Longnecker's Anesthesiology > Part 5. Postoperative Care of the Anesthesia Patient > Chapter 74. Management of Acute Postoperative Pain Jane C. Ballantyne, MD, FRCA

Background

"The idea of the acute pain service arose during the 1980s when "walking" epidurals made epidural analgesia suddenly more feasible for postoperative patients, and when the microchip made patient-controlled analgesia (PCA) pumps small enough to have wide applicability. Initially, pain services ran both these modalities, developed treatment protocols, and taught nurses and others how to manage these new therapies. Soon surgeons and nurses became familiar with the use of PCA, so that this component of postoperative management, at least for routine cases, largely has been taken over by them. Epidurals and other continuous perineural techniques remain the province of anesthesiologists, and the core function of most acute pain services is to manage postoperative epidural analgesia. The acute pain service is also available to help with complex cases, notably cases that cannot be managed using routine measures. Naturally, each institution will structure its pain service differently, according to institutional and local factors—smaller hospitals and ambulatory facilities may not have a service as such.Patients who are informed about their likely postoperative experience are much better able to cope with pain and the other discomforts of the postoperative state than those who enter the experience uninformed.⁴ Whether it is the surgeon, the anesthesiologist, or the nurse who talks to the patient about the postoperative course, the message should always be that the team will use all methods available to make the experience tolerable,..."