Role of acute pain service in optimizing postoperative pain relief in a tertiary care teaching hospital

Objective: To assess the frequency and types of adjustments that acute pain service makes to postoperative analgesic regimes to improve pain relief or treat side effects. Methods: The prospective observational study was conducted at the Aga Khan University Hospital, Karachi, from December 1, 2012, to March 31, 2013. Data was collected from Acute Pain Service register four hours after the pain rounds by a Service member not involved in rounds. Data was collected on a standardised form and analysed using SPSS 19. Results: Of the 323 patients, 209(65%) were receiving epidural infusions and 114(35%) were receiving intravenous patient-controlled analgesia. Overall, 114(35%) required action by Acute Pain Service; 76(66.6%) with epidural infusions and 38(33.3%) intravenous analgesia. Besides, 98(85.9%) had inadequate pain relief, 61(62%) with epidural and 37(38%) with analgesia. Post-intervention, motor block occurred in 13(11.4%) patients, who were managed by change of patient's position and/or lowering the concentration of epidural solution. Improvement was seen in all patients after the adjustments. Conclusion: Acute Pain Service played an important role in improving the quality of postoperative pain relief and management of analgesia-related side effects. Regular feedback to the primary anaesthesiologist can lead to improved practices.