Importance of pain relief

Pain management is an essential part of post-operative care. Good and effective pain management relieves patient's post-operative pain and suffering; and facilitates return to a normal physiological state and expedites recovery.

Consequences of inadequate pain relief

Inadequate pain relief after a major abdominal operation may decrease respiratory movements and the ability to cough leading to basal collapse of the lungs and poor oxygenation. This gives rise to sputum retention and lung infections. For patients with orthopaedic problems, such as after a hand surgery, pain may delay movements of the affected joints resulting in joint stiffness.

In spite of enormous pharmaceutical and tech-nological advances, in-adequate management of post-operative pain remains a major issue. Inappropriate and unmonitored pain management may lead to undesirable side effects, or even morbidity and mortality in the postoperative patients.

Getting Organised to Initiate Pain-relief

A well-organised Acute Pain Service using pain relief techniques are proven means to improve pain relief post-operatively. Experiences in many countries have shown that the introduction of such services has helped to optimise post-operative patients and reduce post-operative morbidity.

With these objectives in mind, the Department of Anaesthesia at Changi General Hospital initated an Acute Pain Service (APS) in our hospital to enhance management of acute pain after major surgery or trauma. This service is co-ordinated by our specialist anaesthetist, and SSN Fauziah Jabil, an acute pain service nurse, in collaboration with other members of the anaesthesiology department and supported by surgical colleagues, ward nursing staff, physiotherapists and pharmacists.

Modalities Used in Acute Pain Service

A combination of specialised therapeutic modalities, like epidural analgesia, patient controlled analgesia, various nerve blocks, and simple analgesics, such as, paracetamol or Non-Steroidal Anti-inflammatory Drugs (NSADS), is used to provide effective pain management.

What is the role of the APS?

An important function of the APS is the daily conduct of ward round to assess the effectiveness of pain relief modalities used; and to ad-minister top-ups of opioids/local anaesthestics.

A 24-hour back-up service is provided by the on-call Registrar or Medical Officer from the Department of Anaesthesia.

Another essential function of the APS is to provide training and continuing education for the medical and nursing staff to ensure the effectiveness and safety of the various pain therapies. Patient education is equally important in ensuring the success of any analgesia technique. Daily collection of audit data is also performed for purpose of quality control of this service.

Who can benefit from APS?

APS is beneficial for post-surgical patients after major surgeries and post-trauma patients with fracture ribs or other major fractures.

Conclusion

Since the inception of the APS in November 1998, 500 patients had been referred to the APS.

The Acute Pain Service is the model for the reorganisation of existing hospital structures that will allow for the safe and efficacious use of these newer methods of pain control. Although anaesthesia-based, this service requires close co-operation of surgeons, nurses and other paramedical staff to achieve the desired results.