Effective postoperative pain control using continuous peripheral nerve block reduced average length-of-stay by nearly a day, University of Pittsburgh School of Medicine physicians reported during the 81st Clinical and Scientific Congress of the International Anesthesia Research Society at the Buena Vista Palace in Orlando, Fla.
Being able to decrease the time that patients spend in the hospital helps to reduce the patient's exposure to the risk of hospital-acquired infection and associated complications, and also has an overall economic benefit, Jacques E. Chelly, M.D., Ph.D., professor and vice chairman of the department of anesthesiology at the University of Pittsburgh School of Medicine and his colleagues found.
"For many people, the prospect of having pain is more stressful than the surgery itself," said Dr. Chelly, who is presenting these study results at the meeting. "If they know that specialists in acute pain medicine can help to minimize the pain associated with surgery, these patients are less stressed and more willing to have the surgery they need."
Dr. Chelly and his colleagues analyzed the hospitalization experiences of 1,527 patients, including 495 undergoing surgery between July 1, 2001, and Aug. 30, 2002, and 1,032 who underwent surgery following the institution of a formalized postoperative pain medicine program, called the acute interventional postoperative pain service, between July 1, 2004, and Aug. 30, 2005. The study included patients who underwent total hip or total knee replacement, chest or prostate surgery.
"Prior to the implementation of our postoperative pain management program, the average length of hospital stay was about three to five days," said Dr. Chelly, who also is director of orthopaedic anesthesia and the acute interventional postoperative pain service at UPMC Shadyside Hospital, part of the University of Pittsburgh Medical Center. "The use of the acute interventional postoperative pain service allowed patients to recover faster, and they were discharged from the hospital an average of 0.675 days per patient earlier, for a total of 597.7 days of hospitalization saved a year."
Before the introduction of the acute interventional postoperative pain service, postoperative pain was managed by surgeons and mostly limited, according to Dr. Chelly. "Morphine and PCA (patient-controlled analgesia) were used," he said. "Now, we can do a peripheral nerve block and use other medications, making postoperative pain control more effective."
In addition to Dr. Chelly, authors are Bruce Ben-David, M.D., Rama Joshi, M.D., Mark Hudson, M.D., and John P. Williams, M.D., all of the department of anesthesia at the University of Pittsburgh School of Medicine.
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