Acute pain service: an Egyptian model

It is becoming increasingly clear that the solution to the problem of postoperative pain management lies not so much in the development of new techniques as in the development of an organization to manipulate existing expertise based on team approach. Such acute pain service is part of a strategy to decrease perioperative morbidity and reduce healthcare costs. The American model of acute pain service is anaesthesiologist based in order to provide highquality analgesia through expensive high-tech pain management. In contrast, the European model encourages a cheaper nurse-based anaesthesiologist-supervised approach. For over a decade I have been under the strong belief that efforts are needed in Egypt to design an appropriate service for acute pain for postoperative surgical patients on the basis of sound scientific foundation. The present review suggests an organizationmodel that addresses the difficult equation in Egypt, being a developing or rather a poor country with limited financial resources, lacking a wide base of algologists and high-tech nursing staff and having hospitals that are mostly multispeciality in nature. Such an Egyptian organization model for acute pain service may open the door to other African and Mediterranean pain authorities, with similar difficult equations, to introduce their own organizational models. Guided by the International Association for the Study of Pain, the interaction of these models might push to light a Third World Acute Pain Service model side-by-side with the now-available American and European models.