A multidisciplinary team approach for improving the Acute Pain Services in Orthopaedic Trauma in a level I trauma centre of India: A Quality Improvement Project

Acute postoperative pain management in orthopaedic trauma patients is paramount for ensuring optimal recovery and patient comfort. Employing a multimodal approach, is essential to address the multifaceted nature of postoperative pain. Opioid analgesics remain the cornerstone in pain management; however, their use should be judicious due to the associated risks of tolerance and dependence, and untoward  systemic effects like respiratory depression, nausea and vomiting and urinary retention. Non-opioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and neuropathic pain medications can complement opioids while reducing their overall dosage. Regional anesthesia techniques, such as epidural analgesia or peripheral nerve blocks, offer effective pain relief while minimizing systemic opioid exposure. Individualized treatment plans, tailored to patients’ specific needs and risk profiles, are essential for optimizing postoperative pain management outcomes in orthopaedic trauma settings.

Despite substantial advancement in availability of drugs and regional techniques, pain relief continues to be suboptimal across all types of postoperative patients. As a solution, evidence based acute pain services (APS) was introduced to manage postoperative pain. It is a dedicated round the clock team of health care personnel that assesses, monitors and treats pain and the side effects of analgesic techniques/medications (3). APS has been started and managed by the Department of Anesthesia of our trauma centre since 2012. However, it is not clear as to what extent the patients felt benefitted. The APS was a well-structured system with routine training and education of staff on pain management, extensive and meticulous pain rounds and prompt referrals to APS team in case of any perioperative pain. During the Covid-19 pandemic, there was a sudden disruption in the efficient management of APS. Post Covid-19, when the Trauma centre started functioning to its full capacity, it was noted that there was a significant drop in the performance of APS. Suboptimal competence indicates the need of re-training health personnel and incorporating strategies to improve the quality of care. Hence, we decided to conduct this Quality Improvement Project involving nursing staff, orthopaedicians, anesthesiologists  team and operation theatre (OT) T technologists  for capacity building of the APS and to evaluate its effectiveness and sustainability in a high-volume level I trauma centre of India.