Acute pain services

An interdisciplinary acute pain service (APS) team seems the most attractive clinical organization model for postoperative pain management (POPM) to fulfil the intentions of pain management guidelines in practice. The specific knowledge of anaesthesiologists in the use of drugs and techniques for pain alleviation is of specific importance. Therefore, the anaesthetist is usually the team leader and works together with nurses in the postanaesthesia care unit (PACU), acute pain nurses (APN) and surgical ward nurses. A nurse-based anaesthesiologist supervised type of APS seems in several respects to be a suitable model for POPM in clinical practice.     

A survey of directors of Canadian academic acute pain management services: the nursing team members role — a brief report

PURPOSE: The purpose of this study was to identify Canadian academic centres with Acute Pain Management Service (APMS), and to describe the nature of nursing involvement on the APMS. METHODS: Departments of Anesthesiology in the 16 Canadian medical schools were contacted to obtain a list of affiliated hospitals and the person most responsible for acute pain. A questionnaire designed to gain insight into nursing involvement on APMS was sent out to the 62 hospitals between June 2000 and January 2001. RESULTS: Seventy-six percent of centres responded and of these 89% (n = 42) had an APMS. In 76% of APMS nursing was involved on the service. Sixty-two percent (n = 26) had a designated nursing team member on the APMS who contributed in the realms of patient care, staff and patient education, and administrative development. The APMS nurse performed patient rounds independently (62%) and with a physician (64%). Decision-making was primarily the responsibility of anesthesiology, however, the APMS nurse (38%) and the bedside nurse (23%) were involved in some centres. The highest educational attainment in the 26 hospitals with an APMS nurse was, diploma RN (27%), BScN (31%) and MSc (12%). The distribution of advance practice nursing was nurse practitioner (12%), clinical nurse specialist (27%), or both (8%). CONCLUSION: Nursing played an important role on the APMS, however, quality acute pain management can only be achieved with continuing efforts by anesthesiology, nursing and hospital administration to support the role of nurses as essential members of the acute pain team.     

Acute pain management

Editor—Macintyre and colleagues¹ highlighted the increasingrole of the acute pain service across the spectrum of inpatientpain problems. We have conducted an audit at the James CookUniversity Hospital to find out the contribution of     

新加坡医院急诊疼痛的分诊管理

从急诊疼痛预检分诊护士资质、预检分诊记录,疼痛分级评估工具以及分诊护士疼痛管理等方面介绍新加坡医院急诊科对疼痛患者的管理方法.新加坡医院通过疼痛管理协议,允许分诊护士在对疼痛患者进行详细的预检分诊记录、细致的分级评估后,对部分疼痛患者采取及时、快速的镇痛措施,大大缩短了患者的诊治时间,减轻了患者的痛苦,值得我国急诊护理...     

Organization of pain management services

Historically, pain services have been poorly integrated into hospital management systems and allocated relatively poor resources. Institutions differ in their needs and complexity, ranging from single modality clinics to large interdisciplinary facilities offering complex treatment including psychological rehabilitation and implantation technologies. The organizational needs of these services differ substantially. Organization has to be considered at three levels: within the department, within the organization, and within the health system. Departmental organization should consider a common management structure for all the interdisciplinary team, including the administrative and clerical staff. The clinical leader of the service need not be a doctor, but must have a job plan that includes sufficient time for necessary managerial tasks. Within a Trust or hospital, the pain service should have the same weighting as other clinical departments and the same resources available. The need for close links with other departments (e.g. orthopaedics, oncology) requires active cooperation between different directorates. Joint clinics can tax organizational systems but can be an effective way of managing patients with complex problems. Chronic pain poses a significant burden on the health care system. Increasing focus on chronic disease management by the production of guidelines and service frameworks for conditions such as diabetes and asthma have done little for the substantial number of people disabled by chronic pain. If pain services are to have a significant impact on chronic painful conditions they have to develop closer ties with primary care and health planning authorities. Such a move would see pain services being as much about education, training and development of policy as simply providing clinical care.     

