Our inpatient service covers the whole of the North Shore Campus. A ward round is carried out daily (Monday –Sunday) from 08.30-13.00 daily. There is always a specialist anaesthetist, specialist pain nurse and on most days a pharmacist. The round focuses on acute postoperative pain management issues as well as taking consults for difficult to manage ongoing pain issues. The inpatient service also takes referalls from the emergency department and reviews those patients in the ICU/HDU areas. Patients are often re-reviewed in the afternoon. The inpatient team frequently discusses difficult to manage patients with their outpatient colleagues and there is overlap of responsibilities.

After 17.30 weekdays and after 15.30 on Saturday and Sunday, pain issues are dealt with by the on call anaesthetic registrar. These clinicians are often undertaking other duties and may not respond immediately. If there are urgent matters to deal with, for inpatient management, nurses should then discuss with the ‘home team’ house officer. In extreme emergencies, the on call anaesthetic consultant can be contacted if there is no reply from the registrar. The number will be with switchboard. 

Inpatient modalities;
Patient controlled analgesia (PCA)
Epidural analgesia (Patient controlled epidural analgesia-PCEA)
Peripheral nerve catheters
Intrathecal opioids

Patients on long term opioids/methadone maintenance treatment
Patients with active or previous pain clinic exposure
Acute neuropathic pain (eg post herpetic neuralgia/ acute prolapsed disc)
Pregnant patient with non-obstetric pain