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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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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 was 55%. ...