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The Acute Perioperative Pain Service: Impact, Organization, and Future Directions

  • Acute Pain Medicine (R Urman, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The Acute Perioperative Pain Service has been established as a relatively new but important concept and service in clinical patient care. Many surgical institutions have dedicated inpatient acute pain services with variable compositions. This review aims to investigate the purpose, clinical and economic implications, and future direction of the Acute Perioperative Pain Service (APPS).

Recent Findings

There is growing evidence of the multiple benefits of a dedicated APPS, especially pertaining to patients at higher risk of poorly controlled postoperative pain. Healthcare providers furthermore realize the importance of the perioperative pain management continuity of care, consisting of preoperative pain evaluations and post-discharge follow-up in an outpatient pain management setting, in coordination with the primary teams. The Transitional Pain Service (TPS) has emerged as the next step in this evolution and has been successfully implemented at various medical centers.

Summary

With the growing number of surgical procedures and the increasing complexity of the patient population, effective management of acute postoperative pain continues to be challenging, despite ongoing advances in clinical care, analgesic modalities, and research. The APPS is becoming the clinical standard of care for managing postoperative pain, and its role continues to expand worldwide.

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Data Availability

The authors confirm that the data supporting the findings of this study are available within the paper and its cited references.

References

Papers of particular interest, published recently, have been highlighted as: •  Of importance

  1. Ready LB, Oden R, Chadwick HS, Benedetti C, Rooke GA, Caplan R, et al. Development of an anesthesiology-based postoperative pain management service. Anesth. 1988;68(1):100–6.

    Article  CAS  Google Scholar 

  2. Kayir S, Kisa A. The evolution of the regional anesthesia: a holistic investigation of global outputs with bibliometric analysis between 1980–2019. Korean J Pain. 2021;34(1):82–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89(3):409–23.

  4. Shapiro DM, Hargett MJ, Kopp S, Neal JM, Mariano ER, Liguori G. History and evolution of regional anesthesiology and acute pain medicine fellowship training. Reg Anesth Pain Med. 2020;45(4):311–4.

    Article  PubMed  Google Scholar 

  5. • Stamer UM, Liguori GA, Rawal N. Thirty-five years of acute pain services: where do we go from here? Anesth Analg. 2020;131(2):650–6. The authors attempted to explore meaningful outcome variables that define success in acute pain management.

  6. Wu CL, Rowlingson AJ, Partin AW, Kalish MA, Courpas GE, Walsh PC, et al. Correlation of postoperative pain to quality of recovery in the immediate postoperative period. Reg Anesth Pain Med. 2005;30(6):516–22.

    Article  PubMed  Google Scholar 

  7. Tawfic QA, Faris AS. Acute pain service: past, present and future. Pain Manag. 2015;5(1):47–58.

    Article  PubMed  Google Scholar 

  8. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. van Dijk JFM, Zaslansky R, van Boekel RLM, Cheuk-Alam JM, Baart SJ, Huygen F, et al. Postoperative pain and age: a retrospective cohort association study. Anesth. 2021;135(6):1104–19.

    Article  Google Scholar 

  10. Yang MMH, Hartley RL, Leung AA, Ronksley PE, Jette N, Casha S, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019;9(4):e025091.

  11. Coppes OJM, Yong RJ, Kaye AD, Urman RD. Patient and surgery-related predictors of acute postoperative pain. Curr Pain Headache Rep. 2020;24(4):12.

    Article  PubMed  Google Scholar 

  12. Werner MU, Søholm L, Rotbøll-Nielsen P, Kehlet H. Does an acute pain service improve postoperative outcome? Anesth Analg. 2002;95(5):1361–72.

    Article  PubMed  Google Scholar 

  13. Said ET, Sztain JF, Abramson WB, Meineke MN, Furnish TJ, Schmidt UH, et al. A Dedicated acute pain service is associated with reduced postoperative opioid requirements in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anesth Analg. 2018;127(4):1044–50.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Steckelberg RC, Funck N, Kim TE, Walters TL, Lochbaum GM, Memtsoudis SG, et al. Adherence to a multimodal analgesic clinical pathway: a within-group comparison of staged bilateral knee arthroplasty patients. Reg Anesth Pain Med. 2017;42(3):368–71.

    Article  CAS  PubMed  Google Scholar 

  15. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.

    Article  PubMed  Google Scholar 

  16. Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review. Anaesth. 2020;75(Suppl 1):e101–10.

    Google Scholar 

  17. Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, et al. Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database Syst Rev. 2018;6(6):CD007105.

  18. Hamilton GM, Ramlogan R, Lui A, McCartney CJL, Abdallah F, McVicar J, et al. Peripheral nerve blocks for ambulatory shoulder surgery: a population-based cohort study of outcomes and resource utilization. Anesth. 2019;131(6):1254–63.

