Evolving Strategies of Acute Post-operative Pain Management Service across Three Time Periods – A Single-centre Retrospective Analysis

Background and Aims: Pain alleviation is essential to enhanced recovery after surgery. In India, the acute pain service (APS) is still not well organised, and there is a wide variation in practices. In this retrospective cohort study, we have aimed to analyse how introducing a structured APS and its subsequent evolution with time has affected the pain scores of our post-operative patients undergoing major abdominal oncosurgeries. Methods: All adult patients who underwent elective major open abdominal oncosurgeries in our institution during the three time periods based on different levels of APS development: Timeline-1 (April 2021–September 2021), Timeline-2 (April 2022–September 2022) and Timeline-3 (January 2023–June 2023) were included, and data on post-operative dynamic pain scores were collected. The pain service delivery was reorganised, and from January 2021 onwards, there was an evolution from once-daily pain rounds to twice-daily pain rounds, facilitated by including a designated pain nurse and further refinement to include pre-operative patient education and staff training. The data were collected and analysed for change in various outcomes related to APS and its outcomes. Results: A total of 936 patients were included in the study. A statistically significant decline in dynamic pain scores was observed over time. Subgroup analysis conducted according to the extent of surgical incision revealed significant declines in dynamic pain scores over time. Conclusion: The study underscores the significance of a structured APS in optimising post-operative outcomes and highlights the need for continued efforts to enhance acute surgical pain management practices in healthcare settings.