C.3- Acute Pain Unit (APU)

The Acute Pain Unit started operating formally in 2004, although we had been treating acute pain, particularly postoperative pain, effectively and intensively for many years before. A good example of the growing interest in postoperative pain is illustrated by the publication in 1992 of the book titled “Postoperative pain: Study, Assessment and Management” written by Dr Alejandro Miranda, presently Head of the Department of Anaesthesiology, Reanimation and Pain Medicine at Instituto Universitario Dexeus.

		However, it is not until 2004 that healthcare and nursing protocols are established. The treatment of postoperative pain is managed either at the Recovery Room or on hospitalisation wards and involves the administration of analgesics (NSAIDs and/or opioid drugs) endovenously and/or the application of regional blocks with local anaesthetics at epidural, plexus or peripheral level. Plexus regional blocks (interscalenic, infraclavicular or axillary) and peripheral nerve blocks (femoral, sciatic) have become increasingly popular in the management of postoperative pain, especially following orthopaedic and/or traumatological surgery, to the detriment of epidural block.

The main reasons for this change in therapeutic approach are owed to the fact that these blocks present:
• Absence of hemodynamic repercussion
• A more favourable risk/benefit relationship
• Applicability independent from heparin prophylaxis in many cases
• Absence of significant motor blockage
• Minimal need for monitoring
• Easier control on the part of the nursing staff

In 2005, the Acute Pain Unit specifically treated over 500 admitted patients who received one of the following therapies:
• Intravenous PCA with opioids (morphine – meperidine - tramadol)
• Epidural blocks with ropivacaine at 0.2% and fentanyl at 0.0001% or methadone
• Femoral blocks with ropivacaine at 0.2%
• Sciatic nerve blocks with ropivacaine at 0.2%
• Interscalenic blocks with ropivacaine at 0.2%
• Axillary blocs with ropivacaine at 0.2%

Any of the above therapies may be administered in combination with Nolotil (metamizole), Enantyum (dexketoprofen trometamol), Voltaren (diclofenac sodium) or Perfalgan (paracetamol), according to the healthcare protocols currently in-force at the Department).

Intravenous PCA is occasionally used as an adjuvant with regional therapies or as rescue therapy. Below, please see a sample of the prescription and control forms used at the Acute Pain Unit.

These forms are subsequently included in the medical record and the most relevant data are filed away in the Department’s archives.