Efficacy and Safety of an Acute Pain Service among 10,760 Postoperative Patients
1 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
2 Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy
3 Vita-Salute San Raffaele University, Milan, Italy
DOI: 10.22514/SV121.102016.14 Vol.12,Issue S1,October 2016 pp.78-90
Published: 10 October 2016
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
FRANCESCO DENI,GABRIELE FINCO,LAURA CORNO,GIOVANNI LANDONI,STEFANO TURI,ELEONORA COLNAGHI,LAURA COMOTTI,MARIO MUSU,RENATO MEANI,ALESSANDRA MELLO,VALERIA PEROTTI,NICOLA PASCULLI,LUIGI BERETTA,ALBERTO ZANGRILLO. Efficacy and Safety of an Acute Pain Service among 10,760 Postoperative Patients. Signa Vitae. 2016. 12(S1);78-90.
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.
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