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Acute pain service: the journey in a developing country setting
P Govind1, P Bhakta, G P Dureja
1Department of Anaesthesia and Pain Management, Indian Spinal Injury Centre, New Delhi, India.
Insights
Establishing an acute pain service (APS) in India significantly reduced surgical patients' pain scores. Regular audits and protocol adherence improved pain management quality, demonstrating the efficacy of advanced analgesia techniques.
Area of Science:
- Anesthesiology
- Pain Management
- Healthcare Services Research
Background:
- Acute pain service (APS) development is limited in India due to low priority for pain management.
- A prospective audit was conducted from 2008-2011 after establishing an APS to evaluate pain management efficacy.
Purpose of the Study:
- To assess the effectiveness of pain management techniques on pain scores, muscle power, and adverse effects.
- To evaluate the impact of implementing an acute pain service.
Main Methods:
- A three-phase audit approach was used, including system assessment, protocol development, and final APS formation.
- Data on patient numbers, pain scores (visual analogue score - VAS), and analgesic techniques (IVPCA, EA, CPNB) were collected and analyzed.
Main Results:
- Increased patient utilization of APS, particularly for intravenous patient-controlled analgesia (IVPCA), epidural analgesia (EA), and continuous peripheral nerve block (CPNB).
- Significant reduction in average VAS scores over the audit period.
- Regional analgesic techniques (EA, CPNB) showed better pain score reduction compared to IVPCA.
Conclusions:
- Implementation of an APS led to decreased pain scores in surgical patients.
- Effective APS requires proper planning, defined roles, protocol adherence, and regular audits to enhance quality of care.
Background:
In India, acute pain service (APS) is in nascent stage because of lesser importance given to pain management. After establishing an APS in our hospital, we conducted a prospective audit (2008-2011) with an aim to regularly assess the efficacy of techniques on pain scores, muscle power, and adverse effects.
Methods:
The audit was undertaken in three phases. An assessment of the existing system and recommendation to modify the APS was undertaken in phase I. In phase II, an APS team was constituted and audits were conducted at six monthly intervals for formation of the protocol. Subsequently in phase III, yearly audits were undertaken that led to the development of a final APS.
Results:
There was a steady increase in the number of patients availing APS in intravenous patient-controlled analgesia (IVPCA), epidural analgesia (EA), and continuous peripheral nerve block (CPNB). At the same time, the average visual analogue score (VAS) decreased significantly as the year progressed. While the VAS score did not differ significantly between EA and CPNB, it was less compared with IVPCA. Introduction of regional analgesic techniques played a major role in improving the pain scores.
Conclusion:
Implementation of APS resulted in reduced pain scores in our surgical patients. Proper planning, role allocation, formation, and adherence to protocols as well as undertaking regular audit resulted in improving the quality of APS.
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