ACUTE PAIN SERVICE IN CATTINARA HOSPITAL IN TRIESTE: APPROACH AND ORGANIZATION

G. Nieddu, M. Grion, R. Dezzoni, E. Roman-Pognuz | Anestesia, rianimazione e terapia antalgica, ospedale universitario di Cattinara ASUGI, Trieste, Italy

Introduction. The Acute Pain Service (APS) is designed to monitor and manage, during the first 48–96 hours, patients undergoing surgery where moderate-to-severe postoperative pain is expected. Suboptimal analgesic control in the postoperative period negatively impacts patient outcomes, including early mobilization, length of hospital stay, side effects and complications, early adherence to rehabilitation programs. At Cattinara Hospital in Trieste, the APS has been operational for more than 20 years, providing 24/7 coverage. The service is based on institutionally validated protocols and procedures that ensure common and standardized postoperative acute pain (PAP) management strategies, while providing operational autonomy to the dedicated team, comprising 4 dedicated nurses, residents, and attending anesthesiologists. The team is capable of early and appropriate identification of complications and adverse events arising in the postoperative period in relation to pharmacological pain treatment and the devices employed, as well as identification of patients with suboptimal PAP control, through serial and regular pain assessments using validated scales, monitoring of relevant vital parameters, and evaluation of pain-related symptoms.
Materials and Methods. The operating room anesthesiologist contacts the APS to refer patients undergoing surgery where PAP is presumed to be of moderate-to-severe intensity and for whom a therapeutic strategy has been planned. Thus, the team is responsible for managing the devices placed for PAP control, such as electronic CADD pumps with a Patient-Controlled Analgesia (PCA) system or elastomeric pumps for intravenous, epidural, or perineural drug infusion. Should PAP remain inadequately controlled, the APS team adjusts dosages and device parameters following institutional protocols, supervised by the anesthesiologist and/or the Service Director. Each patient is assessed six times within the first 24 hours and three times daily on following days. The duration of follow-up is determined by the individual clinical picture, typically ranging from 2 to 4–5 days. A dedicated Postoperative Analgesia Record is completed for each patient, documenting medical history, intraoperative analgesic management, and postoperative analgesia prescription in the first section, and clinical monitoring parameters — including pain intensity, vital signs, adverse events attributable to analgesic use or locoregional anesthetic techniques, and sedation levels — as well as APS-led analgesic management in the second section.
Results. The data summarize APS activity at our institution between 2023 and 2025. In 2023, 907 out of 7029 surgical patients were enrolled (12.9%); 640 intravenous PCA devices, 79 epidural PCA devices, and 132 elastomeric pumps were placed; mean monitoring duration was 2.5 days with a mean of 8.7 assessments per patient. In 2024, 886 out of 6,769 patients were enrolled (13.09%); 739 intravenous PCA devices, 48 epidural PCA devices, and 44 elastomeric pumps were placed; mean monitoring duration was 2.4 days with a mean of 8.9 assessments per patient. In 2025, 746 out of 6969 patients were enrolled (10.70%); 669 intravenous PCA devices, 31 epidural PCA devices, and 12 elastomeric pumps were placed; mean monitoring duration was 2.4 days with a mean of 8.9 assessments per patient. These data constitute a preliminary overview of the service and will serve as the foundation for future studies on postoperative analgesic management.