Postoperative pain survey in Italy (POPSI): a snapshot of current national practices.
ABSTRACT Over the last several years, significant efforts have been directed towards improving the quality of postoperative pain management. As data are lacking on the organization and quality of these services in Italy, we surveyed current Italian practices.
A 16-item questionnaire was randomly supplied to 650 anesthesiologists attending the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care Medicine (SIAARTI) National Congress in 2006. The survey requested information concerning their current practices in analgesic techniques, use of guidelines, educational programs, availability of an Acute Pain Service (APS), and existing barriers to optimal postoperative pain management.
Based on 588 respondents, a sample of 163 hospitals was analyzed (24.4% of Italian public hospitals); 41.7% of the surveyed hospitals had an organized APS. University and teaching hospitals had an organized APS more frequently than did other hospitals (P<0.02). Continuous intravenous analgesia using elastomeric infusion systems was the most commonly used analgesic technique, performed in 44% of the treated patients. The frequency of both intravenous patient-controlled analgesia and epidural techniques was extremely low (5% and 13%, respectively). The main reasons given for suboptimal pain relief were inadequate training of surgeons and nurses (44.3%), poor organization (29.9%), and lack of equipment (21.5%). A total of 51.2% of the respondents would like to have a dedicated anesthesiologist assigned on a daily rotational basis to postoperative pain management.
A comparison to international survey data showed that postoperative pain management in Italy is still below the European standards. Additional efforts to overcome these hurdles and to reach an acceptable level of quality are required.
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ABSTRACT: The combination of ketamine and remifentanil seems to be associated with better analgesia and duration. The aim of this study was to evaluate whether a ketamineremifentanil combination promotes improved postoperative analgesia. Prospective, randomized, double blind study of 40 patients undergoing video laparoscopic cholecystectomy. Anesthesia was performed with remifentanil, propofol, atracurium, and 50% oxygen. Group 1 (GI) patients received remifentanil (0.4mcg.kg(-1).min(-1)) and ketamine (5mcg.kg(-1).min(-1)) and Group 2 (G2) received remifentanil (0.4mcg.kg(-1).min(-1)) and saline solution. Morphine 0.1mg.kg(-1) was administered at the end of the procedure, and postoperative pain was treated with morphine via PCA. We evaluated the severity of postoperative pain by a numerical scale from zero to 10 during 24hours. We registered the time to the first analgesic supplementation, amount of morphine used in the first 24hours, and adverse effects. There was a decrease in pain severity between extubation and other times evaluated in G1 and G2. There was no signifi cant difference in pain intensity between the groups. There was no difference between G1 (22±24.9min) and G2 (21.5±28.1min) regarding time to first dose of morphine and dose supplement of morphine consumed in G1 (29±18.4mg) and G2 (25.1±13.3mg). The combination of ketamine (5mcg.kg(-1).min(-1)) and remifentanil (0.4mcg.kg(-1).min(-1)) for cholecystectomy did not alter the severity of postoperative pain, time to first analgesic supplementation or dose of morphine in 24hours.Revista brasileira de anestesiologia 01/2013; 63(2):178-82.
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ABSTRACT: BACKGROUND.: In recent years, the field of acute pain medicine (APM) has witnessed a surge in its development, and pain has begun to be recognized not merely as a symptom, but as an actual disease process. This development warrants increased education of residents both in the performance of regional anesthesia as well as in the disease course of acute pain and the biopsychosocial mechanisms that define interindividual variability. REVIEW SUMMARY.: We reviewed the organization and function of the modern APM program. Following a discussion of the nomenclature of acute pain-related practices, we discuss the historical evolution and modern role of APM teams, including the use of traditional, as well as complementary and alternative, therapies for treating acute pain. Staffing and equipment requirements are also evaluated, in addition to the training requirements for achieving expertise in APM. Lastly, we briefly explore future considerations related to the essential role and development of APM. CONCLUSION.: The scope and practice of APM must be expanded to include pre-pain/pre-intervention risk stratification and extended through the phase of subacute pain.Pain Medicine 12/2012; · 2.46 Impact Factor
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ABSTRACT: Despite the availability of effective pain treatments, there are numerous barriers to effective management resulting in a large proportion of patients not achieving optimal pain control. Chronic pain is inadequately treated because of a combination of cultural, societal, educational, political and religious constraints. The consequences of inadequately treated pain are physiological and psychological effects on the patient, as well as socioeconomic implications. Unreasonable failure to treat pain is viewed as unethical and an infringement of basic human rights. The numerous barriers to the clinical management of pain vary depending on whether they are viewed from the standpoint of the patient, the physician, or the institution. Identification and acknowledgement of the barriers involved are the first steps to overcoming them. Successful initiatives to overcome patient, physician and institutional barriers need to be multifaceted in their approach. Multidisciplinary initiatives to improve pain management include dissemination of community-based information, education and awareness programmes to attempt to change attitudes towards pain treatment. A better awareness and insight into the problems caused by unrelieved pain and greater knowledge about the efficacy and tolerability of available pain management options should enable physicians to seek out and adhere to treatment guidelines, and participate in interventional and educational programmes designed to improve pain management, and for institutions to implement the initiatives required. Although much work is underway to identify and resolve the issues in pain management, many patients still receive inadequate treatment. Continued effort is required to overcome the known barriers to effective pain management.Clinical Drug Investigation 02/2012; 32 Suppl 1:11-9. · 1.92 Impact Factor