Does an acute pain service improve the perception of postoperative pain management in patients undergoing lower limb surgery? A prospective controlled non-randomized study

Abstract

Background and Aim: An acute pain service (APS) has been running in our institute since April 2013 and is managed by the Department of Anesthesia and Intensive Care. However, it is not clear to what extent the patients feel benefited from the APS. The aim of the study was to compare the perception of postoperative pain management in patients receiving care under APS with those receiving routine postoperative pain relief following lower limb surgery. Material and Methods: This was a prospective, hospital-based, controlled non-randomized study. American Society of Anesthesiologists (ASA) grades I–III patients with age 18–75 years undergoing lower limb orthopedic surgery were prospectively recruited into APS (index group) or routine postoperative care (control group) ( n = 55 each). Postoperatively, American Pain Society Patient Outcome Questionnaire-Revised (APS-POQ-R) and Short Form (SF-12) were used to evaluate the outcome of postoperative pain management at 24 h and health-related quality of life after 4 weeks respectively. Results: Both groups were comparable in terms of demographic data. Patients in the index group had statistically significant better perception of care than the control group. Index group scored significantly higher than control group on median patient satisfaction score (9; interquartile range [IQR] [7–10] vs. 5 [3–6]; P < 0.001). In index group, there was significant reduction of worst pain in first 24 h along with decreased frequency of severe pain. Conclusion: Implementation of acute pain service plays an important role in improving the quality of postoperative pain relief, perception of care, and patient satisfaction.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…If usual surgical recovery is inhibited by unsuccessful functional pain management and/or unacceptable adverse effects despite appropriate multimodal therapies and patient-specific opioid optimization, postoperative pain management specialty consultation is advised. Acute and transitional pain services for surgical patients are evolving, and have been associated with reduced opioid use and length of stay [113,[436][437][438][439][440][441]. Renal impairment increases exposure 1 All listed opioids should be reduced in cases of significant hepatic impairment.…”

Acute Pain Services and pain-related patient-reported outcomes in Hungarian hospitals

“…For instance, Lee et al (Lee et al 2010 ) found that the level of pain in rest was lower among patients, cared for by APS, while according to Gould et al (Gould et al 1992 ) pain scores measured with the visual analog scale decreased remarkably after the introduction of APS at general surgery wards. More recently published studies also confirmed that the intensity of postoperative pain among surgical patients decreased after the introduction of any type of APS (Miaskowski et al 1999 ; Mitra et al 2020 ; Fang et al 2021 ). Regarding the impact of pain on physical mobility, Mitra et al (Mitra et al 2020 ) found that pain limited the everyday activities significantly more of patients who were treated by an APS.…”

“…More recently published studies also confirmed that the intensity of postoperative pain among surgical patients decreased after the introduction of any type of APS (Miaskowski et al 1999 ; Mitra et al 2020 ; Fang et al 2021 ). Regarding the impact of pain on physical mobility, Mitra et al (Mitra et al 2020 ) found that pain limited the everyday activities significantly more of patients who were treated by an APS. Several studies agree that patients cared for by APS could expect better outcomes, such as more effective pain relief, greater satisfaction, and less opioid consumption (Miaskowski et al 1999 ; van Boekel et al 2015 ; Said et al 2018 , Webb & Kim 2018 ), and the same applies to pain-induced negative emotions (Mitra et al 2020 ).…”

“…Regarding the impact of pain on physical mobility, Mitra et al (Mitra et al 2020 ) found that pain limited the everyday activities significantly more of patients who were treated by an APS. Several studies agree that patients cared for by APS could expect better outcomes, such as more effective pain relief, greater satisfaction, and less opioid consumption (Miaskowski et al 1999 ; van Boekel et al 2015 ; Said et al 2018 , Webb & Kim 2018 ), and the same applies to pain-induced negative emotions (Mitra et al 2020 ). Our results are in agreement with previous studies, which have shown that postoperative pain-related anxiety, gloom, fear, and helplessness are less common among APS treated patients, especially if a psychologist is also part of the team (Jepegnanam et al 2021 ).…”

“…Furthermore, our findings show that side effects were more common among patients who received regular care, which again confirms the previously published evidence. According to the international literature, the frequency of nausea and vomiting decreased, when patients were cared for by APS (Miaskowski et al 1999 ; Mitra et al 2020 ; Fang et al 2021 ). Itching, drowsiness, and urinary retention were also found less typical among patients handled by an APS (Miaskowski et al 1999 ; Werner et al 2002 ; Mitra et al 2020 ).…”