Acute Pain Service

Acute Pain Service Groote Schuur Hospital

Our Acute Pain Service is dedicated to providing comprehensive pain management and support for patients undergoing major surgery or painful medical procedures.

At the heart of our Acute Pain Service is a commitment to holistic patient care. We recognise that pain is not just a physical experience but a complex interaction of biological, psychological, and social factors. Our approach is built on the understanding that effective pain management requires more than medication—it involves addressing the biopsychosocial aspects of each patient’s condition.

We use both pharmacological and non-pharmacological modalities to ensure a well-rounded treatment plan. While medications play a vital role in controlling acute pain, we also incorporate non-drug therapies such as cognitive-behavioural techniques, relaxation strategies, and mindfulness to address the emotional and psychological dimensions of pain. We believe in empowering patients with tools to manage pain effectively, which can improve their overall well-being and enhance their journey to recovery.

Our multidisciplinary approach is key to delivering the highest standard of care. We work closely with other specialists to ensure a comprehensive treatment plan incorporating movement, exercise, functional training, and support. Together, we focus on alleviating pain, restoring functionality, improving quality of life, and supporting psychosocial health.

Our daily pain rounds are critical to ensure that each patient receives the appropriate care and pain management tailored to their needs. We meticulously review all Patient-Controlled Analgesia (PCA)devices, wound infusion catheters, and complex cases referred to us. Our multidisciplinary team works together to address various pain management challenges, ensuring comprehensive, compassionate care.

We conduct two daily rounds, which start in our two high-care units: PAHCU (4 beds) and D14 Ortho High Care (4 beds), where we assess and manage pain for new and existing patients. These patients are seen twice daily to ensure that the pain plan produced in the morning is executed and effective later in the day.  We see, on average, 8 new patients daily from these units and follow-up patients from the previous day. We also attend to all patients receiving PCA pumps or wound infusion catheters after surgery, which adds about 3-6 new referrals daily, ensuring around 20-25 patient visits daily. Some patients are seen only for a day or two and need our input for longer.

Some of the key areas we focus on during our rounds include:

• PCA Management: We regularly review and refill PCAs for patients needing continuous pain relief, ensuring optimal dosing and adjusting treatment as necessary.
• Wound Infusion Catheters: Patients with wound infusion catheters are monitored for proper function and pain relief, with adjustments made to ensure the effective management of surgical or trauma-related pain.
• Chronic Pain Patients Preparing for Surgery: For patients with pre-existing chronic pain, we work closely with them to manage their pain effectively during surgery, taking into account their baseline pain levels, medication history, and individual needs. We aim to provide adequate pain relief during surgery while planning for appropriate post-operative care.
• Opioid-Dependent Patients: Some patients may have been heavily reliant on opioids over extended periods due to chronic conditions. In these cases, we implement strategies for opioid weaning during and after surgery, with a focus on minimizing withdrawal symptoms while ensuring sufficient pain control. We approach these situations with careful planning and close monitoring.
• Substance Use and Abuse Considerations: For patients with substance abuse issues, we take a personalized approach to pain management. Their analgesic requirements may differ from other patients due to altered pain processing or a history of opioid misuse. Our team works collaboratively to develop a pain management plan that balances adequate pain relief with minimising the risk of reliance or misuse, ensuring a safe and effective recovery.
• Our Acute Pain Service plays a vital role in the Enhanced Recovery After Surgery (ERAS) programs. We focus on optimizing pain management to support faster recovery and improve surgical outcomes. We provide tailored analgesic care based on established ERAS protocols, ensuring that pain relief is integrated seamlessly into each patient's recovery plan. Our involvement includes managing multimodal analgesia—a combination of pharmacological and non-pharmacological treatments designed to minimize opioid use and reduce side effects while maintaining effective pain control.

By addressing these complex pain management needs, we aim to provide a comprehensive and compassionate care experience that supports physical and emotional recovery. Our approach is always patient-centred, recognizing the unique challenges that each individual may face and tailoring our strategies to ensure the best possible outcomes.