To evaluate the status of perioperative pain management we mailed a anonymous postal survey to all 2,254 surgical departments in Germany. We received answers from 1,000 clinics (44.4%) which were representative related to their regional distribution. We asked the responsible surgeons to report their organizational structure and responsibilities for treating pain patients, the significance of the problem, their methods of measuring pain, and the usage of different analgesic drugs and methods. In 47% the surgeon and the anesthesist together had responsibility for adequate postoperative pain treatment; in 33% and 14%, respectively, it was the surgeon and anesthesist alone. Only 41% knew the interdisciplinary statement on pain therapy of the Professional Societies of German Surgeons and Anaesthesists from 1992. Although the importance of postoperative pain is globally acknowledged, only 19.1% of all departments had a written concept for pain treatment. Pain was measured in only 11% of the clinics mainly by using the visual analogue scale. Most surgeons relieve pain solely with systemic drugs. Regional analgesia was used by 18% only 51% of the surgeons decide on the choice and dosage of analgesic therapy on the ward; 33% admit that pain therapy often starts after complaints of the patient. 70% of all surgeons never participated in a congress on pain. We conclude that postoperative pain management in most German surgical departments still lacks effectiveness, adequacy, and organizational and scientific background.

From 1983 to 1990, 82 knee arthroscopies (8.2%) carried out in our patients found nothing pathological. Sixty-four percent of these patients were active in sports, but trauma was noted in 32% of the cases only. Football and other ball games, skiing, and track and field athletics were the main causes. Twenty-six percent of the patients had undergone previous surgery in the affected knee. At a mean of 4.6 years postoperatively, clinical and radiological re-assessment was conducted so as to compare our pre- and intraoperative findings with the further course of events. We found that 48.2% of the patients were symptom-free after the diagnostic arthroscopy, 37.5% had persistent discomfort and 14.3% had a recurrence of discomfort after 6 months to 2 years. The objective measurement score (Zarins Rowe score), at 47.5 out of 50 points, was better than the subjective score, at 40 out of 50 points. Our diagnoses had to be changed retrospectively: meniscal lesions were diagnosed too frequently, while chondropathia patellae and instability were often missed. Additionally, complaints could be related to abnormal axis, limited range of motion of the hip or knee, leg length inequality and hypermobility. Being unable to verify a presumed intra-articular lesion arthroscopically is frustrating for both doctor and patient. Our data suggest that meniscal signs should be looked at more critically and emphasise the need for a complete evaluation of the whole locomotor system.

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In random order, monofile polyglyconate, or polyester sutures were used in Shouldice hernioplasty. In 416 operations on 376 patients, postoperative complications occurred at a similar low frequency in both groups. The incidence of hematoma and seroma was 3.4%. With subcutaneus drainage it was 2.4% and without it 4.7%. During a mean follow-up period of 401 days, only one real and one pseudorecurrence (femoral hernia) were observed, implying a recurrence rate of 0.2 %-0.5 %. The incidence of testicular atrophy was 10/0. It is concluded that Shouldice repair is a safe method of routine surgery for groin hernias. Zusammenfassung. In randomisierter Folge wurden monofile Polyglyconate bzw. Polyesterf'fiden zurHernienreparation nach Shouldiee verwandt. Bei 416 Operationen an 376 Patienten war die postoperative Komplikationsrate in beiden Gruppen gleichm/iBig niedrig. Fiihrend waren H/imatome bzw. Serome mit 3,4°/0, mit Redondrainage 2,4%, ohne diese 4,7%. Bei einem mittleren postoperativen Intervall von 401 Tagen fand sich ein echtes und ein Pseudorezidiv (Schenkelhernie) -entsprechend einer Rezidivquote von 0.2 bzw. 0,5 %. Hodenatrophien fanden sich in insgesamt 1%. Damit hat sich die Hernioplastik nach Shouldice als sicheres Routineverfahren erwiesen. Sehliisselwiirter: Shouldice Hernioplastik -Leistenbruch -Postoperative Komplikationen -Rezidivrate.

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