Efficacy and safety of an acute pain service among 10,760 postoperative patients

Introduction. Post-operative pain control improves surgical outcome and many hospitals created multidisciplinary teams, called “Acute Pain Services” (APS). We collected APS data on 10,760 adult patients over a five year period, including complications, side effects and patient satisfaction. Methods. Data on patients managed by APS in a high surgical-volume university hospital over a 5-year period were collected and analyzed. Data included demographic characteristics, primary analgesic modality, adjuvant analgesic treatment, type of surgical procedure, Visual Analogue Scale, and analgesia-related sideeffects and complications. Results. Patient controlled analgesia with morphine was used in 4,992 surgical patients 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 occurred in an elderly patient using the patient controlled analgesia system. Acetaminophen 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 associated with better pain control following hip and liver surgery, and with less postoperative nausea and vomiting (5.0%) when compared to morphine patient controlled analgesia (7.2%). Conclusions. An APS, with daily postoperative visits, permits adequate post-operative pain control without serious adverse events. Epidural analgesia was associated with less postoperative nausea and vomiting and had at least similar pain control than morphine patient controlled analgesia.