Gestión de los servicios de dolor agudo postoperatorio en México, requerimientos y consideraciones económicas para su implementación / Management of acute postoperative pain services in Mexico, requirements and economic considerations for their implementation

Resumen: En los 80 surgieron los Servicios de Dolor Agudo (SDA), con el objetivo de disminuir la intensidad del dolor postoperatorio y sus complicaciones; estos servicios son responsables de los protocolos analgésicos de los pacientes, algunos SDA extienden la atención a otros tipos de dolor agudo. La educación y capacitación continua del paciente y todo el personal involucrado con el manejo del dolor fortalecen los resultados en el ámbito de la seguridad y eficacia. La fármaco-economía favorece la implementación de los SDA, los cuales no son factibles si no se cuenta con los recursos necesarios. La gestión de los Servicios de Dolor Agudo es posible en México.

Abstract: In the 80 the acute pain services (APS) were created with the objective of decreasing the intensity of postoperative pain and related complications, responsible for analgesic protocols for patient. Some APS extend their attention to other types of acute pain as well. Education and continuous training for the patient and all personnel involved in the handling of pain brings better results in safety and efficiency. Pharmacoeconomics encourage APS implementation which means investing in the required resources for its success. Acute pain service management is achievable in Mexico.

Ketamina en el manejo del dolor agudo postoperatorio / Ketamine in acute postoperative pain management

Resumen: La ketamina es un inductor de anestesia disociativa conocida desde hace más de 50 años, y cuyo uso ha sido fluctuante en nuestro país. Más allá de sus propiedades anestésicas, su uso como fármaco para el manejo del dolor agudo, crónico y la depresión, le han conferido un nuevo auge; sin embargo, las dosis y el manejo en pacientes con dolor agudo difiere con las guías y las publicaciones establecidas. Este artículo pretende hacer una revisión de las indicaciones establecidas, las dosis recomendadas, así como el manejo de los efectos adversos dentro del marco de un Servicio de Dolor Agudo con respecto al uso de ketamina en el contexto de dolor agudo (para ver el artículo completo visite http://www.painoutmexico.com).

Abstract: Ketamine is an inductor of dissociative anesthesia used for more than 50 years, its use has been variable through the years in our country. Beyond its anesthetic properties, this drug is also use for acute and chronic pain alongside with refractory depression, making its use trendy again. This paper review the present indications in the acute pain field regarding patient selection, doses, adverse events and the safety precautions under an acute pain service scheme (full version visit http://www.painoutmexico.com).

Preventing and treating chronic disabling pain after surgery

Chronic postoperative pain (CPP) is an important health problem. This is a narrative review of etiologies, mechanisms, risk factors, means of reducing the risk, and treatment of chronic postoperative pain. Methods: This is a topical review based on a focused literature review and personal clinical experience and research efforts on chronic pain after surgical interventions. Results: CPP is defined as new pain in the area of surgery that lasts more than 3-6 months after the operation, is clearly related to tissue and nerve injuries during the operation and cannot be explained by other etiologies. The overall prevalence is that 20-40 percent have some pain and discomfort for a few weeks, 10 percent have moderate pain that cannot be neglected for a few months, about 1 percent develop debilitating CPP. CPP is caused by nerve and tissue injury and abnormal reactions to such injury. Only those who have pre and peri-operative risk factors determined in part by genetic makeup, reinforced by abnormal pain modulating mechanisms, having chronic pain in other part(s) of the body, having psychological stress factors andc atastrophizing thoughts and anxiety, having severe acute pain during and immediately after surgery, chemotherapy or radiation after cancer surgery, and being younger rather than elderly. Risks of CPP can be estimated by a simple scoring system with approximate risk prediction determined by the number and degree of preoperative risk factors. A number of procedures and drugs can ameliorate these risk factors: Regional and local anesthetic techniques when appropriate, anti-hyperalgesic drugs with nitrous Introduction Long-lasting new pain after an operation is a common, sometimes a debilitating consequence of surgery. We know some factors that increase the risk of developing chronic postoperative pain (CPP). The patients’ GP, surgeon, and anesthesiologist must focus on these risks and prioritize efforts to reduce their effects...

Effect evaluation of NBASS-APS in patients with abdominal surgery / 中国实用护理杂志

Objective To evaluate the application effect of nurse based,with clinicians and anesthesiologists supervised acute pain service (NBASS-APS)in clinical postoperative pain management.Methods 300 cases of abdominal surgery were divided into the observation group and the control group with 150 cases in each group,the observation group was given NBASS-APS,the control group used the traditional acute pain service mode.The total cost and postoperative analgesia effect were recorded in all patients.Results The hospitalization costs,anal exhaust time,ambulation time and hospital stay in the observation group were significantly less than those in the control group,and postoperative 48h sleep time was significantly longer than that in the control group,VAS scores of each time period were significant-ly lower than those in the control group,there was significant difference.Conclusions Application of NBASS-APS in patients after abdominal surgery can effectively reduce hospitalization costs and improve cost efficiency.

Postoperative Analgesia

Uncontrolled or inadequately controlled postoperative pain may lead to delayed recovery from surgery, pulmonary complications, and restriction of mobility leading to increased risk of thromboembolism. Standardized regimens for pain management can lead to safer and better pain control. Of these regimens, patient-controlled analgesia, a delivery system with which patients self-administer small, predetermined analgesic doses, produced improved pain relief, greater patient satisfaction, less sedation, and fewer postoperative complications. Anesthesiologists have played an important role to make this pain management feasible. The introduction of acute pain services at hospitals prompted improvements in postoperative pain management in addition to the minimization of related complications.