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publications have reported that the presence of an APS reduced pain scores (Gould et al, 1992
Level III‐3; Harmer & Davies, 1998 Level III‐3; Miaskowski et al, 1999 Level IV; Sartain & Barry, 1999
Level III‐3; Salomaki et al, 2000 Level III‐3; Bardiau et al, 2003 Level III‐3; Stadler et al, 2004 Level III‐3)
and side effects (Schug & Torrie, 1993 Level IV; Stacey et al, 1997 Level III‐3; Miaskowski et al, 1999
Level IV; Sartain & Barry, 1999 Level III‐3).
A review of publications (primarily audits) looking at the effectiveness of APSs (77% were
physician‐based, 23% nurse‐based) concluded that the implementation of an APS is associated
with a significant improvement in postoperative pain and a possible reduction in PONV, but
that it was not possible to determine which model was superior (Werner et al, 2002 Level IV).
The authors comment, however, that it is not possible to assess the contribution of factors
such as an increased awareness of the importance of postoperative analgesia, the use of more
effective analgesic regimens (eg epidural analgesia), the effects of APS visits and better
strategies for antiemetic therapy.
Possible benefits of an APS are summarised in Table 3.1.
Although systematic reviews have been attempted (McDonnell et al, 2003; NICS, 2002), the poor
quality of the studies looking at the effectiveness or otherwise of APSs, and the many different
types of APSs, means that a proper meta‐analysis cannot be performed.
In addition, the above studies looked at outcome in terms of immediate pain and side effects
in postoperative patients only. It is possible that an APS may benefit patients in other ways. CHAPTER 3
Combination of an APS with a physician‐based critical care outreach team, which
systematically reviewed high‐risk postoperative patients for 3 days after their return to a
general ward, showed a significant improvement in postoperative outcome; the incidence of
serious adverse events decreased from 23 events per 100 patients to 16 events per 100
patients, and the 30‐day mortality fell from 9% to 3 % (Story et al, 2006 Level III‐2). Finally,
members of an APS may also be more likely to recognise the early onset of neuropathic pain
associated with surgery, trauma or medical disease, and institute the appropriate treatment
(Counsell et al, 2008).
Table 3.1 Possible benefits of an Acute Pain Service
Benefit References

Better pain relief Gould et al, 1992; Harmer & Davies, 1998; Miaskowski et al,
1999; Sartain & Barry, 1999; Salomaki et al, 2000; Werner et
al, 2002; Bardiau et al, 2003; Stadler et al, 2004
Lower incidence of side effects Schug & Torrie, 1993; Stacey et al, 1997; Miaskowski et al,
1999; Sartain & Barry, 1999; Werner et al, 2002
Lower postoperative morbidity/ mortality Story et al, 2006

Management of analgesic techniques that Obata et al, 1999; Senturk et al, 2002; Gehling & Tryba, 2003
may reduce the incidence of persistent
pain after surgery

Acute pain management: scientific evidence 49