Letters to the Editor: Letters & Announcements
To the Editor:
In 2003 Bardiau et al. (1) described the process of implementation of a nurse-based Acute Pain Service (APS) in a general hospital. APS models vary considerably according to differences in health care system, availability of drugs and equipment, funds, and personnel. Recently Rawal (2) concluded that there is no uniformly optimal APS and that tailoring an APS to the local environment may be as important as the choice of analgesic modalities.
In our 750-bed general hospital with 12,000 surgical interventions per year, we developed a postanesthesia care unit (PACU)-based APS model. A team of anesthesiologists, surgeons, surgical nurses, and anesthesia nurses developed a comprehensive approach to postoperative pain management. This team proposed analgesic guidelines for every type of operation, including monitoring pain during the first 48–72 h postoperatively, with the intent of keeping the visual analogical scale (VAS) score below 4. The PACU, run by 1 anesthesiologist and 3 nurses, acts as an APS coordination center. Patients are not discharged from the PACU until they achieve effective analgesia (VAS <4), as recommended by practice guidelines (3). Nurses of each ward monitor VAS throughout the day, administer rescue analgesics if necessary, and report to the PACU nurse if they are unable to effectively manage pain. PACU nurses monitor the patient twice daily and report to the anesthesiologist. In this way, we tap the expertise among our PACU staff in managing acute postoperative pain to implement comprehensive pain management after surgery, without requiring additional personnel.
Yigal Leykin, MD, MSc
Tommaso Pellis, MD
Department of Anesthesia and ICU
“S.Maria degli Angeli” Hospital
1. Bardiau FM, Taviaux NF, Albert A, et al. An intervention study to enhance postoperative pain management. Anesth Analg 2003;96:179–85.
2. Rawal N. Organization, function and implementation of acute pain service. Anesthesiology Clin N Am 2005;23:211–25.
3. Leykin Y, Costa N, Gullo A. Analysis and comparison of the guidelines regarding recovery-room management. Minerva Anestesiol 2001;67:563–71.