ORGANIZATION OF ACUTE PAIN SERVICES - A LOW-COST MODEL

It is being increasingly recognized that the solution to the problem of inadequate postoperative pain relief lies not so much in development of new techniques but in development of a formal organization for better use of existing techniques. Acute Pain Services (APS) are being increasingly established to provide good quality postoperative analgesia. In the United States such 24-h services usually consist of anesthesiologists, residents, specially trained nurses and pharmacists. However, less than 30% of US surgical population has access to APS. Furthermore, only patients selected by surgeons receive the benefits of these services. Additionally, the economic costs of such services are high (greater than or equal to $200/patient). Less expensive alternatives have to be developed if the aim is to improve the quality of postoperative analgesia for every patient after any type of surgery. Sophisticated analgesia techniques such as epidural and patient-controlled analgesia (PCA) are neither necessary nor realistic for the majority of patients. Our nurse-based anesthesiologist-supervised model is based on the concept that postoperative pain relief can be greatly improved by provision of in-service training for surgical nursing staff, optimal use of systemic opioids and use of regional analgesia techniques and PCA in selected patients. Regular recording of each patient's pain intensity by VAS every 3 h and recording of treatment efficacy on a bedside vital-sign chart are the cornerstones of this model. A VAS greater than 3 is promptly treated. Surgeon and ward nurse participation are crucial in this organization. An Acute Pain Nurse (APN) makes daily rounds of all surgery departments. Her duties include referral of problem patients to the anesthesiologist. At our hospital about 18,000-20,000 surgical procedures are performed each year; our low-cost ($3-4/patient) organization is designed to benefit all of these patients. This organization has been functioning satisfactorily for 3 years, and it can be easily modified for non-surgical wards.