RESUMEN
INTRODUCTION: We report the results of an observational study of pain intensity before and after implementation of an algorithm for postoperative pain management. The algorithm included multiple factors for treatment. METHODS: Data of 130âconsecutive patients with defined surgical procedures were extracted from charts before and after implementation of the algorithm. Our patients documented pain intensity at rest and on movement on a numerival rating scale (NRS) from 0 (=âno pain) to 10 (=â worst pain). A successful pain management was definded as maximum pain intensity at rest ≤â3 and on movement ≤â5 on the NRS. For statistical analysis we used the Wilcoxon and the chi squared test. RESULTS: The frequency of a successful pain management increased from 49â% (individual pain management) to 85â% (algorithm) at rest 8 (pâ<â0.001), on movement the rates were 42â% and 86â%, respectively (pâ<â0.001). In the total group, we found a reduction of maximum pain intensity at rest (meanâ±âsd) from 4.05â ±â 2.54 to 2.18â±â1.82 (pâ<â0.001) and with movement from 6.04â±â2.51 to 3.5â±â2.08 (pâ<â0.001). CONCLUSION: Implementing an algorithm for postoperative pain management resulted in a clinically relevant reduction of postoperative pain. Our findings reflect the result of a complex change in pain management, and therefore cannot be attributed to any single factors involved.
Asunto(s)
Algoritmos , Analgésicos Opioides/uso terapéutico , Analgésicos/uso terapéutico , Procedimientos Quirúrgicos del Sistema Digestivo , Hernia Inguinal/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Cirugía Torácica Asistida por Video , Procedimientos Quirúrgicos Torácicos , Acetaminofén/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Aminas/administración & dosificación , Analgesia Epidural , Ácidos Ciclohexanocarboxílicos/administración & dosificación , Dipirona/administración & dosificación , Etoricoxib , Femenino , Gabapentina , Alemania , Humanos , Capacitación en Servicio , Ketamina/administración & dosificación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/clasificación , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/prevención & control , Pirinitramida/administración & dosificación , Piridinas/administración & dosificación , Garantía de la Calidad de Atención de Salud , Sulfonas/administración & dosificación , Resultado del Tratamiento , Adulto Joven , Ácido gamma-Aminobutírico/administración & dosificaciónRESUMEN
In 1996 we performed a prospective study with 279 patients suffering from benign nodular goiter. The study investigates the influence of a standardized morphologically adjusted resection technique--SMART--on complication rates in surgery. Apart from the number of transient and permanent recurrent laryngeal nerve lesions and hypocalcemia, we focused in particular on the rate of "false relapses" associated with residual nodular tissue after resection. Bilateral ligation of the inferior thyroid artery in a bilobal approach as well as the entire preparation towards the ligament of Berry permit a reduction in irreversible nerve lesions in all lobal resections to 0.4% and permanent hypocalcemia to 0.3%. Bilateral ligation of the inferior thyroid artery results in a significantly larger number of transient hypocalcemia, without any impact on the long-term course. By applying a standardized surgical technique, a residual nodular goiter rate of 1.4% can be achieved. In spite of thorough intraoperative exploration, false relapses cannot completely be ruled out, however. Nodular tissue might remain undetected by conventional intraoperative exploration even in the presence of sophisticated preoperative ultrasound of the thyroid gland. Also, performing an enucleation can lead to remaining nodules, particularly in the posterior areas. For the future intraoperative ultrasound may be an interesting method in these doubtful cases.