    Article  Google Scholar 

  19. May KA, Craven JM, Wright C, Tran B. Regional anesthesia and the acute pain service: compliance and controversies. Curr Opin Anaesth. 2022;35(2):224–9.

    Article  Google Scholar 

  20. Sun E, Dexter F, Macario A. Can an acute pain service be cost-effective? Anesth Analg. 2010;111(4):841–4.

    Article  PubMed  Google Scholar 

  21. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377(9784):2215–25.

    Article  CAS  PubMed  Google Scholar 

  22. Brummett CM, Evans-Shields J, England C, Kong AM, Lew CR, Henriques C, et al. Increased health care costs associated with new persistent opioid use after major surgery in opioid-naive patients. J Manag Care Spec Pharm. 2021;27(6):760–71.

    PubMed  Google Scholar 

  23. Webb CAJ, Kim TE. Establishing an Acute Pain Service in Private Practice and Updates on Regional Anesthesia Billing. Anesth Clin. 2018;36(3):333–44.

    Article  Google Scholar 

  24. • Missair A, Visan A, Ivie R, Gebhard RE, Rivoli S, Woodworth G. Daring discourse: should acute pain medicine be a stand-alone service? Reg Anesth Pain Med. 2021;46(6):529–31. Described the most common acute pain service models utilized in pain management today.

  25. American Society of Anesthesiologists Task Force on Acute Pain M. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesth. 2012;116(2):248–73.

  26. Louw A, Diener I, Landers MR, Zimney K, Puentedura EJ. Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy. J Spine Surg. 2016;2(4):289–98.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Oldman M, McCartney CJ, Leung A, Rawson R, Perlas A, Gadsden J, et al. A survey of orthopedic surgeons’ attitudes and knowledge regarding regional anesthesia. Anesth Analg. 2004;98(5):1486–90, table of contents.

  28. Miclescu A, Butler S, Karlsten R. The changing face of acute pain services. Scand J Pain. 2017;16:204–10.

    Article  PubMed  Google Scholar 

  29. Schug SA, Lavand’homme P, Barke A, Korwisi B, Rief W, Treede RD, et al. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. 2019;160(1):45–52.

    Article  PubMed  Google Scholar 

  30. Johansen A, Romundstad L, Nielsen CS, Schirmer H, Stubhaug A. Persistent postsurgical pain in a general population: prevalence and predictors in the Tromso study. Pain. 2012;153(7):1390–6.

    Article  PubMed  Google Scholar 

  31. • Katz J, Weinrib AZ, Clarke H. Chronic postsurgical pain: from risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service. Can J Pain. 2019;3(2):49–58. The authors described the service’s role as a multi-professional and multimodal team involved in preventing and treating the factors that increase the risk of chronic postsurgical pain and related disability.

  32. Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, Peelen LM, Kappen TH, van Wijck AJ, et al. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2014;120(5):1237–45.

    Article  PubMed  Google Scholar 

  33. Wang L, Guyatt GH, Kennedy SA, Romerosa B, Kwon HY, Kaushal A, et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ. 2016;188(14):E352–61.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mikhaeil J, Ayoo K, Clarke H, Wasowicz M, Huang A. Review of the Transitional Pain Service as a method of postoperative opioid weaning and a service aimed at minimizing the risk of chronic post-surgical pain. Anaesthesiol Intensive Ther. 2020;52(2):148–53.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Flynn HK, Manoharan D, Hsu YJ, Xie A, Shechter R, Hanna M, et al. A multidisciplinary transitional pain service to improve pain outcomes following trauma surgery: a preliminary report. Scand J Pain. 2022.

  36. • Featherall J, Anderson JT, Anderson LA, Bayless K, Anderson Z, Brooke BS, et al. A multidisciplinary transitional pain management program is associated with reduced opioid dependence after primary total joint arthroplasty. J Arthroplasty. 2022;37(6):1048–53. The authors presented objective evidence of the impact of introducing a transitional pain service at their institution.

  37. Clarke H, Azargive S, Montbriand J, Nicholls J, Sutherland A, Valeeva L, et al. Opioid weaning and pain management in postsurgical patients at the Toronto General Hospital Transitional Pain Service. Can J Pain. 2018;2(1):236–47.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Columbia University Irving Medical Center, New York, USA

    Ibrahim Al-Saidi, Alex Russell & Anis Dizdarevic

  2. NewYork-Presbyterian/Columbia Univ Med Ctr, 622 W 168th St, NY, PH5-133 10032, New York, USA

    Ibrahim Al-Saidi

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  1. Ibrahim Al-Saidi
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Correspondence to Ibrahim Al-Saidi.

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Al-Saidi, I., Russell, A. & Dizdarevic, A. The Acute Perioperative Pain Service: Impact, Organization, and Future Directions. Curr Pain Headache Rep 27, 399–405 (2023). https://doi.org/10.1007/s11916-023-01133-2

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