Entwicklungsperspektiven für das Europäische Parlament

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.

Section: Introductionunclassified

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

Volberg,

Gschnell,

Eubel

et al. 2024

“…Optimal pain management should therefore always be one of the primary treatment goals. [4][5][6] Pain perception and assessment are highly subjective and cannot be generalized. However, it has been shown that people with chronic pain, women, outpatients undergoing trauma surgery, and younger patients are more likely to experience postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

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

Volberg,

Gschnell,

Eubel

et al. 2024

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.

“…4 Pain management is therefore a central task in the patient care, since sufficient pain relief, ideally freedom from pain, is to be regarded as an essential principle of modern medicine and can also be defined as an individual patient right in accordance with Article 1 and 2 of the German Basic Law (Grundgesetz) as "… every person shall have the right to life and physical integrity". 5 In dermatology, most studies and recommendations on pain management focus on the treatment of acute and chronic pain in skin diseases, e.g. (post-)herpetic neuralgia, and very rarely on the therapeutic management of (post-)operative pain.…”

Section: Introductionmentioning

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.