What does the scope of an Acute Pain Service (APS) in a hospital typically entail?

From the Guidelines

The scope of an acute pain service (APS) in a hospital typically entails comprehensive management of pain for patients experiencing acute pain, particularly following surgery or trauma, with a focus on multimodal analgesia regimens, patient education, and standardized pain assessment protocols. An APS team usually consists of anesthesiologists, specialized nurses, pharmacists, and sometimes physical therapists who collaborate to provide optimal pain control. The service manages various analgesic techniques including patient-controlled analgesia (PCA) with medications like morphine (1-2mg bolus, 5-10 minute lockout) or hydromorphone (0.2-0.4mg bolus), epidural analgesia (typically bupivacaine 0.0625-0.125% with fentanyl 2-4 mcg/mL at 4-10 mL/hour), regional nerve blocks (single-shot or continuous catheters), and multimodal analgesia regimens 1.

Some key aspects of APS include:

• Daily rounds to assess pain scores, medication efficacy, and potential side effects, making necessary adjustments to treatment plans
• Education to patients about pain management expectations and to hospital staff about best practices
• Implementation of standardized protocols for pain assessment using validated tools like the Numerical Rating Scale (0-10)
• Monitoring for complications such as respiratory depression, nausea, or motor blockade
• Consideration of patient-specific factors, such as preoperative chronic pain, psychiatric comorbidities, and substance abuse history, to tailor pain management plans 1

The goal of APS is to improve patient outcomes by reducing pain scores, decreasing opioid consumption, enabling earlier mobilization, and potentially shortening hospital stays while improving patient satisfaction. According to recent guidelines, APS teams should prioritize multimodal analgesia regimens, minimize opioid use, and provide individualized care to patients with complex pain needs 1.

From the Research

Scope of Acute Pain Service in Hospital

The scope of acute pain service in hospital typically entails a multidisciplinary team approach to address pain management inside hospitals. The key aspects of this service include:

• Defining and applying pain treatment protocols specific to each surgery 2
• Using a combination of analgesic techniques, such as epidural analgesia, IV patient-controlled analgesia (PCA), and perineural catheters 2
• Assessing pain using standardized tools, such as the Visual Analog Scale (VAS) at rest and during movement 2
• Monitoring for side effects and complications, such as dural punctures, epidural hematoma, and meningitis 2

Pain Management Strategies

The acute pain service may employ various pain management strategies, including:

• Multimodal approach to pain management, using a combination of nonopioid and opioid analgesics 3, 4
• Reserving opioids for patients with severe pain that cannot be managed with other agents 3, 4
• Using nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as alternative or adjunctive treatments for acute pain 4
• Considering combination therapy using a small amount of opioid together with a nonopioid pain reliever 4

Goals and Challenges

The primary goal of the acute pain service is to provide optimal analgesia and prevent progression to chronic pain 5, 3. However, challenges remain, such as determining the best medication regimen for post-operative pain management 5 and balancing the benefits and risks of different analgesic options 6, 4.