By Georgine M. Steude, M.D.
Our acute pain service provides care primarily for postoperative surgical patients, medical patients with pain problems, and cancer patients on a referral basis. While we consult on and manage intravenous PCA (patient controlled analgesia) infusions and local anesthetic-opioid epidural infusions, we do use many other medications and recommend and carry out peripheral or central nerve blocks when appropriate.
We also employ and recommend adjuvant drugs. These would be principally anti-anxiety agents and tricyclic anti-depressants. NSAIDS (non-steroidal anti-inflammatories) are used as primary pain medication and as adjuvants in patients with severe pain.
We are interested in non-pharmacologic methods of pain control especially for those patients who have difficulty controlling their pain with drugs. There are a few tape recorders and relaxation tapes on hand that are offered to select patients. TENS, (transcutaneous electrical nerve stimulation) units are used on occasion, and biofeedback, massage, and music therapy are modalities we use when we can identify personnel in the hospital trained in their use.
The personnel on our Acute Pain Service consist of one anesthesia faculty each day, an anesthesia house officer covering the service for 24 hours, and a clinical nurse specialist in house from 7:00 a.m. to 1:00 a.m. Formal rounds take place on every patient each morning. Each afternoon the house officer and afternoon nurse round on any patients with special pain problems and all those with epidural catheters. A pharmacist is assigned to our service and rounds with us at least once a week. This has been very helpful in smoothing out problems concerning the pharmacy or with making up special solutions. It also provides us with an excellent source of drug information.
We have between 35 and 75 patients on the service each day. They range in age from 16 to over 90. Each anesthesia house officer spends one week on the service, and those taking a third-year, three-month pain rotation spend an additional three weeks on the Acute Pain Service. It is a very different experience for our house officers as compared to taking care of patients in the operating room.