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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2010 Agosto;76(8):657-67
Postoperative pain treatment SIAARTI Recommendations 2010. Short version*
Savoia G., Alampi D., Amantea B., Ambrosio F., Arcioni R., Berti M., Bettelli G., Bertini L., Bosco M., Casati A., Castelletti I., Carassiti M., Coluzzi F., Costantini A., Danelli G., Evangelista M., Finco G., Gatti A., Gravino E., Launo C., Loreto M., Mediati R., Mokini Z., Mondello E., Palermo S., Paoletti F., Paolicchi A., Petrini F., Piacevoli Q., Rizza A., Sabato A. F., Santangelo E., Troglio E., Mattia C. ✉
The aim of these recommendations is the revision of data published in 2002 in the “SIAARTI Recommendations for acute postoperative pain treatment”. In this version, the SIAARTI Study Group for acute and chronic pain decided to grade evidence based on the “modified Delphi” method with 5 levels of recommendation strength.
Analgesia is a fundamental right of the patient. The appropriate management of postoperative pain (POP) is known to significantly reduce perioperative morbidity, including the incidence of postoperative complications, hospital stay and costs, especially in high-risk patients (ASA III-V), those undergoing major surgery and those hospitalized in a critical unit (Level A).
Therefore, the treatment of POP represents a high-priority institutional objective, as well as an integral part of the treatment plan for «perioperative disease», which includes analgesia, early mobilization, early enteral nutrition and active physiokinesitherapy (Level A).
In order to improve an ACUTE PAIN SERVICE organization, we recommend:
— a plan for pain management that includes adequate preoperative evaluation, pain measurement, organization of existing resources, identification and training of involved personnel in order to assure multimodal analgesia, early mobilization, early enteral nutrition and active physiokinesitherapy (Level A);
— the implementation of an Acute Pain Service, a multidisciplinary structure which includes an anesthetist (team coordinator), surgeons, nurses, physiotherapists and eventually other specialists;
— referring to high-quality indicators in establishing an APS and considering the following key points in its organization (Level C):
• service adoption;
• identifying a referring anesthetist who is on call 24 hours a day;
• patient care during the night and weekend;
• sharing, drafting and updating written therapeutic protocols;
• continuous medical education;
• systematic pain assessment;
• data collection regarding the efficacy and safety of the implemented protocols;
• at least one audit per year.
— a preoperative evaluation, including all the necessary information for the management of postoperative analgesia (Level C);
— to adequately inform the patient about the risks and benefits of drugs and procedures used to obtain the maximum efficacy from the administered treatments (Level D). We describe pharmacological and loco-regional techniques with special attention to day surgery and difficult populations. Risk management pathways must be the reference for early identification and treatment of adverse events and chr onic pain development.