Acute pain management is a very important component of the overall treatment of both medical and surgical patients here at Stony Brook University Medical Center. The Acute Pain Service is available 24 hours a day, 365 days a year for consultation. The service is composed of attending anesthesiologists, resident anesthesiologists, nurse practitioners, and registered nurses with extensive experience in the management of acute pain. The service is proficient in the placement of nerve blocks and epidural catheters for the optimal management of pain and is well-equipped to manage intravenous patient-controlled analgesia.
A dedicated attending and resident anesthesiologist, one or two nurse practitioners, and one or two registered nurses are in-house Monday through Friday from 6:30 am until 5:00 pm. An Acute Pain Service registered nurse is in house until 11:00 pm and has back-up help by telephone with the attending and back-up help in house with a resident and the anesthesiologist on overnight. Weekends and holidays are covered by an in-house registered nurse who rounds with the covering attending and turns the pager over to the overnight anesthesiology resident at 3:00 pm. The attending anesthesiologist is available by telephone the entire day and night.
Patient safety and satisfaction in the management of pain is of utmost importance to the acute pain service. Each patient is evaluated on an individual basis and a plan for optimal pain control and safety is formulated. Recommendations for pain management are discussed with the patient and primary service and a plan is implemented.
Multimodal analgesia is considered the standard for optimal pain management for both patient safety and satisfaction. This mode of management entails attacking the pain response from two to three different angles. Decreasing reliance on opioids for pain control increases patient safety and satisfaction. Side effects such as nausea, vomiting, sedation, respiratory depression, urinary retention and constipation have long been hindrances in the optimal rehabilitation of hospitalized patients, and by decreasing opioid usage, these side effects can be and should be diminished. Multimodal analgesia includes, but is not limited to, the addition of non-steroidal anti-inflammatories, anti-convulsants, anti-depressants, and best of all, regional analgesia to the regimen.
Prior to surgery, patients are evaluated for regional analgesia and offered the opportunity to have epidural catheters or peripheral nerve blocks and catheters placed in the preoperative holding area. With these advanced acute pain management techniques in place, patients may have the surgical region completely insensitive to the impending operation. The incidence of negative sequalae of suboptimal acute pain control, such as chronic pain and cancer recurrence or metastasis, may be decreased.
For patients who are not candidates for regional analgesia and are admitted to the hospital post-operatively, intravenous patient-controlled analgesia (IV PCA) combined with adjuvant medications such as non-steroidal anti-inflammatories and local anesthetics are the preferred method for pain control. IV PCA has consistently been shown in numerous studies to be the preferred method of post-operative pain control by patients across the world. The current choices in opiate medication are morphine, hydromorphone and fentanyl. The concept involves the use of small frequent doses that the patient can self-titrate to reach their particular needed level of comfort. Maximum settings are programmed for patient safety, and the elimination of intermittent dosing by nurses increases their efficiency. The earliest devices were introduced in the 1960s and wide-spread use has been successful since the 1980s.
The Acute Pain Service at Stony Brook University Medical Center is dedicated to providing the absolute best in acute pain management care and was put in to service for the greater good of our patients. We are available for consultation at all times and are happy to help make our patients hospital experience as ‘non-painful’ as possible. Feel free to contact us through the Acute Pain Service pager, or page the nurse practitioner, attending, or Dr Brian Durkin for any questions or concerns.
