A benchmark of 3 years experiences in acute pain service at Srinagarind hospital

Summary 

Background

In order to reduce post-operative pain, acute pain service (APS) has been integrated in many hospitals. Our university hospital initiated full-time APS 3 years ago, which should supply a benchmark of experiences for assessing potential improvements to our APS.

Methods

The APS record forms for 2004–2006 were retrospectively reviewed. Outcomes of interest were demographic data, number of APS services delivered each year compared with total anaesthesia service in the operating room, methods and quality of pain control, pain scores, side-effects and patient-satisfaction.

Results

Ten to 12% of operated patients had engaged in APS and of these the majority was between 22 and 64 years of age. An average of 90% of patients over 10 years of age could use the numeric rating scale (NRS). The top three operative sites receiving APS were the lower and upper abdomen and the extremities. Intravenous patient controlled analgesia (IV PCA) was the major post-operative pain modality used during the respective 3 years (52, 47 and 40%) followed by the epidural technique (27%), intravenous infusion of narcotic and spinal morphine with IV PCA. Moderate pain at rest (NRS 5–6) was decreased each respective year (28, 26 and 24%). Severe pain at rest (NRS 7–10) was not improved (10–12%); however, severe pain while moving improved each year (47, 43 and 41%, respectively). Mild-grade nausea/vomiting was found at an average 12%. Overall there was a 97% rate of satisfaction with our APS service.

Conclusion

The APS was expanded, especially in the infant and elderly groups, for an overall high level of patient-satisfaction; notwithstanding, severe pain at rest was still high which needs addressing.

Keywords: Acute pain service, Benchmark, Post-operative pain management, University hospital