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POSTOPERATIVE ACUTE PAIN UNIT (PAPA)
2004: Creation of the PAPA, and generation of healthcare treatment and nursing care protocols
The PAPA was formally created in our Centre in 2004, although we had already been treating acute pain for many years, particularly postoperative pain, intensely and effectively. Excellent proof of the interest generated by postoperative pain is the publication, in 1992, of the book titled "Dolor Postoperatorio: Estudio, Valoración y Tratamiento" [Postoperative Pain: Study, Assessment and Treatment] by Dr Alejandro Miranda, current Head of Healthcare of the Department of Anaesthesiology, Resuscitation and Pain Treatment of the Hospital Universitario Quirón Dexeus.
However, the definitive healthcare treatment and nursing protocols were produced definitively in 20104. Post-operative pain is treated both in the Resuscitation Unit and in the ordinary hospitalisation wards, and provides for the administration of analgesics (intravenous NSAIDs and/or opiates) and/or regional blocks with local epidural, plexus or peripheral anaesthetic.
Change in therapy: epidural block to regional plexus blocks and peripheral nerve blocks
Regional plexus blocks (interscalene, infraclavicular, axillary) and peripheral nerve blocks (femoral, sciatic) have taken on increasingly greater prominence in the treatment of postoperative pain, particularly after traumatological and/or orthopaedic surgery, to the detriment of epidural block.
The main reasons for this therapeutic switch are:
- Absence of haemodynamic repercussion
- More favourable risk-benefit ratio
- Applicability irrespective of heparin prophylaxis in many cases
- Absence of significant motor block
- Minimum monitoring requirements
- Easier control for nursing staff
Dr. Alejandro Miranda Postoperative pain. Assessment and treatment study