BACKGROUND AND RATIONALE 

Postoperative pain control is crucial for patients to return to normal function and minimize the negative effects of acute postsurgical pain. Traditionally, opioid analgesic therapy has been the primary treatment, but the rise in opioid misuse has necessitated more research into multimodal pain treatment strategies. In tertiary care hospitals, where surgery complexity and patient volume are high, the demand for efficient pain management strategies becomes even more pronounced. Acute Pain Services (APS) are a structured, multidisciplinary approach developed to address postoperative pain challenges. These services involve a team of healthcare professionals, including anesthesiologists, pain specialists, nurses, and physiotherapists, who collaborate to create and implement individualized pain management plans. The primary goal is to enhance pain control, reduce reliance on opioids, and minimize side effects associated with conventional pain relief methods. Multimodal analgesia has been shown to limit opioid consumption and provide more effective pain control than opioids alone. Hospitals are introducing APS to increase awareness of the importance of perioperative opioid-sparing analgesia and create surgery-specific analgesic protocols. APS employs multimodal analgesia, an evidence-based strategy that combines different classes of analgesic agents and techniques to provide synergistic pain relief. Techniques such as regional anesthesia, patient-controlled analgesia (PCA), and continuous peripheral nerve blocks are commonly used by APS to optimize pain management. Despite the proven benefits of APS, the implementation and impact vary widely among healthcare institutions. Factors such as resource availability, staff training, and institutional protocols influence the effectiveness of these services. Studies have shown that hospitals with well-established APS report better patient outcomes, including reduced postoperative pain scores, quicker mobilization, decreased length of hospital stay, and improved overall patient satisfaction. Sharma et al (2020) conducted a study on acute postoperative pain experiences, its interference with daily activities, emotions, sleep, and intra-operative pain response (IPR), and satisfaction with pain management among elective surgery patients. The results showed a high incidence of acute pain (82.5%), with significant interference with ADLs, sleep, and emotions. Most patients reported pain being assessed once or twice in each shift. Despite poor pain control, a majority of patients were satisfied with overall pain treatment (69%). Cruz et al (2021) conducted a prospective cross-sectional study on 2508 patients who underwent gynaecological and obstetrical surgery between January 2011 and February 2016. The study found that interventions with the highest reported pain scores were laparoscopic removal of ovarian cysts and caesarean section. Factors associated with higher pain intensity included younger age, chronic pain, and surgery performed outside the regular day shift. Shorter duration of surgery, peridural or local analgesic, and preoperative sedation reduced postoperative pain. Sundaram Venkatesan G et al (2022) conducted a prospective observational study in a tertiary care center in Coimbatore, India, to assess the efficacy of an ongoing pain management system. The results suggested the need for a policy change for quality improvement. Banerjee et al (2023) aimed to evaluate the intensity and severity of postoperative pain in patients undergoing orthopaedic, gastrointestinal, general surgery, obstetrics, and gynaecological surgeries in New Delhi, India. The study found that 48.7% of patients had moderate-to-severe pain on the first day after surgery, with pain severity being associated with poor recovery and patient satisfaction. Yoon et al (2024) developed a smartphone application for postoperative pain management and conducted a feasibility study. The SmartAPS application offered tools for postoperative pain assessment and educational materials for pain management. The TASMAN Collaborative (2024) study compared the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity and re-presentation to healthcare providers owing to side-effects of medication. Opioid-free discharge analgesia should be adopted routinely to improve postoperative pain management in China.

Aims and Objectives

AIM:

·        To evaluate the impact of Acute Pain Services (APS) on postoperative outcomes (VAS scale at post op days 1,3 and 7) in patients at a tertiary care hospital

Objectives:

Primary Objective:

·        To assess the impact of APS on post op pain in post surgical patients using VAS scale at 1,3 and 7 days

Secondary Objectives:

·        To assess impact of APS on patient’s satisfaction on post op Day 1,3 and at the time of discharge using Likert scale

·        To assess impact of APS on evaluation recovery time

To assess impact of APS on post operative complications

MATERIAL AND METHODS

Study setting:

The study will be conducted in Department of Anaesthesiology, King George’s Medical University, Lucknow after written informed consent will be obtained from either of the patients/Guardian.  All patients undergoing major surgeries who consented to participate.

Study duration:

18 months

Study design:

Prospective Observational study

Sample size: For paired comparisons (e.g., VAS scores on postoperative days 1, 3, and 7 for the same patient), the following formula can be used:

n=43.56=44

The study uses a conservative sample size of 100 cases to ensure robustness, account for potential dropouts, and increase reliability, ensuring sufficient power and confidence in detecting meaningful changes in VAS scores postoperatively.

Inclusion Criteria:

·        Patients giving written informed consent

·        Adult patients (aged 18 years and above) undergoing elective major surgeries.

Exclusion Criteria:

·        Patients not giving informed consent

·        Patients with pre-existing chronic pain conditions, those unable to consent, and individuals with significant cognitive impairments.

Methodology:

Eligible patients will be enrolled preoperatively and followed postoperatively. The APS team provided a structured pain management protocol tailored to each patient, which included multimodal analgesia, regular pain assessments, and necessary adjustments to pain management plans.

Data Collection: Pain scores will be recorded using the VAS scale at post op 1,3 and 7 days post-surgery. Analgesic consumption, patient-reported satisfaction, and adverse effects will be  documented. Postoperative complications and recovery parameters, including time to mobilization and length of hospital stay, will be also collected.

Statistical analysis

The study used SPSS 26th for data analysis, analyzing categorical and continuous demographic variables. The study analyzed data using descriptive statistics, paired t-tests, and chi-square tests to compare pain scores and outcomes before and after APS intervention, with a p-value <0.05.

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