Perioperative Schmerztherapie mit Nichtopioidanalgetika

Die Anaesthesiologie - Nichtopioidanalgetika werden bei vielen Patienten zur perioperativen Analgesie eingesetzt. Zu einigen praktischen Fragen beim Einsatz von Nichtopioidanalgetika liegen...     

Kritische Ereignisse in der Akutschmerztherapie – eine Risikoanalyse von CIRS-Meldungen

Die Anaesthesiologie - Tätigkeitsgebiete mit vielen Schnittstellen, wie die Akutschmerztherapie, gelten per se als Bereiche, in denen ein erhöhtes Risiko für Fehler und...     

Prozessoptimierung durch zentrale Steuerung der Akutschmerztherapie

Background

The aim of this investigation was to describe the effects of standardization and central control of the processes involved in postoperative pain management from patient and employee perspectives.

Materials and methods

Patients (n?=?282/307) and respective hospital staff (n?=?149/119) evaluated the processes, the quality of postoperative pain management and result parameters 3 months before and 12 months after the introduction of standardization of the postoperative pain therapy process using a set of standardized questionnaires.

Results

Pain level and the waiting period for an analgesic partially decreased and a higher subjective effectiveness of medication was achieved in patients after the standardization. Patients felt that the pain was taken more seriously and contacted the staff for additional medication more frequently. From an employee viewpoint the quality of care and individual competence and ability to treat pain increased after the introduction of standardization. Pain assessment was improved and employees rated their knowledge and education level as higher than before the intervention. Patients with pre-existing chronic pain and patients with special regional therapy benefited only partially after the introduction and an increase in pain intensity was even observed.

Conclusions

The quality of care was improved by standardization of the postoperative pain management. The legal and practical ability of the nursing stuff to administer pain medication within well-defined margins reduced the dependence on the ward doctor and at the same time patient pain levels. Patients received analgesics more quickly and experienced increased effectiveness. These results should be an incentive to reconsider the importance of the organization of postoperative pain management, because the quality of care with all potential medical and economic advantages, can be easily optimized by such simple mechanisms. They also show that the quality assessment of acute pain and the selection of appropriate indicators need further development.     

Management von Patienten mit chronischen Schmerzen in der Akut- und perioperativen Medizin

Die Anaesthesiologie - Chronische Schmerzen sind eine häufige Komorbidität von Patienten im Krankenhaus und wirken sich auf den klinischen Verlauf und die Liegezeit aus. Um eine...     

Ist die Supplementierung der Ohrakupunktur bei operativer Zahnentfernung in Lokalanästhesie effektiv?

Background

The application of ear acupuncture can contribute to a reduction of acute pain. Data on the application of ear acupuncture following oral surgery in odontology is insufficient.

Objective

This study investigated the effectiveness of ear acupuncture as an auxiliary analgesic treatment in addition to local anesthesia for operative tooth removal.

Methods

In this prospective open non-randomized pilot study (in accordance with the CONSORT publication) 2 cohorts of 50 patients each with the indications for an operative tooth removal either with or without the application of ear acupuncture in addition to local anesthesia with articain were observed. Patients were allocated to the groups according to their preference. Pain intensity while resting and while chewing was recorded as the primary parameter for a period of 10 days. The secondary parameters were the subjective experience of anxiety and symptoms, such as headaches, dizziness and nausea.

Results

The two groups did not differ significantly with respect to demographic variables or the use of local anesthetics. At the various measurement intervals, pain intensity while resting or chewing differed significantly between the two groups (ANOVA, p = 0.004, p = 0.007, respectively). Furthermore, the experience of anxiety (ANOVA, p = 0.0001), the number of patients taking analgesics (χ²-test, p = 0.017) and the total postoperative consumption of analgesics (t-test, 0.001) revealed significant differences. In both groups the numerical rating scales (NRS) for postoperative headaches, dizziness and nausea were low.

Discussion and conclusion

Despite a potential bias and methodological limitations of the study design, the results of this investigation suggest that ear acupuncture influences the experience of pain and anxiety in the postoperative period after tooth removal. As a treatment method with low adverse effects ear acupuncture can contribute to postoperative pain control, especially in patients with preoperative anxiety.

     

Die Vorgaben des Gemeinsamen Bundesausschusses zum Akutschmerzmanagement

Die Anaesthesiologie - Die Qualität der postoperativen Schmerztherapie in Deutschland zeigt eine heterogene Versorgungspraxis und große Qualitätsunterschiede zwischen einzelnen...     

Klinische Schmerzkonsile

Background

The aim of this investigation was to describe the performance profile and the requirements for the management of complex pain patients for the structures of a consultation service.

Material and methods

The content and number of all inpatient consultations of the pain department (as an independent service in addition to acute pain and palliative care services) were evaluated for the period from 2008?C2010.

Results

During the study, 1,391?contacts were made in 882?patients; in approx. 50% of the consultations diagnostic or specific (interventional) procedures were requested. Beside additional diagnostic tests, physiotherapy (19.2%), psychological and psychiatric care (11.1%), and other therapeutic approaches (e.g., mirror therapy, transcutaneous electrical nerve stimulation, progressive muscle relaxation) or the long-term follow-up in specialized pain service (20.5%) were recommended.

Conclusion

Within the scope of the pain consultation, a wide spectrum of pain diagnoses and difficult patients are examined. Mixed forms of acute, chronic, and tumor-related pain are often present. Therapeutically, optimization of only the pharmacological regimen is often not sufficient. Similar requirements for a multimodal diagnosis and therapeutic concept as established in ambulatory and/or specialist care are ultimately needed.     

Empfehlungen zur perioperativen Anwendung von Metamizol

Die Anaesthesiologie - Metamizol wird in vielen Ländern häufig perioperativ eingesetzt. Unsicherheit besteht jedoch hinsichtlich der möglichen Komplikation einer Agranulozytose. Bei...