via your chemoport.

What are the advantages of Chemoport?

You need not be pricked in your hand every time to search for veins. The insertion of chemoport helps protect your body from unnecessary damage to peripheral veins in the arms and legs.

Are there any restrictions of mobility?

No. You can perform all routine activities like bathing, swimming with your port. There are no special restrictions for Chemoport.

How long Chemoport can be kept in the body?

Chemoport can be left in place for months and even years without any problem.

How is Chemoport placed?

The device is surgically inserted under the skin in the upper chest and appears as a bump/button under the skin. The surgery itself is considered minor, and is typically performed under both local anaesthesia and general anaesthesia.

How long do I need to be in hospital for Chemoport insertion procedure?

It is done as a day care procedure and patient can go home on the same day.

Will I have pain after Chemoport insertion?

Patients sometimes have a little discomfort after the procedure, and can be managed with a pain killer for 24–48 hours. Rarely, there could be severe pain at Chemoport placement site.

How is Chemoport used?

Once the chemoport is placed, it is ready to be used. Whenever a medical treatment is needed, a special needle (Huber needle) is placed in the port. For most patients there is only a mild pricking sensation felt during needle insertion.

Can I receive blood through my Chemoport?

Yes. You can receive blood transfusion through your Chemoport.

What special care needs to be taken for Chemoport?

Till the Chemoport wound heals, cleanliness and care as suggested by the doctor needs to be followed. After the wound heals, no special precautions are required and you can resume your daily activities. If the chemoport is used infrequently, it needs to be flushed with heparin locks at least once in a month.

Are there any risks associated with Chemoport?

Like any procedure, this procedure too is associated with a very small risk of bleeding and infection. Other less common complications are vessel injury, nerve injury, port occlusion, thrombosis and catheter breakage. Very rarely (1:100) the infection may be severe enough to require the removal of the port. There is also a risk of blockage of the catheter if heparin flushes are not done as advised by the doctor.

When will my Chemoport be removed?

Chemoport can be kept in the body for as long as it is needed to provide a regular venous access. Once the chemotherapy cycles are over, your doctor, would advice you the removal of Chemoport which can be planned. Chemoport removal procedure is a minor procedure done in Operation Theater.

What is the cost of Chemoport?

Ask your doctor the cost for placement of Chemoport. Some insurance companies cover the cost, while others don’t. You need to check it with your insurance company.

What are the risks of anesthesia?

All operations and all types of anesthesia do have some element of risk, depending upon many factors including the type of surgery and the pre-existing medical problems of the patient like hypertension, diabetes, etc. Fortunately, adverse events are very rare. Your anaesthesiologist takes precautions to prevent an accident from occurring just as you do when driving a car or crossing the street. The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anaesthesiologist about any risks that may be associated with your anesthesia.

What about eating or drinking before my anesthesia?

As a general rule, you should not eat or drink anything after midnight before your surgery. Under some circumstances, you may be given permission by your anaesthesiologist to drink clear liquids up to a few hours before your anesthesia.

Should I take my usual medicines?

It is important to discuss this with your anaesthesiologist. Do not interrupt medications unless your anesthesiologist or surgeon recommends it.

Would I have pain after surgery?

All surgical procedures are associated with a certain degree of pain and discomfort depending on the nature of the procedures. Also, patients have varying thresholds to pain. All measures are taken by us to alleviate pain using a multimodal approach.

What else should I know about anesthesia?

Many people are apprehensive about surgery or anesthesia. If you are well informed and know what to expect, you will be better prepared and more relaxed. Talk with your anaesthesiologist. Ask questions. Discuss any concerns you might have about your planned anesthetic care. Your anaesthesiologist is not only your advocate but also the physician uniquely qualified and experienced to make your surgery and recovery as safe and comfortable as possible.