Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach

Abstract

Background:

There has been considerable investment in efforts to improve postoperative pain management, including the introduction of acute pain teams. There have also been a number of guidelines published on postoperative pain management and there is widespread agreement on how pain should be practically managed. Despite these advances, there is no apparent improvement in the number of patients experiencing moderately severe or extreme pain after surgery. This highlights significant scope for improvement in acute postoperative pain management.

Scope:

In January 2009, a multidisciplinary UK expert panel met to define and agree a practical framework to encourage implementation of the numerous guidelines and fundamentals of pain management at a local level. The panel recognised that to do this, there was a need to organise the information and guidelines into a simplified, accessible and easy-to-implement system based on their practical clinical experience.

Given the volume of literature in this area, the Chair recommended that key international guidelines from professional bodies should be distributed and then reviewed during the meeting to form the basis of the framework. Consensus was reached by unanimous agreement of all ten participants.

Findings:

This report provides a framework for the key themes, including consensus recommendations based upon practical experience agreed during the meeting, with the aim of consolidating the key guidelines to provide a fundamental framework which is simple to teach and implement in all areas. Key priorities that emerged were: Responsibility, Anticipation, Discussion, Assessment and Response. This formed the basis of RADAR, a novel framework to help pain specialists educate the wider care team on understanding and prioritising the management of acute pain.

Conclusion:

Acute postoperative pain can be more effectively managed if it is prioritised and anticipated by a well-informed care team who are educated with regard to appropriate analgesic options and understand what the long-term benefits of pain relief are. The principles of RADAR provide structure to help with training and implementation of good practice, to achieve effective postoperative pain management.

Key words: :

• Acute pain
• Anaesthesia
• Pain management
• Postoperative

Transparency

Declaration of funding

Bristol-Myers Squibb Pharmaceuticals supported the publication of this article.

Declaration of financial/other relationships

All members of the consensus panel have disclosed that they received fees for speaking and consultancy from Bristol-Myers Squibb. In addition, A.V. has disclosed that he has received fees for speaking and consultancy from Janssen-Cilag, Napp Pharmaceuticals and Pfizer Ltd. R.H. has disclosed that he has received fees for speaking and consultancy from Grunenthal Ltd, Janssen-Cilag, Napp Pharmaceuticals and Pfizer Ltd. R.M. has disclosed that he has received fees for speaking and consultancy from Grunenthal Ltd, Janssen-Cilag, Javelin Pharmaceuticals, Inc, Napp Pharmaceuticals and Pfizer Ltd. I.P. has disclosed that he has received fees for speaking and consultancy from Janssen-Cilag, Napp Pharmaceuticals, Pfizer Ltd, Sanofi Pasteur, Schering Plough and Merck Sharp & Dohme Limited. The remaining authors have disclosed that they have no additional relevant financial relationships.

Some peer reviewers receive honoraria from CMRO for their review work. Peer reviewers 1 and 2 have both disclosed that they have no relevant financial relationships.

Acknowledgements

The authors thank Sharmilla Blows of Medicom Group for providing medical writing support, which has been funded by Bristol-Myers Squibb. The perioperative plan was adapted from the preoperative assessment form developed by the Acute Pain Nursing Team (CN Martin Howarth) with contributions from the other members and the preoperative nursing team at Salford Royal NHS Foundation Trust.

The opinions expressed in this article are the independent consensus views of the authors, and have not been influenced by third-party sponsorship.

The material in this paper was discussed at an expert panel meeting held in London on 22 January 2009. The authors’ attendance at the meeting and the medical writing support provided by Medicom Group were funded by Bristol-Myers Squibb.