Daring discourse: should acute pain medicine be a stand-alone service?

Abstract

Acute pain medicine (APM) has been incorporated into healthcare systems in varied manners with some practices implementing a stand-alone acute pain service (APS) staffed by consultants who are not simultaneously providing care in the operating room (OR). In contrast, other practices have developed a concurrent OR-APS model where there is no independent team beyond the intraoperative care providers. There are theoretical advantages of each approach primarily with respect to patient outcomes and financial cost, and there is little evidence to instruct best practice. In this daring discourse, we present two opposing perspectives on whether or not APM should be a stand-alone service. While evidence to guide best practice is limited, our goal is to encourage discussion of the varied APS practice models and research into their impact on outcomes and costs.

Virtual Pain Unit Is Associated with Improvement of Postoperative Analgesia Quality: A Retrospective Single-Center Clinical Study

“…Various APS models have been reported in the literature, including physician-led [ 9 ] and nurse-led [ 17 ] operation models. A stand-alone APS model independent of OR was widely discussed recently [ 11 ], potentially enhancing multimodal pain management and improving postoperative analgesia quality. In the present study, a novel VPU model was designed on the basis of the “virtual ward” concept to create an independent virtual nursing unit.…”

“…The APS was introduced as a new organizational structure to improve postoperative analgesia and has been implemented for the past three decades [ 10 ]. Healthcare providers continue to discuss the acute pain management model [ 11 ] as the APS faces new challenges and opportunities in the era of enhanced recovery after surgery (ERAS).…”