Effectiveness of an acute pain service inception in a general hospital.

Autor: Bardiau FM; Department of Anesthesiology, University Hospital Center, Charleroi, Belgium., Braeckman MM, Seidel L, Albert A, Boogaerts JG
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 1999 Nov; Vol. 11 (7), pp. 583-9.
DOI: 10.1016/s0952-8180(99)00101-4
Abstrakt: Study Objectives: To assess the effects of an Acute Pain Service (APS) inception on postoperative pain management in a general teaching hospital using pain indicators as performance measures.
Design: Open, prospective, nonrandomized, observational study.
Setting: Postanesthesia Care Unit, surgical wards of University Hospital Center of Charleroi.
Patients: 1304 patients in the pre-APS inception phase and 671 patients after its implemention who have undergone various types of surgery (orthopedics, gynecology, urology, neurosurgery, stomatology, ear, nose, and throat, ophthalmic, abdominal, vascular-thoracic, plastic, and maxillofacial).
Interventions: An APS, nurse-based, anesthesiologist-supervised model was devised, based on the concept that postoperative pain relief can be greatly improved by providing in-service training for surgical nursing staff and optimal use of systemic analgesics.
Measurements and Main Results: Postoperative pain was assessed using a visual analog scale (VAS) every 4 hours for 72 hours in the two phases. Analgesic consumption was registered at the same time. Time-related VAS scores were summarized using several pain indicators. There was an overall improvement in the pain scores after APS inception. The differences were most pronounced, around 50%, in patients undergoing vascular, maxillofacial, gynecologic, and urologic surgeries, and stomatology. Regular administration of paracetamol and nonsteroidal antiinflammatory drugs decreased morphine consumption in the second phase.
Conclusion: This study validates the benefits of a formal APS, using continuous monitoring of rest pain intensity and analgesic consumption in the postoperative period. Results not only support previous research findings but also offer outcome-based tools to evaluate current practices as compared with desired outcomes.
Databáze: MEDLINE
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