Canadian Journal of Anaesthesia

, Volume 40, Issue 6, pp 568–575 | Cite as

Postoperative pain management and Acute Pain Service activity in Canada

  • D. L. Zimmermann
  • J. Stewart
Occasional Review

Abstract

A survey of postoperative pain management practices was mailed to the 56 Canadian university-affiliated teaching hospitals in December 1991. The aims of the survey were (1) to determine the prevalence, structure, and function of Acute Pain Services and (2) to determine the use and management of patient-controlled analgesia (PCA) and epidural opiate analgesia (EOA) in teaching hospitals. Responses were received from 47 hospitals, representing a return rate of 84%. Twenty-five hospitals (53%) operated an Acute Pain Service and an additional 17 (35%) were attempting to organize one. “Time commitment” was given as the primary reason why hospitals were unable to offer an Acute Pain Service. Most commonly used methods of pain relief were EOA and PCA. Most services were multidisciplinary, with 60% having a nurse and 29% a pharmacist. Irrespective of the presence of an Acute Pain Service, PCA was used at 32 (68%) hospitals, and EOA was used at 41 (87%); however, only 15 provided EOA on general wards. Complications have occurred with both PCA and EOA, with 14 of 32 hospitals indicating that they have had a major or serious complication. The data suggest an estimated incidence of severe respiratory depression of 0.03% with PCA and 0.13% with EOA. No deaths were reported at the time of the survey. Epidural opioid-local anaesthetic EOA-LA combinations were used at 26 (63%) hospitals; however, only six administered these combinations on general wards. We conclude that a multidisciplinary team approach to manage postoperative pain is viable in university teaching hospitals of all sizes. EOA and PCA are widely used; however, only a minority of hospitals use EOA or EOA-LA combinations on general wards.

Key words

anaesthetic techniques: epidural, patient-controlled analgesia: postoperative pain: acute, postoperative 

Résumé

En décembre 1991, un questionnaire sure l’exercice de la thérapie algique a été expédié à 56 hôpitaux d’enseignement affiliés à des universités canadiennes. L’enquête portait 1) sur le dénombrement, la structure et le fonctionnement des services de traitement de la douleur aiguë et 2) l’usage et la gestion de l’analgesie auto-contrôlée (PCA) et de l’analgésie épidurale aux opiacés (EOA) dans les hôpitaux d’enseignement. Quarantesept hôpitaux ont répondu pour un pourcentage de 84%. Vingtcinq hôpitaux (53%) faisaient fonctionner un service de traitement de la douleur aiguë et 17 autres (35%) désiraient en organiser un. La contrainte qu’impose le temps est la raison principale rapportée pour laquelle des hôpitaux ne pouvaient offrir ces services. Les méthodes les plus utilisées sont la PCA et l’EOA. La plupart des services sont multidisciplinaires, 60% employent une infirmière et 29% un pharmacien. Mme en absence d’un service formel, la PCA est utilisée dans 32 hôpitaux (68%), et l’EOA dans 41 (87%); cependant l’EOP n’est disponible aux chambres que dans 15 hôpitaux. Quatorze parmi trente-deux hôpitaux rapportent des complications majeures avec la PCA et l’EOA. Les données recueillies permettent d’évaluer l’incidence de la dépression respiratoire à 0,03% avec la PCA et à 0,13% avec l’EOA. On ne rapporte pas de décès. L’épidurale associant opiacé et anesthésique local (EOA-AL) est utilisée dans 26 hôpitaux (63%), mais on ne l’administre à la chambre du patient que settlement six hôpitaux. Nous concluons que l’approche multidisciplinaire pour la prise en charge du traitement de la douleur postopératoire est viable dans les hôpitaux universitaire de toutes les dimensions. L’EOA et la PCA sont utilisés sur une haute échelle, mais une minorité d’hôpitaux seulement utilise l’EOA ou l’EOA-AL à la chambre du patient.

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Copyright information

© Canadian Anesthesiologists 1993

Authors and Affiliations

  • D. L. Zimmermann
    • 1
  • J. Stewart
    • 1
  1. 1.Department of AnaesthesiaFoothills Hospital at University of CalgaryCalgaryCanada

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