Acute pain management after surgery or in the emergency room in Switzerland: a comparative survey of Swiss anaesthesiologists and surgeons

Abstract

The treatment of acute pain remains unsatisfactory despite advances in pain research and the publication of numerous guidelines. The aim of this study was to survey postoperative and emergency room acute pain treatment in Switzerland, particularly regarding compliance with practice guidelines on therapeutic responsibility, treatment algorithms, pain documentation, quality control and education.A representative sample of anaesthesiologists and surgeons (general and orthopaedic) was selected from all Swiss hospitals with regular surgical activity and sent a 256 point questionnaire on acute pain management. Five hundred and seventy five doctors were contacted in 98 hospitals, 44% of doctors (covering 89% of hospitals) returned fully completed questionnaires. Half the respondents work in a hospital with an acute pain service. For postoperative pain management, only 10% of prescription is by algorithm, less than a third of respondents regularly determine pain scores, only 15% perform any statistical analysis of pain management, less than one third regularly meet to discuss management problems, and half claim not to have received-or be receiving-formal (i.e. structured/accredited) pain education. The situation is even less satisfactory for emergency room analgesia. Respondents accept the contribution of postoperative and emergency room analgesia to reduced costs and improved medical outcomes. Asked to highlight their major concerns in acute pain management, lack of education and inadequate organisation are listed in first and second positions. This survey suggests that compliance with published practice guidelines for acute pain management can be improved, and highlights the need for continuing organisational and educational development in acute analgesia, particularly for the emergency room.

Cost-effectiveness of different postoperative analgesic treatments

“…Acute pain services are common in the US, Canada, New Zealand, Germany and Switzerland and are present in other countries as well [95][96][97][98][99][100]. However, the construction and duties of a postoperative pain service varied from country to country and within the US from institution to institution.…”

Research to Practice in Pediatric Pain: What Are We Missing?

“…In a Swiss survey of practice, only 37% of anesthesiologists and surgeons reported that they regularly assessed therapeutic success of analgesic administration. 10 In a US study of practice in the emergency department, only during 44.5% of children's visits were pain scores documented, 11 and in a Canadian study of postoperative pain, only 13% of parents recalled being instructed to use round-the-clock analgesics after their child's surgery. 6 These are just a few examples of figures documenting that standard pain care for children lags behind established guidelines.…”

Treatment of acute abdominal pain in the emergency room: A systematic review of the literature

“…Hence, timely and adequate pain control will assist in decreasing pain-related complications and achieving faster recuperation, with an associated increase in patient satisfaction, quality of life and overall reduced health-care costs (Kehlet and Holte, 2001;Wilder-Smith et al, 2002;Kehlet, 2004;Reichl and Pogatzki-Zahn, 2009). …”