Acute pain service: the journey in a developing country setting

Abstract

Background: In India, acute pain service (APS) is in nascent stage because of lesser importance given to pain management. After establishing an APS in our hospital, we conducted a prospective audit (2008-2011) with an aim to regularly assess the efficacy of techniques on pain scores, muscle power, and adverse effects.

Methods: The audit was undertaken in three phases. An assessment of the existing system and recommendation to modify the APS was undertaken in phase I. In phase II, an APS team was constituted and audits were conducted at six monthly intervals for formation of the protocol. Subsequently in phase III, yearly audits were undertaken that led to the development of a final APS.

Results: There was a steady increase in the number of patients availing APS in intravenous patient-controlled analgesia (IVPCA), epidural analgesia (EA), and continuous peripheral nerve block (CPNB). At the same time, the average visual analogue score (VAS) decreased significantly as the year progressed. While the VAS score did not differ significantly between EA and CPNB, it was less compared with IVPCA. Introduction of regional analgesic techniques played a major role in improving the pain scores.

Conclusion: Implementation of APS resulted in reduced pain scores in our surgical patients. Proper planning, role allocation, formation, and adherence to protocols as well as undertaking regular audit resulted in improving the quality of APS.