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Adequate perioperative analgesia is essential for the reduction of postoperative morbidity1–4 and mortality.2 Inadequately treated postoperative pain delays patient discharge and recovery and results in an inability to participate in rehabilitation programs, leading to poor patient outcomes. Recent studies5 show that pain is inadequately treated despite the availability of drugs and techniques for pain management. The problem of inadequate pain relief is usually due to the lack of an appropriate department or service that utilizes available expertise and pharmacologic options, rather than the development of new medications or pain management modalities.

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Although several authors in the late 1970s advocated the introduction of pain management teams to assume the responsibility for teaching and training in postoperative pain management, almost a decade passed before specialized in-hospital postoperative pain services eventually emerged. Recently, various medical and health care organizations have recommended the widespread introduction of an acute pain service (APS).6–12 Having an APS is a prerequisite for accreditation for training by the Royal College of Anaesthetists in the United Kingdom and by the Australian and New Zealand College of Anaesthetists.13

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Table 78–1 shows the prevalence of such services in Europe, North America, Australia, and New Zealand.13–27 Although the number of hospitals with an APS has increased worldwide, standards with respect to the structure and function of an APS are still lacking.24 The nature of service provided, the staffing and facilities, the training and competence of personnel, and the effectiveness of an APS vary greatly. Many hospitals consider their current pain service adequate for their patients' needs, although they have only some but not all of the essential components of an APS.20

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Table 78-1. National Surveys of the Prevalence of Acute Pain Services
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In 2004, a Canadian survey showed that the percentage of academic hospitals with an APS increased from 53% in 1993 to 92% in 2004.26 However, an APS with anesthesiologists as sole pain management providers decreased from 36% to 22% in the same time span because of growing clinical demands and a reduced number of anesthesiologists. Only 44% of centers had a designated group of APS physicians, whereas nursing representation ...

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