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Regional anesthesia and analgesia in perioperative pain treatment in Croatia

Taking acute pain management into focus is essential because an acute pain level lowers patients' quality of life and is a predictor for the development of chronic postoperative pain. Regional anesthesia in the treatment of perioperative pain proved more acceptable than other methods but it also requires greater expertise, focused continuing education, and higher hospital cost for the training of staff in this technique. It is important to compare its use with foreign hospitals in which the proportion of regional anesthesia ismuch higher than other techniques, implying that a one-time cost of higher education for professionals in this field is generating long-term benefits for both the hospital budget and the central figure of the health system – the patient. After processing statistical data, we can conclude that, with regard to the percentage of using regional anesthesia in Croatia, there is still room for considerable improvement. It is important to emphasize thatthe use of regional anesthesia according to guidelines does not only result in somewhat reduced incidence of morbidity and mortality in patients and decreases postoperative pain, but it also generates lower cost in the long run. Specifically, regional anesthesia requires special skills and expertise of anesthesiologists, and thus continuous education for specialists. By investment in professional staff, i.e. subspecialists for regional anesthesia that work according to guidelines and with appropriate equipment and facilities, hospitals can benefit in various ways: reduce postoperative complications, increase patient satisfaction, reduce the length of hospital stay and thereby save space and resources leading to a better organization within the department since the speed of performing processes is not a less important factor than the quality of their execution. The ultimate goal is to achieve maximum satisfaction and patient safety – a patient satisfied with the service provided. In order to optimize business processes in hospital and increase the quality, continuous postoperative pain intensity scoring is recommended, which ultimately leads to reduced analgesic requirements in postoperative management, improved recovery and patient satisfaction. Regional anesthesia, conducted according to guidelines with reduced analgesic consumption necessarily leads to a better financial situation in terms of control of hospital budgets, which leaves room for reallocation of funds. Furthermore, the goal is to reduce the incidence of perioperative adverse events and incidents, as a principle of perioperative treatment of acute and chronic pain quality. Regional anesthesia performed according to guidelines, permanent training of physicians in the acquisition of skills, use of ultrasonic devices for the detection of nerve structures, with rationalization of anesthetics consumption and reduction in the number of failed procedures, will lead to quality improvements in treatment of perioperative and chronic pain, and to satisfaction and patient safety. The aim of the initiative is to reduce perioperative and posttraumatic acute pain as much as possible with minimal side effects during the whole treatment chain in the course of hospital stay with the method of regional anesthesia. To achieve this, a comprehensive Integrated Quality Management concept has been established with undergraduate and postgraduate course and workshops related to improvement of Structure quality by formulating standards for interdisciplinary communication, development of tools for pain therapy, and by education program of School of Medicine, University of Zagreb, University of Osijek and Croatian Society of Regional Anesthesia and Analgesia, Croatian Medical Association.

Regional anesthesia; Analgesia; Perioperative treatment

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