IMPLEMENTATION AND FUNCTION OF ACUTE PAIN MANAGEMENT SERVICE: Aga Khan University Hospital experience

Acute pain may be defined as pain that is present in patients because of preexisting diseases, the surgical procedure or the combination of disease or surgery related sources.1 It may be the worst experience in a life of patient, as most of them perceive it the most ominous aspect of surgery. Inadequate postoperative pain relief is associated with increase in morbidity and mortality after surgery.2 Physiological changes associated with acute pain includes irritability, nervousness, untoward cardiovascular effects like hypertension and tachycardia, splinting in lungs during ventilation leads to basal atelectasis, urinary retention and gut stasis.3 Adequate post operative pain relief helps in blunting many of these adverse physiological changes, thereby assisting in recovery.4 Several means have to be taken for proper pain control and on the top of it is the organization of structured Acute Pain Service (APS) in hospitals. Implementation of APS has been associated with significant reduction in postoperative pain and its associated complications.5 Need for APS to supervise and administer analgesics was realized several decades ago but the real impetus was provided by the development of first acute pain services in 1985 in USA and Germany, followed by a joint report from Royal college of Surgeons of England and College of Anesthetists. They recommended the development of APS in all hospitals under taking acute surgery,6,7 which led to widespread introduction of APS. Several APS models have been introduced since earlier studies have shown reduction in pain intensity after introduction of APS. In 2004 percentage of academic hospitals having APS had increased to 83-92% respectively in UK and Canada. Effectiveness of acute pain management service depends not only on the introduction of newer and safer modalities but also on the education of patients, nurses and other medical personals involved. Attention should be given to organizational aspect of this service rather than the analgesic techniques used.8 Experienced consultants, residents and specially trained pain nurses have key role in running APS effectively. Retrospective audits and review of problematic areas are helpful in reducing critical events and side effects.9 APS also helps in implementation of monitoring protocols, treatment and managing adverse effects guide lines according to the availability of recourses at particular setup.