Powell A E, Davies H T O, Bannister J, Macrae W A
Centre for Public Policy and Management, University of St Andrews, St Andrews KY16 9AL, UK.
Br J Anaesth. 2004 May;92(5):689-93. doi: 10.1093/bja/aeh130. Epub 2004 Mar 19.
The study aimed to explore the extent to which NHS acute pain services (APSs) have been established in accordance with national guidance, and to assess the degree to which clinicians in acute pain management believe that these services are fulfilling their role.
A postal questionnaire survey addressed to the head of the acute pain service was sent to 403 National Health Service hospitals each carrying out more than 1000 operative procedures a year.
Completed questionnaires were received from 81% (325) of the hospitals, of which 83% (270) had an established acute pain service. Most of these (86%) described their service as Monday-Friday with a reduced service at other times; only 5% described their service as covering 24 hours, 7 days a week. In the majority of hospitals (68%), the on-call anaesthetist was the sole provider of out of hours services. Services were categorized by respondents as thriving (30%), struggling to manage (52%) or non-existent (17%). There was widespread agreement (> or =85%) on the principles that should underpin acute pain services, and similar agreement on the need for better organizational approaches (95%) rather than new treatments and delivery techniques (19%).
More than a decade since the 1990 report Pain after Surgery, national coverage of comprehensive acute pain services is still far from being achieved. Despite wide consensus about the problems, concrete solutions are proving hard to implement. There is strong support for a two-fold response: securing greater political commitment to pain services and using organizational approaches to address current deficits.
本研究旨在探讨国民保健制度（NHS）的急性疼痛服务（APSs）在多大程度上符合国家指南的要求，并评估急性疼痛管理方面的临床医生认为这些服务履行其职责的程度。
向每年实施超过1000例手术的403家国民保健制度医院发送了一份邮寄问卷调查表，收件人为急性疼痛服务负责人。
81%（325家）的医院回复了完整问卷，其中83%（270家）已建立急性疼痛服务。其中大多数（86%）称其服务时间为周一至周五，其他时间服务减少；只有5%称其服务为每周7天、每天24小时提供。在大多数医院（68%），值班麻醉师是非工作时间服务的唯一提供者。受访者将服务分为蓬勃发展（30%）、管理困难（52%）或不存在（17%）三类。对于支撑急性疼痛服务的原则存在广泛共识（≥85%），对于需要更好的组织方法（95%）而非新的治疗和提供技术（19%）也有类似的共识。
自1990年《手术后疼痛》报告发布十多年来，全面急性疼痛服务的全国覆盖仍远未实现。尽管对问题有广泛共识，但具体解决方案却难以实施。对于以下双重应对措施有强烈支持：确保政界对疼痛服务给予更大承诺，并采用组织方法解决当前的不足。
