Anaesthesiological Involvement in Postoperative Pain Treatment

Study Overview
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Brief Summary
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This study aims to investigate the current organization and management of postoperative pain in Denmark, especially for invasive pain treatment modalities (epidural infusions, PCA and regional blocks), in a national survey covering the activities in Danish Hospitals. This study is an electronic questionnaire survey, that aim to describe and map the foundation for future developments within, and improvement of, postoperative pain management.

Detailed Description
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Postoperative pain is one of the major challenges in postoperative care and several studies continue to demonstrate that postoperative pain is generally undertreated. A key focus for postoperative pain is to identify gold standards within procedure-specific pain treatment. However, results from single randomized trials do not per se lead to better treatment, as this requires both efforts within implementation of best evidence, quality control of efficacy, including efficacy on the individual level, and education of staff and physicians. It has been suggested, that a way forward must include changes at the organizational level. For basic postoperative pain treatment, the major responsibility for planning and execution often rests on the surgical departments. For invasive pain treatment methods, e.g. epidural analgesia with continual infusion, patient controlled epidural analgesia (PCEA), patient controlled analgesia (PCA), and regional blocks, both single and continuing, this treatment is instituted at the departments of anaesthesia, but the responsibility for follow up is rarely described. Generally, epidural analgesia is widely recommended because of superior benefits in reducing postoperative pain, pulmonal complications and surgical stress, as compared to systemic opioid treatment. However, epidural analgesia is not without complications especially not for abdominal and thoracic surgery. The accompanying unwanted motor blockade may delay recovery and recent studies question this treatment. Likewise, up to 20 % percent of patients will not receive adequate analgesia for the first 48 hours postoperative with this method. Finally, it is possible, that adverse effects and complications from epidural treatment are currently being underestimated, due to lack of routine monitoring and missing protocols. Besides epidural analgesia, the use of Patient controlled analgesia (PCA), Patient controlled epidural analgesia (PCEA) and regional blocks have gained ground the last decades. With these techniques it might be possible to reduce overall opioid requirements. Nevertheless, a daily evaluation of benefits and harms of such analgesic techniques may be required to justify these treatment modalities. It is suggested, that regularly monitoring of invasive analgesic methods is of great concern when it comes to optimal postoperative pain management and reduction of adverse effects. A structured organizational approach has the potential to improve benefit and harm of postoperative pain management. A number of studies argues that in order to obtain optimal postoperative pain treatment there need to be regular monitoring, and optimization of the analgesic regimens and techniques, preferably in a clinical setting with either an Acute Pain Service (APS) or a similar setup. With the decline of the use of APS's in Denmark it seems that the organization and management around postoperative pain treatment in general, and for invasive pain treatment methods in particular, needs to be investigated. As of today, it is not known how patients with such pain treatment are monitored and taken care of after leaving the post anaesthesia care unit, and where the responsibility for this pain treatment lies

Official Title
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Anaesthesiological Involvement in Postoperative Pain Treatment - A Questionnaire Survey at Danish Hospitals

Conditions
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Pain, Postoperative, Anesthesia, Epidural Analgesia, Acute Pain

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All departments of anesthesia with a PACU in Denmark Exclusion Criteria: PACUs as part of day case surgery will be excluded
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Head of Post Anaesthesia Care Unit<br>The chief physician of PACUs at all Danish Anaesthesia departments will receive electronic survey on postoperative pain treatment | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of hospitals, with a department of anesthesia, providing postoperative monitoring of epidural analgesia on postoperative day (POD) one. | The respondent will answer the question: What invasive pain treatments are routinely inspected by the department of anesthesia and choose from a list of options: No, Yes 1. POD, Yes 2. POD, Yes 3. POD or other: the respondent will specify. | From april 15th to may 1st 2018. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Size of hospital (number of beds) | Number of beds | From april 15th to may 1st 2018. | 
| Number of Post Anesthesia Care Units (PACU) | Number of PACU's | From april 15th to may 1st 2018. | 
| Size of PACU (number of beds) | Number of beds | From april 15th to may 1st 2018. | 
| Availability of a well defined acute pain unit with connected personnel | The respondent will choose yes, no or don't know | From april 15th to may 1st 2018. | 
| Availability of a chronical pain unit/pain clinic | The respondent will choose yes, no or don't know | From april 15th to may 1st 2018. | 
| Availability of a specialized pain unit for children | The respondent will choose yes, no or don't know | From april 15th to may 1st 2018. | 
| Involvement of the department of anesthesia in inspection of patients with postoperative pain | The respondent will choose from a list of options: On request from the ward, Agreements on certain types of patients, As a part of the work of the Acute Pain Service, As part of the work of the chronical pain team, We don't make inspections or Other: the respondent will specify. | From april 15th to may 1st 2018. | 
| Availability of a general protocol for postoperative pain in the PACU? | The respondent will choose yes, no or don't know | From april 15th to may 1st 2018. | 
| Availability of a procedure specific protocol for postoperative pain | The respondent will choose yes, no or don't know | From april 15th to may 1st 2018. | 
| Elaboration on the availability of a procedure specific protocol for postoperative pain between specialties | The respondent will choose yes, no, not relevant for my department or don't know for each specialty | From april 15th to may 1st 2018. | 
| Availability of protocols for perioperative management for patients with complicated pain issues and/or high opioid consumption | The respondent will choose yes, no or don't know | From april 15th to may 1st 2018. | 
| Follow-up for patients with complicated pain issues after discharge from the hospital | The respondent will choose from a list of options: Yes at the surgical department, Yes at the multidisciplinary pain team/ chronical pain unit, Yes at the local physician, No follow-up, Don't know or Other: the respondent will specify. | From april 15th to may 1st 2018. | 
| Type of invasive pain treatment offered | The respondent will choose from a list of options: Epidural Pain Catheter, PCEA, PCA, Regional Block (single shot), Regional Block (continual infusion), Regional Block (patient controlled bolus), Other: the respondent will specify og No, none of the above | From april 15th to may 1st 2018. | 
| Daily responsibility for follow-up/control of invasive pain treatment when the patients leave the PACU | The respondent will choose from a list of options: Department of anesthesia, The ward, Don't know or Other: the respondent will specify | From april 15th to may 1st 2018. | 
| Routinely inspection by the department of anesthesia of the invasive pain treatment | The respondent will choose from a list of options:No, Yes 1. POD, Yes 2. POD, Yes 3. POD or other: the respondent will specify for each invasive pain treatment offered at the hospital. | From april 15th to may 1st 2018. | 
| Routinely inspection by the department of anesthesia of the invasive pain treatment with regards to involved personnel | The respondent will choose from a list of options: Physician, Nurse, Acute pain team, Chronical pain unit or Other: the respondent will specify. | From april 15th to may 1st 2018. | 
| Decisions on removal and duration of treatment with an epidural catheter | The respondent will choose from a list of options: Department of anesthesia, The ward, Don't know or Other: the respondent will specify. | From april 15th to may 1st 2018. | 
| Involvement of the department of anesthesia in extension of the invasive pain treatment | The respondent will choose from a list of options: Yes, every time, Yes often, Yes rarely, No never or Don't know | From april 15th to may 1st 2018. | 
| Participation of the department of anesthesia in other activities regarding postoperative pain treatment | The respondent will choose from a list of options: Education in pain treatment, Departmental quality assesment including guidelines and audits), Implementation, Research or Other: the respondent will specify. | From april 15th to may 1st 2018. |