Acute Pain Service

The Acute Pain Service (APS) is a collaborative team that consists of professionals from the Department of Anesthesiology and an Anesthesia Assistant who specialize in Acute Pain Management. 
 
The APS’s mission is to provide the best possible researched based pain management.  Our goal is to reduce pain to a comfort zone that allows the patient to sleep, deep breathe, eat, move around and carry on with activities.  It is very important for the patient not to try and put up with the pain.  Unrelieved pain can lead to many complications. The APS uses a multi-modal analgesia approach. This means different medications will be ordered by the APS team. The combinations of medications, complement each other to decrease the overall total amounts of medication used as well as decreasing the side effects from all of the medications.
 
The APS Team is involved in the care of post-operative patients who require patient controlled analgesia, single dose Epimorph and epidurals.  The APS Team conducts rounds on all APS patients Monday – Friday and is available for assistance on weekends through Anesthesia.  The types of patients referred to the pain service include major abdominal, or pelvic surgery, major vascular and major orthopaedic surgery.
 
 
POST-OP PAIN MANAGEMENT EDUCATION FOR PATIENTS
 
Adapted from RVH Post-op Pain Management Pre-Admission pamphlet. No two people experience the same amount of pain in the same manner.
 
A multi-modal (more than one method) approach to pain management is used at RVH. This includes spinal anesthesia, epidural anesthesia/analgesia, patient controlled analgesia, oral, rectal and injectable medications and/or a combination of all of the above. Other modes of pain control include relaxation, distraction and application of heat or cold. A member of the Acute Pain Service will discuss your pain management options with you.
 
Advantages of Multi-Modal Pain Management:

  • Reduces the amount of pain after surgery
  • Reduces the amount of analgesic you will need
  • You will be more alert
  • You will be up walking sooner
  • You will begin eating sooner
  • Your bowel and bladder function will return to normal sooner

Patients recover faster and leave the hospital sooner
 

Assessing your Pain
Pain is difficult to measure, and only you know how much pain you feel. You will be asked to rate your pain on a scale of 0 to 10. “0” means you are pain free. “10” is the worst pain possible. “2” means you are sore, but still able to walk around and do your deep breathing and coughing. Anything over “3” means you need more medication. Being able to rate your pain accurately is important to us so that we know exactly how much discomfort you are having or whether there is something more we should be doing to make you more comfortable.
 
The nurse will also ask you to describe other aspects of your pain.  We will ask you to tell us exactly where your pain is and if there is anything that you do that makes it better or worse. We will ask you what type of pain you are having (heavy, crushing, burning, squeezing, stabbing). You will also be asked if the pain travels to another part of your body and how long you have had the pain for.
 
Patients that have used multi-modal pain management enjoy the increased control it gives them and have expressed an increased satisfaction in their overall post-operative experience. We do look forward to helping make your hospital stay as pleasant as we can!
 
* Medications by Mouth or Rectum: This will be the baseline method for controlling your post-operative pain. As well you may be given an anti-inflammatory medication to swallow at regular intervals. You will be given a choice of pain pills to be taken every 4 hours. If you are unable to take them by mouth, the nursing staff will insert a suppository into the rectum.
 
   It is very important to keep on a regular schedule of oral or rectal medications so your pain control becomes the best it can be. Epidural or intravenous medicine is used for breakthrough pain only, to help you through the first few days.  Even if you are having no pain, take medications every four hours to keep pain under control.
 

* Injectable Medications: Your Surgeon or Anesthesiologist may order pain medication to be given through your intravenous or by an intramuscular needle injection into your arm, leg or bottom. An injection into a muscle works within 10-30 minutes and lasts about 2-4 hours. Medication given through the intravenous works a little faster, but it doesn’t last as long.
 
   Again, it is important to be on a regular schedule of oral or rectal medicine as well to help you control your pain as best as you can.
 
* Patient Controlled Analgesia (PCAIV or PCEA): After major surgery, one of the most effective methods of pain control is a method called patient controlled analgesia (PCA). The medicine contained in the PCA pump is delivered to you through a catheter in your arm connected to a tube called an intravenous line, or through an epidural in your back. When you feel pain, you push a special button that makes the pump give you a small, safe dose of pain relieving medicine. This will have an effect after a few minutes. You will be able to ensure that you get your pain medication when you need it.  You will not have to wait for a nurse to come and give you a pain-relieving pill or injection.  You will be in charge!  It is important to remember that only you are to push the button, because only you can judge how much medicine makes you comfortable. You don’t have to worry about giving yourself too much medication because the controls on the pump are set by the Acute Pain Team to prevent this.
 
* Spinal/Epidural Anesthesia/Analgesia: You don’t feel pain if the nerves carrying the sensation of pain from the area of surgery are numbed before they reach the spinal cord. In order for this to work, medicine (local anesthetic and narcotic) is injected between the bones in your back, ending up near your spinal cord; this procedure is performed by an Anesthesiologist.  Local anesthetic (numbing medicine) is injected just under the surface of the skin on your back. This hurts like a bee sting. After that, most people feel only pressure as the rest of the procedure is completed. The medicines that are injected into your back will reduce the pain that you feel and may make your legs feel heavy.
 
For an epidural, the Anesthesiologist puts a needle into your back into the space just outside where the fluid is around your spinal cord. A small tube goes in   through this needle, and the needle is removed. The tube is taped to your back and stays in place. The medicine is given continuously or intermittently through this tube. It starts to work as soon as the medicine is put into your back, but takes about 20 minutes to work its best. After your surgery is over, the epidural can stay in for up to three days to help you with pain control. During this time, a smaller dose of local anesthetic and narcotic is used. Your legs should not feel as heavy and numb as they did during the surgery. 
 
When a spinal is performed, a much smaller needle is used to put the medicine directly into the fluid that is around your spinal cord. No tube is left in, so it is a ‘one shot’ thing. It starts to work faster than an epidural, but totally numbs you for only up to 3 hours. Again, a mixture of medicine (local anesthetic and a short-acting narcotic with or without a long-acting narcotic) will be put in through the spinal needle to numb you for the surgery and then to help you with pain control afterward. If your surgery is expected to be longer than about 3 hours, the Anesthesiologist may also insert an epidural catheter at the same time. This is called CSE (combined spinal and epidural). Then, as the spinal is ‘wearing off’, medicine goes through the epidural catheter to help keep you comfortable. 
 
All of these procedures are safe and are used often for pain control. Side effects from a spinal or an epidural are usually minor and can easily be treated. There are some serious things that happen very rarely. These should be discussed with the Anesthesiologist, and you should have your questions answered before you have an epidural or spinal.
 
If you have any questions, please contact the Acute Pain Service at ext. 46511.
 
References:
 
1.   Instructions for Surgery Patients – Economou & Economou
2.   PCA Pamphlet – Baxter Healthcare Corporation
3.   Mosby’s Medical, Nursing & Allied Health Dictionary – Fifth Edition
4.   Dr Susan Goheen - Special Delivery at RVH - The Barrie Advance
5.   Department Of Anesthesia – RVH
6.   2002 Wodonga Regional Health Service – Peri-operative Acute Pain Management