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

Abstract

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.

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

“…Pain should be regularly assessed perioperatively to ensure adequate analgesia. However, our survey of dermatologic surgeons found that only a quarter of respondents performed a standardized pain assessment 21 . Simple rating scales (e.g., the Numerical Rating Scale [NRS] with a classification of pain intensity from 0 = no pain to 10 = worst pain imaginable) are best suited for assessing pain intensity 1 .…”

“…There are no guidelines for postoperative pain management after dermatologic surgery in Germany. In most cases, patients are treated on the experience of doctors or clinical in‐house standards 21 . International evidence shows that treatment with non‐opioid analgesics is often sufficient after dermatologic surgery under local anesthesia.…”

“…published recommendations for pain management during and after dermatologic surgery, referring to Raffa et al.’s pain pyramid instead of the well‐known WHO stage model 5,19,20 . A survey we conducted among dermatologic surgeons revealed that perioperative pain management varies widely and is strongly influenced by personal experience 21 . Problems arise from the fact that there are very few prospective data collections on pain perception during dermatologic surgery under local anesthesia, or that another local anesthetic technique (e.g., tumescent local anesthesia) is used instead of infiltration anesthesia during surgery 22–24 .…”