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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2004 November;70(11):779-87

language: English, Italian

Acute Pain Service and multimodal therapy for postsurgical pain control: evaluation of protocol efficacy

Moizo E., Berti M., Marchetti C., Deni F., Albertin A., Muzzolon F., Antonino A.

Department of Anesthesiology, IRCCS H San Raffaele, Vita - Salute University of Milan, Milan, Italy


Aim. The insti­tu­tion of a post­op­er­a­tive Acute Pain Control Service is man­da­to­ry to ­improve the con­trol of ­pain ­induced by sur­gi­cal inju­ry. Treatment of post­op­er­a­tive ­pain may be ­achieved ­using a com­bi­na­tion of anal­ge­sic ­agents and tech­niques, reduc­ing the inci­dence of ­side ­effects ­owing to the low­er dos­es of the indi­vid­u­al ­drugs. In 1997 we estab­lished an Acute Pain Service (APS) at the San Raffaele Hospital in Milan. The aim of ­this ­study was to ­assess the effi­ca­cy and safe­ty of our APS ­both in ­terms of treat­ment pro­to­cols and organ­isa­tion­al ­issues.
Methods. In ­this pros­pec­tive obser­va­tion­al ­study we includ­ed 592 ­patients under­go­ing abdom­i­nal, gyne­co­log­ical, or ortho­pe­dic sur­gery ­with ­severe expect­ed ­pain. According to gen­er­al guide­lines on ­pain treat­ment, the ­patients ­were ­assigned to dif­fer­ent treat­ment pro­to­cols ­based on the ­kind of oper­a­tion. All pro­to­cols ­were ­based on the mul­ti­mod­al ther­a­py, ­with the asso­ci­a­tion of non­ster­oid­al ­anti-inflam­ma­to­ry ­drugs (­NSAIDS), opi­oids and region­al anes­the­sia tech­niques. During the ­first 48 ­h of the post­op­er­a­tive peri­od we record­ed ­vital ­signs, lev­el of ­pain and occur­rence of any ­side ­effect.
Results. Our anal­ge­sic pro­to­cols ­proved to be effec­tive and ­safe (low inci­dence of ­side ­effects) for eve­ry sur­gery. The inci­dence of post­op­er­a­tive nau­sea and vom­it­ing was high­er in ­patients receiv­ing ­patient-con­trolled mor­phine ­than ­that ­with con­tin­u­ous epi­du­ral or ­nerve ­block. After low­er abdom­i­nal sur­gery, ­pain at move­ment at 24 h was sig­nif­i­cant­ly low­er in the epi­du­ral ­group ­than in the ­Patient Con­trol Anal­ge­sia ­group. Nausea and vom­it­ing, numb­ness and pares­the­sias at the low­er ­limbs ­were high­er in gyne­co­log­ical ­patients. A larg­er per­cent­age of ortho­pe­dic ­patients in the epi­du­ral ­group report­ed numb­ness and pares­the­sias at the low­er ­limbs in com­par­i­son ­with ­patients receiv­ing con­tin­u­ous periph­er­al ­nerve ­block.
Conclusion. In agree­ment ­with pre­vi­ous lit­er­a­ture, ­this ­study con­firmed ­that a mul­ti­mod­al ­approach to ­pain treat­ment pro­vides an ade­quate con­trol of post­op­er­a­tive ­pain, min­i­miz­ing ­side ­effects.

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