The importance of the acute pain management service for regional techniques in cardiac anesthesia

This review focuses on the importance of a well integrated acute pain management service (APMS) as an infrastructural prerequisite to establish, maintain, and improve the implementation of regional techniques in cardiac anesthesia. The basic organization of the APMS is outlined; manpower, necessary technical equipment, and electronic data management are detailed. The most important part is the role of the APMS as an anchor to facilitate thorough information transfer between all the health care providers: anesthesiologists, cardiac surgeons, intensivists or nurses, and physiotherapists. The establishment of well-defined clinical pathways is necessary to avoid complications or enable the rapid recognition and treatment of complications. The APMS is a key in teaching new postoperative pain treatment modalities and allowing a smooth transition between regional techniques and oral multimodal pain strategies. Patient information sheets are presented for the principal regional techniques: spinal anesthesia, thoracic epidural anesthesia, or paravertebral blocks. In addition, multimodal pain models are presented. It is important that all health care providers are aware that complications of regional techniques in cardiac surgery can be severe; however, good organization and communication between all health care providers under the leadership of the APMS can help to prevent these complications and implement these promising techniques. Electronic data acquisition helps to maintain the quality of the care provided and can be the basis for clinical and scientific improvement.