Efficacy and Safety of an Acute Pain Service among 10,760 Postoperative Patients

Introduction. Post-operative pain con-trol improves surgical outcome and many hospitals created multidisciplinary teams, called “Acute Pain Services” (APS). We col-lected APS data on 10,760 adult patients over a five year period, including compli-cations, side effects and patient satisfac-tion.

Methods. Data on patients managed by APS in a high surgical-volume university hospital over a 5-year period were col-lected and analyzed. Data included demo-graphic characteristics, primary analgesic modality, adjuvant analgesic treatment, type of surgical procedure, Visual Ana-logue Scale, and analgesia-related side-effects and complications.

Results. Patient controlled analgesia with morphine was used in 4,992 surgical pa-tients while epidural analgesia was used in 3,687 surgical patients and 1,670 pregnant women for delivery analgesia. A total of 411 patients received other forms of analgesia. No epidural haematoma was observed. A single case of respiratory depression oc-curred in an elderly patient using the pa-tient controlled analgesia system. Acetami-nophen was the most frequently adjuvant drug prescribed. Postoperative nausea and vomiting was the most frequent analgesia-related side effect. Visual Analogue Scale at rest and on movement was low on day one (0.84±1.15 and 2.05±1.67) and decreased thereafter with epidural analgesia associ-ated with better pain control following hip and liver surgery, and with less postop-erative nausea and vomiting (5.0%) when compared to morphine patient controlled analgesia (7.2%).

Conclusions. An APS, with daily postop-erative visits, permits adequate post-oper-ative pain control without serious adverse events. Epidural analgesia was associated with less postoperative nausea and vom-iting and had at least similar pain control than morphine patient controlled analge-sia.

 acute pain service, epidural an-algesia, patient controlled analgesia, anes-thesia, surgery

1. Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 1998;86:598-612.

2. Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 2001;93:853-8.

3. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001;87:62-72.

4. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1493.

5. Flisberg P, Rudin A, Linnér R, Lundberg CJ. Pain relief and safety after major surgery. A prospective study of epidural and intrave-nous analgesia in 2696 patients. Acta Anaesthesiol Scand 2003;47:457-65.

6. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002;183:630-41.

7. Miaskowski C, Crews J, Ready LB, Paul SM, Ginsberg B. Anesthesia-based pain services improve the quality of postoperative pain management. Pain 1999;80:23-9.

8. Werner MU, Søholm L, Rotbøll-Nielsen P, Kehlet H. Does an acute pain service improve postoperative outcome? Anesth Analg 2002;95:1361-72.

9. Pöpping DM, Zahn PK, Van Aken HK, Dasch B, Boche R, Pogatzki-Zahn EM. Effectiveness and safety of postoperative pain manage-ment: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 2008;101:832-40.

10. Rawal N. Organization, function, and implementation of acute pain service. Anesthesiol Clin North America 2005;23:211-25.

11. Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010;35:64-101.

12. Paul JE, Buckley N, McLean RF, Antoni K, Musson D, Kampf M, et al. Hamilton acute pain service safety study: using root cause analysis to reduce the incidence of adverse events. Anesthesiology 2014;120:97-109.

13. Schug SA, Torrie JJ. Safety assessment of postoperative pain management by an acute pain service. Pain 1993;55:387-91.

14. Singelyn FJ, Gouverneur JM. Postoperative analgesia after total hip arthroplasty: i.v. PCA with morphine, patient-controlled epidural analgesia, or continuous “3-in-1” block?: a prospective evaluation by our acute pain service in more than 1,300 patients. J Clin Anesth 1999;11:550-4.

15. Landoni G, Pasin L, Monti G, Cabrini L, Beretta L, Zangrillo A. Towards zero perioperative mortality. Heart Lung Vessel 2013;5:133-6.

16. Koh JC, Lee J, Kim SY, Choi S, Han DW. Postoperative Pain and Intravenous Patient-Controlled Analgesia-Related Adverse Effects in Young and Elderly Patients: A Retrospective Analysis of 10,575 Patients. Medicine (Baltimore) 2015;94:2008.

17. Ferrell BA. Pain evaluation and management in the nursing home. Ann Intern Med 1995;123:681-7.

18. Closs SJ, Barr B, Briggs M. Cognitive status and analgesic provision in nursing home residents.

19. Br J Gen Pract 2004;54:919-21.