Pain management concept: the “Pain Team”

The Center for Anesthesiology and Perioperative Medicine provides the full cycle of pain management: from pre-operative preparation to long-term rehabilitation. Who is responsible for making procedures at the clinic painless? Pain management cannot be the same for an adult, a child, a pregnant woman, an older person aged 65+, a person with impaired kidney/liver function or a person with severe dental anxiety. That is why every surgical patient at our clinic is managed by a GP/internist (and a child with indications for surgery by a pediatrician) together with the following specialists.

Perioperative medicine group

1. Pediatric anesthesiologist (key role)

Role: the chief architect of the child’s comfort. Functions:

• Premedication — choosing an individual sedation regimen to reduce anxiety before the procedure
• Intraoperative monitoring — keeping vital functions stable during medication-induced sleep
• Managing emergence from anesthesia — minimizing the risk of agitation in children after they wake up
• Alternating regimens — drawing up a home schedule for taking paracetamol and ibuprofen

2. Adult anesthesiologist

Functions:

• Implementing multimodal protocols (NSAIDs + dexamethasone + blocks)
• Working with risk groups (older patients, patients with comorbidities)
• Managing “breakthrough” pain in the early postoperative period

Clinical support group

3. Pediatrician / internist

Functions:

• Assessing general health before treatment
• Monitoring side effects of analgesics (GI tract, kidneys)
• Adjusting doses for weight and age

4. Specialists (dentist, ENT, maxillofacial surgeon)

Functions:

• Timely initiation of the “Pain Council” protocol
• Technically flawless procedures to reduce tissue trauma
• Feedback to the anesthesiologist on the specifics of the procedure

5. Psychologist / play therapist (for children)

Functions:

• Developing non-pharmacological support: distraction, VR technology, breathing techniques
• Working with dental anxiety and fear of surgery (when clinically indicated)
• Teaching parents how to behave in stressful situations (when clinically indicated)

Administrative unit

6. Case manager (administrator)

Functions:

• Collecting pain scale data before and after treatment (a postoperative round of all patients in addition to the medical staff)
• Making sure follow-up visits are booked to assess the effectiveness of analgesia
• A link between the patient’s family, the “Pain Team” and the clinic’s management for feedback and corrective action

7. Chief medical officer

Functions:

• Developing and updating local pain relief protocols as part of a working group
• Monitoring quality indicators
• Coordinating work between surgeons, pediatricians and anesthesiologists

Responsibility matrix in pediatric practice