Diana Butkovic1
1) Croatia
This paper shows the improvement of the postoperative care quality and patients' satisfaction in the Children's Hospital Zagreb (CHZ), Croatia through setting up of the Acute Pain Service (APS) in 2012. It is well-known that under-treatment of acute postoperative pain can lead to the chronification of pain, physiological and psychological complications and consequences.
The Clinic for Chronic Pain Treatment in Children was set up in 2002 within the CHZ, but due to the need for an organized postoperative pain treatment, the APS was formed 5 years ago. CHZ performs more than 5000 operations annually, varying from the neonatal, abdominal, urogenital, thoracic, orthopaedic, plastic, neurosurgical, ENT to ophthalmologic. The postoperative pain is of different intensity, duration and analgesia needs. Patients’ age ranges from premature new-borns to 18 year-old adolescents.
The APS organization model is the cost-effective “nurse-based anaesthesiologist-supervised” one. Nurses check the quality of postoperative analgesia on surgical wards by using the age-appropriate pain scales (FLACC, Faces, VAS, Numerical 1-10), noting the analgesic therapy side-effects and complications and informing the anaesthesiologist-member of APS team. Protocols for the postoperative pain treatment were made by following the principles of multimodal approach and pre-emptive analgesia. The US-controlled peripheral nerve blocks of upper and lower extremity and of the trunk are performed.
The number of peripheral nerve blocks increased from 2012 to 2016: ilioinguinal from 35 to 118, TAP from 24 to 83, brachial plexus blocks (interascalenus, supra and infraclavicular, axillar) from 36 to 206, femoral from 11 to 116, femoropopliteal, popliteal, saphenopopliteal from 31 to 151 annually.
Questionnaires for patient/parental satisfaction with postoperative analgesia treatment were used and the results were high: 8,7 (on the 1-10 scale). The APS’ founding is an indicator for improvement of the hospital’s standard of quality, as stated by the Croatian Ministry of Health’s Quality Assurance Committee.
