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Tissue injury from trauma and surgery often leads to acute pain. In most cases, the pain is short-lasting and will usually subside once the wound heals.
Effective pain management, especially post-operation, is paramount in a patient's recovery, and has shown to be associated with earlier mobilization, reduced post-operative complications, shorter hospital stay, reduced hospital costs and increased patient's overall satisfaction1. Furthermore, good and effective acute pain management leads to reduced incidence of post-surgery chronic pain.
At CGH, patients facing acute moderate to severe pain are managed by a group of nurses and doctors specializing in pain management.
Each year, the acute pain service team manages about eight hundred patients using various acute pain control techniques which include patient controlled analgesia (PCA) with intravenous opioid, epidural analgesia, peripheral nerve blocks with oral analgesics. PCA is the most frequently used technique in acute pain management.
Patients using these techniques are monitored frequently by nurses to ensure the effectiveness of pain relief and to identify side effects resultant from the medications used. The acute pain service team reviews patients every day to assess the quality of pain control so as to be able to modify patient’s analgesic regimen to achieve an optimal control, as well as to treat adverse effects associated with the pain control techniques.
Data collected in year 2010 showed that the quality of pain control is comparable with the international data3 in terms of pain severity, as illustrated in Table 1, and incidence of adverse effect2, as illustrated in Table 2.
About 90% of the patients have no or mild pain at rest during the first few days after surgery. Although 59.5% of our patients had moderate to severe dynamic pain (i.e. pain on movement) on the first day post-operation, this incidence is comparable to similar international data (Table 1) found in peer reviewed journals.
At CGH, the Acute Pain Service team is always looking into ways to implement more strategies to improve post-operative dynamic pain, for instance, promoting more widespread use of multimodal pain treatments, stationing specialist pain nurses in the Post-anaesthesia Care Units of the operating rooms, initiating targeted audit on a specific technique, as well as ensuring continuous staff education.
97% of the patients who were managed by our pain team were satisfied with their pain control, upon termination of our pain control techniques. A small number of our patients complain of nausea (13.8%) and vomiting (4.8%). These incidences were significantly lower than the international standards. No patients were found to be in respiratory depression.
| |
2010 CGH Data |
2009 Hong Kong Data1 |
2006 Thailand Data3 |
| At Rest |
Upon Movement |
At Rest |
Upon Movement |
At Rest |
Upon Movement |
| Post-Op Day 1 |
11.4% |
59.5% |
25.8% |
56.1% |
36.8% |
71.9% |
| Post-Op Day 2 |
3.0% |
34.4% |
12.4% |
41.9% |
- |
- |
| Post-Op Day 3 |
1.3% |
12.9% |
19.7% |
37.2% |
- |
- |
Table 1: Incidence of acute moderate to severe pain
| |
International Standard2 |
2006 Thailand Data3 |
2010 CGH Data |
| Nausea |
25.0% |
21% |
13.8% |
| Vomiting |
20.0% |
4.8% |
| Sedation |
2.6% |
3.7% |
1.0% |
| Pruritus |
14.7% |
- |
5.3% |
Table 2: Incidence of adverse effects
Effective acute pain control is an important aspect of patient's recovery after surgery.
With further advancements in the provision of acute post-operative analgesia, the APS is likely to continue to play an important role in overall recovery of the patients.
(Source: Department of Anaesthesia) |