Acute pain services-20 years after Brian Ready Where have we been? Where are we going?

摘要

Publication of the paper Development of an Anesthesiology-based Postoperative Pain Management Service by Ready et al. in 1988, describing the first 18-month's experience of an Acute Pain Service (APS) at the University of Washington (Seattle, USA), signified a major turning point in the management of acute pain. Until this time, in most hospitals, postoperative pain was commonly managed using prn opioid injections prescribed by (often junior) medical staff. Ready et al. noted that whilst patient-controlled analgesia (PCA) and epidural analgesia (EA) had become more readily available (i.e. in the early 1980s), their widespread use was limited by, among other things, "a lack of structured programs for the provision of PCA and EA".Ready's concept of an APS was a service staffed by anaesthetists and a senior nurse. The predominantrole of the APS was to supervise, on a daily basis, acute pain management in patients after surgery using one of the more "high-tech" methods of pain relief such as EA or PCA.Among the stated goals in developing and implementing their APS were:1. improvement of postoperative analgesia;2. application and advancement of new analgesic techniques, and;3. clinical research in postoperative pain management.