Implementierung eines standardisierten perioperativen Schmerzmanagementkonzepts in drei Krankenhäusern eines Klinikverbundes

Abstract

It was possible to implement a standardized perioperative pain therapy concept in three hospitals of a consortium. Whether an adequate pain relief can be improved with the help of standard measurements and documentation, could not be evaluated in this study.

The effectiveness of an oral opioid rescue medication algorithm for postoperative pain management compared to PCIA

“…Implementation of standardized protocols has improved pain management for various surgical procedures and clinical settings as shown in studies using preintervention/postintervention measurements [ 2 , 5 , 6 , 14 , 15 , 18 , 27 , 32 , 35 ]. Standardized protocols seem to be pivotal elements in the management of acute and postoperative pain, especially when a dedicated APS is not readily available [ 13 , 22 ]; however, these investigations were not based on a single intervention or randomized controlled trials, but reflect a whole range of procedural and structural changes [ 2 , 5 , 6 , 14 , 15 , 18 , 27 , 32 , 35 ]. Thus, a multifactorial mix of effects likely contributes to the improvements demonstrated in these studies.…”

“…Standard protocols or algorithms, which enable regular nursing floor staff to react to the patients’ needs, including an adequate response to an acute increase in pain, are considered essential to ensure sufficient analgesia [ 10 , 27 ]. Despite significant heterogeneity, these concepts typically include instructions for a rescue medication to be administered in cases of insufficient pain relief [ 2 , 5 , 6 , 14 , 15 , 18 , 27 , 32 , 35 ]. Germany has widely adopted protocols including oral opioids for rescue medication [ 6 ].…”

“…Ease of administration and independence from any sort of catheter or device, thought to impair the patients’ mobilization or mobility, are obvious advantages of this approach. Despite the widespread adoption of protocols including oral opioids as rescue medication in most German hospitals, the effectiveness of such protocols has only been evaluated longitudinally in a before and after setting, meaning before and after their implementation within a clinical setting [ 2 , 3 , 5 , 6 , 9 , 14 , 15 , 18 , 27 , 32 , 35 ]. Patient-controlled intravenous analgesia (PCIA) has been the technique of choice for comparisons for years and is still considered the gold standard [ 21 ].…”

Treatment of acute abdominal pain in the emergency room: A systematic review of the literature

“…Ultimately, these delays and inadequate dosing of analgesia have impacted patient care and patient satisfaction. In comparison with postoperative analgesia, which has a patient satisfaction level of more than 90% (Saur et al, 2008), patient satisfaction with preoperative pain therapy remains inadequate, only 40-60% (Marinsek et al, 2007;Jawaid et al, 2009). Interestingly, this discrepancy in pre-diagnostic analgesia has not been evident in recent studies of trauma patients, in whom the focus for many decades has been directed to prompt diagnosis with laboratory and imaging studies (Jawaid et al, 2009).…”

Prozesssteuerung in der Akutschmerztherapie

“…Neben der Reduktion von Schmerz intensität, Nebenwirkungen und Warte zeiten auf Analgetika auf Seiten der Pa tienten sowie einer Steigerung der Zufrie denheit auf Seiten der Stationsmitarbei ter fanden sich jedoch auch negative Ef fekte, z. B. ein Anstieg der Schmerzinten sität oder eine Zunahme von Nebenwir kungen [2,7,18].…”