Evaluation of the activity of a postoperative analgesia department in a Canadian hospital

To describe the setting up and the activity of an acute pain service (APS). Retrospective descriptive study including two surveys among the nursing staff, the first one eight months after the setting up of the APS and the second one ten months later. In the first 19 months, 3,404 patients were treated in the APS: 1,456 with patient-controlled analgesia (PCA), 1,299 with epidural analgesia, 589 with spinal opioids and 60 with continuous nerve blocks. The resulting overall incidence of respiratory depression was 0.7%. It ranged from 0% with continuous nerve block to 1.2% with PCA. It was at 0.3% with epidural analgesia and 0.5% with spinal opioids. Both surveys confirmed that nurses had a positive attitude toward the APS, mainly because they believed it offered patients significant advantages. Many of them thought that epidural analgesia and PCA were likely to impede patient's ambulation and most of them agreed that these techniques increased their work load. Although the incidence of respiratory depression was low among the APS patients, it can probably still be decreased by a more refined patient selection. Setting up an APS is viewed positively by the nursing staff in spite of some perceived disadvantages.