Safety assessment of postoperative pain management by an acute pain service

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While there are increasing demands for improved post-operative analgesia and the implementation of Acute Pain Services (APS), the safety of such an approach remains under discussion. This paper analyses the safety outcome of 3016 consecutive post-operative patients treated under the care of a formalised Acute Pain Service. No serious complication resulting in morbidity or mortality occurred. Potentially severe complications without sequelae were discovered in 16 patients (0.53%); this incidence was similar for techniques of systemic opioid administration and continuous regional analgesia. Patient-controlled analgesia (PCA) alone had a significantly lower rate of respiratory depression than PCA with a background infusion or continuous morphine infusion. In 1069 patients receiving continuous regional analgesia (epidural, interpleural, peripheral) no trauma to nervous structures, no infection and no local anaesthetic toxicity occurred. In conclusion, an anaesthesiology-based APS can provide postoperative pain relief using a wide range of relatively invasive techniques without endangering patient safety.

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