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Montreal Heart Institute

October 17, 2012 » Montreal

SUSTAINED POSITIVE IMPACT OF AN ACUTE PAIN SERVICE FOR CARDIAC SURGERY

Following the realisation of the prevalence of very high levels of pain after cardiac surgery in our institution we undertook the establishment of an Acute Pain Service (APS) and began operation in November 2009. The service is nurse run and anesthesiologist supervised. All patients are seen daily for the first four days after surgery. The mainstay of our program is multimodal medication combined with regular dosing. Medication adjustments and rescue techniques are provided as necessary. Over the past 2 years we have evaluated over 3,900 patients and have over 14,000 pain scores in the database . Average pain scores at rest, on a numeric scale of 0 to 10 for patients who have pain, hover between 3.9 (from 4.0) on Day 1 to 2.9 (from 3.7) on Day 4. Pain on movement for patients with pain is now between 4.2 (from 5.3) on Day 1 to 3.1 (from 4.6) on Day 4. The number of pain free patients on Day 1 has increased from 27% to 50% and from 34% to 77% on Day 4. We feel that our success in managing acute postoperative cardiac pain is directly related to the structure of our APS service. It combines both “low tech” and “personalized therapy”. To underscore our success and inform all participants, patients and staff, we have posted two posters on the wards and had a small article written for publication in the hospital news paper.