The First Year's Experience of an Acute Pain Service

Wheatley, R.G.; Madej, T.H.; Jackson, Ian; Hunter, Deborah

doi:10.1093/bja/67.3.353

Cited by 182 publications

(87 citation statements)

References 6 publications

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“…In particular, the rising popularity and widespread use of epidural analgesia in obstetrics confirms the acceptability, efficacy and safety of the technique [19,20]. Existing data in the area of postoperative pain are equally encouraging [21][22][23][24][25], thoracic epidural infusions provide excellent pain relief [26] and, when used as part of a multimodal approach, appear to reduce overall postoperative morbidity when compared with conventional analgesia [15].…”

Section: N B Scott and M Hodsonmentioning

confidence: 99%

Public perceptions of postoperative pain and its relief

Scott

Hodson

1997

Anaesthesia

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SummaryIn order to evaluate the general public's knowledge of postoperative pain and its management, a simple questionnaire was devised and sent out to five general practices in Scotland and Yorkshire. Questionnaires were completed voluntarily by 529 people attending their general practitioner for reasons not related to surgery. Five hundred and fifteen completed questionnaires were analysed. Two hundred and thirty-nine (46.4%) responders had undergone previous major surgery whereas 267 (51.8%) had not. Attitudes to pain varied greatly and confirm the findings of other surveys that amongst the general public there is little or no understanding of the nature of postoperative pain or of the methods available to treat it. Despite the published literature, the public have a high degree of confidence in the ability of doctors and nurses to treat such pain. Widespread public and professional education is required before further improvements can be made to such a universal and basic clinical problem. Pain following surgery is a universal and potentially dangerous problem which until the last decade received little attention from the medical profession. The publication in 1990 of the report of the working party of the Royal Colleges of Surgeons and Anaesthetists has led to some organisational improvements in the provision of pain relief after surgery [1] and, to meet the report recommendations, many hospitals have established pain teams which can achieve significant reductions in pain scores [2]. However, other surveys have highlighted the lack of improvement in some hospitals in staff attitudes to pain and the poor knowledge amongst patients in hospital awaiting surgery [3][4][5][6]. No data are available regarding the perceptions and knowledge that the general public have of postoperative pain or on the importance it places in the topic. This was the purpose of the study. MethodsA simple questionnaire was designed to assess the knowledge and attitudes of the general public towards postoperative pain and the methods currently available for its treatment. An initial 30 questionnaires were sent out to nonclinical staff and to hotel staff within the HCI hospital complex to determine the ease with which the questions were understood and completed. Following this, questionnaires were sent to four general practices in Scotland (two in Aberdeen, one in Edinburgh, one in Dumfries) and one practice in Keighley, Yorkshire. Over a 6-month period, patients attending the general practices for reasons unrelated to surgery were invited to complete the questionnaires voluntarily. It was not necessary for patients to have undergone previous surgery. If blanks were left, the answers were counted as a 'don't know' or in the case of questions on sex or age 'not answered'. The differences in responses between males and females, different age groups and previous surgery and no surgery groups were examined using the Chi-squared test. A probability of less than 0.05 was taken to be significant. ResultsFive hundred and twenty-nine questionnair...

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Section: N B Scott and M Hodsonmentioning

confidence: 99%

Public perceptions of postoperative pain and its relief

Scott

Hodson

1997

Anaesthesia

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“…8,9,15 The services in Canada provided a mean of 3.0 days of care with a range of 1.0 to 14 days. The most popular techniques used by Acute Pain Services in Canadian teaching hospitals were EOA and PCA.…”

Section: Acute Pain Servicementioning

confidence: 99%

Postoperative pain management and Acute Pain Service activity in Canada

Zimmermann

Stewart

1993

Can J Anaesth

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“…Routine postoperative provision of these techniques through an anaesthesia-based acute pain service (APS) is now a globally prevalent practice [1][2][3]. In view of the large number of patients managed, despite the generally reported low incidence of complications with these techniques, it is nonetheless essential to adopt a reliable monitoring and management protocol in order to prevent, to detect promptly and to treat any complications.…”

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confidence: 99%

An audit of the safety of an acute pain service

et al. 1997

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SummaryWe audited and analysed the adverse effects and safety of postoperative pain management on 2509 consecutive patients under care of the Acute Pain Service at a tertiary referral teaching hospital over a 32-month period. Our standard respiratory monitoring consisted of continuous pulse oximetry, hourly respiratory rate counting, sedation scoring and intermittent arterial blood gas sampling. This protocol was reliable and detected six episodes of bradypnoea, 13 of hypercapnia and 23 of oxygen desaturation occurring in 39 patients (1.8% of all spontaneously breathing patients). Two patients required naloxone injection and none had long-term sequelae. Hypotension due to epidural bupivacaine 0.0625% and fentanyl 3.3 mg.ml ¹1 infusion occurred in four patients (1.2%), all with a sensory block higher than T 5 . They readily responded to fluid infusion and ephedrine (two patients). Postoperative nausea or vomiting occurred in 723 (28.8%) and 380 (15.1%) patients, respectively. Odds ratio analysis showed that the risk factors for postoperative nausea and vomiting were: female gender, gynaecological operations, nongeriatric patients and systemic analgesia. Postoperative nausea and vomiting decreased analgesic efficacy by discouraging the use of patient-controlled analgesia and was regarded as equally distressing as pain. Other side-effects included: pruritus in 182 patients; dizziness in 333 and lower limb weakness in 73 (21.2% of patients receiving epidural local anaesthetics). It is concluded that a standard monitoring and management protocol, an experienced nursing team and reliable Acute Pain Service coverage is mandatory for the safe use of modern analgesic techniques.

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The First Year's Experience of an Acute Pain Service

Cited by 182 publications

References 6 publications

Public perceptions of postoperative pain and its relief

Public perceptions of postoperative pain and its relief

Postoperative pain management and Acute Pain Service activity in Canada

An audit of the safety of an acute pain service

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