Auswirkung einer stationsweiten Standardisierung der Akutschmerztherapie

SummaryBackgroundDermatosurgical procedures are predominantly performed under local anesthesia, yet there are few studies on perioperative pain management for extensive or staged procedures under local anesthesia. The purpose of this study was to assess pain during dermatologic surgery, describe perioperative pain management, and identify factors that influence pain perception.Patients and methodsThis prospective, monocentric study included inpatients undergoing dermatologic surgery under local anesthesia from April to December 2021. Preoperative demographic data, a pain questionnaire, and four psychometric questionnaires (PCS, LOT‐R, SFQ, PHQ‐9) were collected. Postoperative pain and analgesic use during the first 24 hours were recorded.ResultsA total of 120 patients (with a total of 191 interventions) were included in the study. Mean postoperative pain was reported to be very low (NRS < 2). Preoperative pain and expected postoperative pain were found to be predictive of postoperative pain. There was a strong correlation between catastrophizing and preoperative anxiety (r = 0.65) and a moderate correlation between depression and preoperative anxiety (r = 0.46).ConclusionsDermatologic surgery under local anesthesia is generally considered painless. During preoperative counseling and assessment, attention should be paid to patients who fear surgery, report pain, or anticipate postoperative pain, as they have an increased risk of experiencing postoperative pain.

Section: Discussionmentioning

confidence: 99%

“…This approach facilitates a structured management strategy and provides guidance to staff who may be uncertain about postoperative pain management. 5,39…”

Section: Malesmentioning

confidence: 99%

Perioperative pain perception in patients undergoing dermatologic surgery with local anesthesia – A prospective observational study

Volberg,

Gschnell,

Eubel

et al. 2024

“…9,12,13,15,18 Establishing internal standards can be very helpful, as shown by the fact that more than half of respondents reported using them. The implementation of pain management standards in the field of dermatosurgery is therefore associated with positive effects for both the patient and the practitioner 19 and should be further expanded and supported by research. For this purpose, Bialas et al recommend a classification of surgeries into three categories (mild, moderate, severe) according to the expected pain and a correspondingly adapted pain management.…”

Section: Discussionmentioning

confidence: 99%

Perioperative pain management in dermatosurgery – current practice in Germany: Data analysis of a Germany‐wide online survey among dermatosurgeons

Gschnell

Volberg

Eubel

et al. 2023

SummaryBackgroundAdequate pain management should be part of the standard of care in surgical procedures. However, there is a paucity of data in the field of dermatosurgery. In a standardized online survey among dermatosurgeons working in Germany, the current practice of perioperative pain management was investigated.MethodsMembers of the German Society for Dermatosurgery (DGDC) and heads of dermatosurgical departments were asked to participate. Questions were related to practical implementation of perioperative pain management, pain documentation and personal sources of information on the topic.Results116 questionnaires were analyzed. While prophylactic analgesia is rarely used, the vast majority (86%) reported the use of postoperative on‐demand medication. The majority of surgeons do not have a fixed regimen. Mostly NSAIDs and occasionally low potency opioids are used. Pain is documented by the majority (59.1%) as free text. Personal experience (69%) and in‐house standards (51%) are the most important factors in pain management. The use of guidelines (25%) plays a minor role.ConclusionsPerioperative pain management in dermatosurgery is strongly influenced by personal experience and may vary depending on the surgery performed. Consensus‐based standardized recommendations are lacking. For adequate perioperative analgesia, the development of demand‐oriented pain concepts is desirable. This requires prospective studies that address the specific patient population and surgical procedures in dermatology.

“…dies empfehlen. Dadurch kann strukturiert vorgegangen werden und es hilft Mitarbeitenden, die gegebenenfalls unsicher in der Behandlung postoperativer Schmerzen sind 5,39 …”

Section: Diskussionunclassified

Perioperatives Schmerzempfinden von Patienten bei dermatochirurgischen Eingriffen in Lokalanästhesie – Eine prospektive Beobachtungsstudie

Volberg,

Gschnell,

Eubel

et al. 2024

ZusammenfassungHintergrundDermatochirurgische Eingriffe finden überwiegend in Lokalanästhesie statt, jedoch gibt es nur wenig Studien zum perioperativen Schmerzmanagement ausgedehnter oder mehrzeitiger Operationen. Das Ziel dieser Erhebung ist die Erfassung von Schmerzen im Rahmen dermatochirurgischer Eingriffe, der Darstellung der perioperativen Schmerztherapie sowie der Identifizierung von Einflussfaktoren auf das Schmerzempfinden.Patienten und MethodikIn diese prospektive, monozentrische Studie wurden stationäre Patienten von April bis Dezember 2021 eingeschlossen, die einen dermatochirurgischen Eingriff in Lokalanästhesie erhielten. Präoperativ wurden demographische Fragen, ein Schmerzfragebogen und vier psychometrische Fragebögen (PCS, LOT‐R, SFQ, PHQ‐9) erhoben. Postoperativ empfundene Schmerzen und benötigte Schmerzmedikamente der ersten 24 Stunden wurden erhoben.Ergebnisse120 Patienten (mit insgesamt 191 Eingriffen) wurden eingeschlossen. Durchschnittliche postoperative Schmerzen wurden sehr niedrig (NRS < 2) angegeben. Präoperativ bestehende Schmerzen und postoperativ erwartete Schmerzen zeigten sich als prädiktive Merkmale für postoperativen Schmerz. Ein starker Zusammenhang zwischen Katastrophisieren und Angst vor der Operation (r = 0,65) sowie ein mittlerer Zusammenhang für Depression und Angst vor der Operation (r = 0,46) konnten dargestellt werden.SchlussfolgerungenDermatochirurgische Eingriffe in Lokalanästhesie werden insgesamt als schmerzarm empfunden. Bei der präoperativen Aufklärung und Untersuchung sollte auf Patienten geachtet werden, die bereits Schmerzen angeben oder postoperativ Schmerzen erwarten, da sie ein erhöhtes Risiko für die Entwicklung postoperativer Schmerzen zeigten.