Organization of pain management services

Pain is ubiquitous and is common throughout healthcare. Appropriate and timely pain treatment and management is a human right. The knowledge and skills needed to deliver pain treatments should not be confined to specialized centres. It is the duty of all clinicians irrespective of profession to be able to treat patients who suffer with pain. Pain Services should be organized to deliver assessment and treatment for the patient in pain in a timely fashion and in the appropriate place. This may well be in the community or primary care setting as well as in secondary or tertiary care. The treatment of chronic pain can present a significant challenge. Patients often present with complex problems and may need the expertise of a multi-professional team with skills in diagnostics, specific pain therapies, rehabilitation and psychological counselling. Some centres have developed a ‘central intake’, which is designed to ensure that patients referred to the service receive tailored assessment and treatment delivered by the most appropriate healthcare professional and, where possible in their community.     

疼痛管理中的同质服务实践

目的探讨同质服务在疼痛护理中的应用效果。方法将200例患者按照入院时间分为对照组与观察组各100例。对照组实施常规疼痛护理;观察组将同质服务应用于疼痛护理,即成立疼痛管理小组,规范同质化疼痛管理制度,落实同质化疼痛护理培训。比较两组疼痛护理质量评价及患者对疼痛护理满意度。结果观察组疼痛护理质量合格率、患者对疼痛控制及教育的满意度显著高于对照组(均P0.01)。结论将同质服务应用于疼痛护理有助于规范疼痛护理行为,提高疼痛护理质量及患者满意度。     

Acute pain management in the neonate

Acute pain management in the neonatal period remains a challenge for the clinician. Responses to pain and analgesic intervention are developmentally influenced and cannot be not directly extrapolated from the older child. Successful and safe intervention will minimize acute physiological and behavioural distress, reduce pain scores and potentially improve short- and long-term outcomes. This requires an understanding of the physiology and pharmacology in this age group alongside a multi-modal approach to treatment using both pharmacological and non-pharmacological interventions.     

Acute pain management in symptomatic cholelithiasis

AIMTo review the evidence for the use of different non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of biliary colic.METHODSThe strategies employed included an extensive literature review for articles and studies related to biliary colic from electronic databases including PubMed, Science Direct, Wiley Inter Science, Medline and Cochrane from last 15 years.     

Acute pain management in the neonate

Management of acute pain in the neonate is challenging and involves a multimodal approach using non-pharmacological and pharmacological techniques after pain assessment using appropriate tools. Simplicity equates to safety in these vulnerable patients.     

Acute pain management in the neonate

Acute pain management in the neonatal period remains a challenge for the clinician. Responses to pain and analgesic intervention are developmentally influenced and cannot be directly extrapolated from the older child. Successful and safe intervention will minimize acute physiological and behavioural distress, reduce pain scores and potentially improve short- and long-term outcomes. This requires an understanding of the physiology and pharmacology in this age group alongside a multi-modal approach to treatment using both pharmacological and non-pharmacological interventions.     

Acute pain management in the neonate

Recognition and identification of acute pain in neonates is essential for effective pain management. Despite the abundance of research supporting this concept there continues to be inconsistency in practice. Neonatal pain management requires a holistic and multimodal approach using non-pharmacological and pharmacological interventions. This article outlines the key principles and techniques for successful neonatal pain management.     

Acute pain management in the neonate

Neonates may require a variety of painful procedures during their time in hospital. The stark differences in physiology and drug handling in this age group pose the attending clinician a significant and unique challenge when considering appropriate analgesic strategies. A multimodal approach, with careful modification of established analgesic practices, is required in order to both minimize the negative sequelae of pain and limit adverse effects. Those tasked with the care of neonates should be familiar with the different analgesic options at their disposal, utilizing a combination of non-pharmacologic, pharmacologic and interventional strategies in order to improve patient care.     

Acute pain management for patients undergoing thoracotomy

Management of thoracotomy pain can be difficult, but the benefits of effective pain control are significant. A variety of modalities for treating postoperative pain after thoracotomy are available, including systemic opiates, regional analgesics, and new oral and parenteral agents. This work provides a review of the literature and recommendations for the clinician.