Background and Aims Pain remains a major complaint in the immediate post-operative phase. Despite enhanced recovery protocols (ERP) and procedure specific pain therapy up to 80% of patients experience significant uncontrolled pain. Aim of this quality control pain audit was assessing pain intensity in institutional developed multimodal perioperative care pathways. Analyses of efficacy locoregional analgesia, management and protocol adherence. Determine possible improvements of guidelines and procedures

Methods Prospective data were collected on 118 patients undergoing six types of surgery. Pain scores were evaluated on postoperative care unit (PACU) and first five days following surgery. Primary outcome was worst recorded pain score. Secondary outcomes included median pain on ward, incidence of postoperative nausea and vomiting, time to first mobilization. Following procedures were included: minimal invasive cardiac surgery, video assisted thoracic surgery, esophageal resection, total knee arthroplasty, laparoscopic colorectal surgery and robotic prostatectomy.

Results Numeric Rating Scale higher then three was observed in 89% of study population. At PACU esophageal resection showed worst pain scores despite neuraxial analgesia (Median: 7, IQR 5-8). Total knee arthoplasty resulted in worst pain scores on ward following surgery (median: 7, IQR 5-8). Disappointingly only 25% of patients received pain medication following institutional ERP guidelines. Current ERP-guideline are similar to ERAS guidelines found in literature.

Conclusions Multimodal pain therapy should become standard of care. Constant evaluation of pain guidelines are necessary. Audits and evaluation of protocol adherence next to clear guidelines and managing patient information, expectations are pivotal.