The Perioperative Surgical Home: A New Role for the Acute Pain Service

Zaccagnino, Michael P.; Bader, Angela M.; Sang, Christine N.; Correll, Darin

doi:10.1213/ane.0000000000002165

Cited by 34 publications

(12 citation statements)

References 28 publications

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“…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.…”

Section: Postoperative Opioid Considerationsmentioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Postoperative Opioid Considerationsmentioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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“… 15 In addition, this patient-centered, physician-led, team-based approach is the cornerstone of the Perioperative Surgical Home, which strives to improve perioperative outcomes and reduce cost. 16 …”

Section: Discussionmentioning

confidence: 99%

A Dedicated Acute Pain Service Is Associated With Reduced Postoperative Opioid Requirements in Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

Said¹,

Sztain²,

Abramson³

et al. 2018

Anesthesia &Amp; Analgesia

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BACKGROUND:The Acute Pain Service (APS) was initially introduced to optimize multimodal postoperative pain control. The aim of this study was to evaluate the association between the implementation of an APS and postoperative pain management and outcomes for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).METHODS:In this propensity-matched retrospective cohort study, we performed a before–after study without a concurrent control group. Outcomes were compared among patients undergoing CRS-HIPEC when APS was implemented versus historical controls (non-APS). The primary objective was to determine if there was a decrease in median total opioid consumption during postoperative days 0–3 among patients managed by the APS. Secondary outcomes included opioid consumption on each postoperative day (0–6), time to ambulation, time to solid intake, and hospital length of stay.RESULTS:After exclusion, there were a total of 122 patients, of which 51 and 71 were in the APS and non-APS cohort, respectively. Between propensity-matched groups, the median (quartiles) total opioid consumption during postoperative days 0–3 was 27.5 mg intravenous morphine equivalents (MEQs) (7.6–106.3 mg MEQs) versus 144.0 mg MEQs (68.9–238.3 mg MEQs), respectively. The median difference was 80.8 mg MEQs (95% confidence interval, 46.1–124.0; P < .0001). There were statistically significant decreases in time to ambulation and time to solid diet intake in the APS cohort.CONCLUSIONS:After implementing the APS, CRS-HIPEC patients had decreased opioid consumption by >50%, as well as shorter time to ambulation and time to solid intake. Implementation of an APS may improve outcomes in CRS-HIPEC patients.

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“…While the concept of acute pain services has matured with support from enhanced surgical recovery programs, 28,29 a critical gap in pain care has been exposed between hospital discharge and the return to primary care. 30 The use of a transitional pain service (TPS) for post-discharge follow-up and preoperative preparation of complex patients, such as those with chronic pain or opioid use, may facilitate a more coordinated approach to postoperative opioid tapering and subacute pain management and is consistent with the Perioperative Surgical Home model of care.…”

Section: Better Coordinationmentioning

confidence: 99%

“…30 The use of a transitional pain service (TPS) for post-discharge follow-up and preoperative preparation of complex patients, such as those with chronic pain or opioid use, may facilitate a more coordinated approach to postoperative opioid tapering and subacute pain management and is consistent with the Perioperative Surgical Home model of care. 29 Given that chronic pain costs over $600 billion per year, the need to improve pain care delivery and outcomes is unarguable. Improved predictive ability through AI may facilitate appropriate selection of TPS patients and interventions 34 and the early application of effective pain therapies to assist in chronic pain prevention and treatment and aid in either avoiding opioids altogether or opioid cessation.…”

Section: Better Coordinationmentioning

confidence: 99%

The Future of Pain Medicine

Rosenquist¹,

Mariano²

2021

ASA Monitor

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OUR SPECIALTy BEyOND OPERATIVE ANESTHESIAManagement Best Practices Inter-Agency Task Force report, 8 and recognition of surgery as a risk factor for the development of chronic opioid use, 9 has caused the medical community to respond in recent years with opioid prescribing recommendations and safety initiatives [10][11][12] and an emphasis on multimodality as the pathway to better pain management. 13 The acceptance of pain as a potentially chronic condition defined at the level of the individual is also driving the field of pain medicine toward increased personalization. In addition, subspecialty areas in acute and transitional pain to complement the established field of chronic pain have emerged in recent years to fill existing gaps and provide comprehensive care. 14,15 In looking ahead, we wish to highlight three priority areas for improvement: prediction, coordination, and implementation.

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The Perioperative Surgical Home: A New Role for the Acute Pain Service

Cited by 34 publications

References 28 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

A Dedicated Acute Pain Service Is Associated With Reduced Postoperative Opioid Requirements in Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

The Future of Pain Medicine

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