Effectiveness of an acute pain service in surgical patients — a hospital comparison study

The implementation of an acute pain service (APS) has been advocated as the cornerstone of effective pain management. However, convincing evidence demonstrating the effectiveness of an APS in controlled studies is scarce. In this study we compared both subjective and objective variables of surgical patients in two similar hospitals, one of which had established an APS. During the study period of two years 498 patients were prospectively enrolled. Pain and other related variables (appetite, mobility, need for sleep, fatigue, and general satisfaction) were assessed pre- and postoperatively by means of 10 cm VAS scales printed on two identical questionnaires. Additional data were retrieved from the patients' records. Those patients who were cared for by an APS suffered less pain (25 mm VAS at rest), sleepiness (13 mm VAS), mobility restriction, and loss of appetite. For most measures the beneficial effects of the APS were present pre- and postoperatively. However, hospital stay was similar in both hospitals (13.7 vs 14.3 days; A vs B). Our data indicate large and patient-relevant benefits of an APS, but our study design was vulnerable to various kinds of bias.