title: Acute Pain Service and multimodal therapy for postsurgical pain control: evaluation of protocol efficacy.
abstract: OBJECTIVE
  The institution of a postoperative Acute Pain Control Service is mandatory to improve the control of pain induced by surgical injury. Treatment of postoperative pain may be achieved using a combination of analgesic agents and techniques, reducing the incidence of side effects owing to the lower doses of the individual drugs. In 1997 we established an Acute Pain Service (APS) at the San Raffaele Hospital in Milan. The aim of this study was to assess the efficacy and safety of our APS both in terms of treatment protocols and organisational issues.
  
  
  METHODS
  In this prospective observational study we included 592 patients undergoing abdominal, gynecological, or orthopedic surgery with severe expected pain. According to general guidelines on pain treatment, the patients were assigned to different treatment protocols based on the kind of operation. All protocols were based on the multimodal therapy, with the association of nonsteroidal anti-inflammatory drugs (NSAIDS), opioids and regional anesthesia techniques. During the first 48 h of the postoperative period we recorded vital signs, level of pain and occurrence of any side effect.
  
  
  RESULTS
  Our analgesic protocols proved to be effective and safe (low incidence of side effects) for every surgery. The incidence of postoperative nausea and vomiting was higher in patients receiving patient-controlled morphine than that with continuous epidural or nerve block. After lower abdominal surgery, pain at movement at 24 h was significantly lower in the epidural group than in the Patient Control Analgesia group. Nausea and vomiting, numbness and paresthesias at the lower limbs were higher in gynecological patients. A larger percentage of orthopedic patients in the epidural group reported numbness and paresthesias at the lower limbs in comparison with patients receiving continuous peripheral nerve block.
  
  
  CONCLUSIONS
  In agreement with previous literature, this study confirmed that a multimodal approach to pain treatment provides an adequate control of postoperative pain, minimizing side effects.
authors.affiliation: Department of Anesthesiology, IRCCS H San Raffaele, Vita-Salute University of Milan, Milan, Italy. moizo.elena@hrs.it
authors.forename: E
authors.initials: E
authors.lastname: Moizo
authors.forename: M
authors.initials: M
authors.lastname: Berti
authors.forename: C
authors.initials: C
authors.lastname: Marchetti
authors.forename: F
authors.initials: F
authors.lastname: Deni
authors.forename: A
authors.initials: A
authors.lastname: Albertin
authors.forename: F
authors.initials: F
authors.lastname: Muzzolon
authors.forename: A
authors.initials: A
authors.lastname: Antonino
mesh_terms: D000005:Abdomen / Q000601:surgery; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D019637:Orthopedic Procedures; D018710:Pain Clinics; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal