The Acute Pain Service

Except in extraordinary cases, some level of pain often follows orthopedic surgery. Because of the severity of orthopedic postoperative pain, surgeons at HSS often consult the Acute Pain Service (APS) to assist with pain management. The APS consists of a specialized team of clinicians including an anesthesiologist, a nurse with special training in pain management, a pharmacist and a physical therapist. Chronic pain management physicians may be consulted as well, should the need arise.

The APS at HSS often employs a multi-modal regimen to control postoperative pain. This means that several different types of "pain killers" are used to help reduce pain by different mechanisms. This helps to limit the side effects of high doses of one or another "pain killer". Local anesthetics, narcotics, anti-inflammatory drugs, and ice therapy, are among the modes of pain killers currently employed at HSS.

The older, conventional way to treat pain was the use of injections of potent narcotics such as morphine. Patients would experience pain and call for a nurse. When the nurse arrived, he or she would prepare an injection. Upon receiving the injection, the patient would shortly gain some relief, but might also experience side effects such as nausea, drowsiness, confusion, and depressed breathing. If pain relief was not complete, no further therapy could be given due to fear of side effects. At HSS, this method has been largely abandoned.

A newer technique commonly employed at HSS is known as PCA or patient-controlled analgesia. Patients have the ability to give themselves small doses of pain killers on a frequent, as-needed basis. The APS will set limits and controls to help avoid side effects. Extra doses can be given to control pain during peaks of discomfort which may occur during physical therapy. This method of pain management has been associated with higher levels of patient satisfaction, better pain control, and fewer side effects.

After several days under the care of the APS, patients are transitioned to oral pain killers in anticipation of discharge. An anesthesiologist and a nurse on the APS visit every patient on the service once or twice per day. If questions, concerns, or problems arise, a physician on the team is "in-house" 24-7.

The Acute Pain Service at HSS is committed to reducing postoperative pain, and assisting with the early phases of rehabilitation from orthopedic surgery.