Subject(s)
Anesthetics, Local/administration & dosage , Hernia, Umbilical/surgery , Nerve Block/methods , Aged, 80 and over , Bupivacaine/administration & dosage , Female , Humans , Lidocaine/administration & dosage , Rectus Abdominis/diagnostic imaging , Rectus Abdominis/innervation , Ultrasonography, Interventional/methodsSubject(s)
Intubation, Intratracheal/instrumentation , Laryngoscopes , Adult , Aged , Female , Humans , Intubation, Intratracheal/methods , Male , Middle Aged , Time FactorsABSTRACT
INTRODUCTION: The management of postoperative pain is an increasingly important aspect of healthcare, leading to the establishment of acute pain services in major surgical centres worldwide. The acute pain service (APS) was established in most Singapore hospitals in the 1990s. We analysed data collected in our institution over a ten-year period (1998-2007), documenting our experiences, outcomes and complications encountered by our APS. METHODS: Data was chronologically divided into two groups for analysis: years 1998-2003 (3,248 cases) and 2004-2007 (2,466 cases). Analysis included a comparison of patient profiles, modalities of analgesia used, effectiveness of pain relief, adverse effects, complications and patient satisfaction. Results were also compared to published audits and proposed standards in medical literature. RESULTS: The patient profile served by the APS remained unchanged over the years, but a move away from central neuraxial blocks was noted with an increased utilisation of patient-controlled analgesia. There was no clinically significant change in pain scores over the two periods of analysis (0.9 vs. 1.0 at rest, 3.0 vs. 3.0 on movement). There were also no statistically significant changes in the prevalence of patients reporting severe pain while on the APS (1.5 percent vs. 1.6 percent at rest, p-value is 0.66; 8.5 percent vs. 9.4 percent on movement, p-value is 0.25). Complication rates remained well within international standards and no major complications were reported. Patient satisfaction remained high (94.3 percent vs. 94.6 percent, p-value is 0.6). CONCLUSION: The move away from invasive and less targeted analgesic modalities has not compromised the quality of analgesia provided. Major morbidity remains extremely rare and incidence of complications has been reduced over the years. Patient satisfaction remains well in excess of 90 percent, and the side effects are largely well controlled. With further advancements in the provision of acute postoperative analgesia, the APS will continue to play an important role in the holistic convalescence of the surgical patient.