Gregor F Raschke1, Winfried Meissner2, Andre Peisker3, Gabriel Djedovic4, Ulrich Rieger4, Arndt Guentsch5, Daria Porwit3, Marta Gomez Dammeier3, Stefan Schultze-Mosgau3. 1. Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. raschke.gregor@googlemail.com. 2. Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. 3. Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. 4. Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany. 5. Marquette University School of Dentistry, Milwaukee, WI, USA.
Abstract
OBJECTIVES: Postoperative pain management is of highest interest for patients undergoing maxillofacial surgery including microvascular reconstructive surgery. Currently, there is a lack of information regarding process and outcome of postoperative pain management after microvascular reconstruction. MATERIALS AND METHODS: In a prospective clinical study, 31 adults were evaluated on the first postoperative day following microvascular reconstruction with a radial forearm flap using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It enables a standardized assessment of patients' characteristics, pain parameters, outcome and pain therapy process parameters. RESULTS: Pain management consisted predominately of premedication with midazolam, sufentanil and metamizol intraoperatively, piritramid in the intensive care unit and metamizol, tramadol and fentanyl patches on ward. Nineteen patients (61.3 %) showed inadequate pain management with pain levels ≥4. Among other significant relations, patients exhibiting an age below the median presented significant higher levels of pain under strain (p = .041) and maximum pain (p = .006) as well as rate of breathing (p = .009) and mood (p = .006) disturbance. Performance of pain counselling showed specific impact on pain under strain (p = .008), maximum pain (p = .004) and satisfaction with pain intensity (p = .001). Whether microvascular reconstruction was performed with primary or secondary intention or performance of a neck dissection did not show significant influence. CONCLUSIONS: QUIPS helped us to adequately evaluate the procedure-specific quality of postoperative management following microvascular reconstruction with a radial forearm flap. It helped us to identify a surprisingly high amount of inadequate pain management. Postoperative pain levels seem to be primarily influenced by the performed reconstruction. CLINICAL RELEVANCE: Establishment of a continuous and procedure-specific evaluation of postoperative pain levels should help to avoid inadequate pain management, which is widely prevalent according to the literature and our study. Preoperative pain counselling is essential and should be procedure specific to be its best.
OBJECTIVES:Postoperative pain management is of highest interest for patients undergoing maxillofacial surgery including microvascular reconstructive surgery. Currently, there is a lack of information regarding process and outcome of postoperative pain management after microvascular reconstruction. MATERIALS AND METHODS: In a prospective clinical study, 31 adults were evaluated on the first postoperative day following microvascular reconstruction with a radial forearm flap using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It enables a standardized assessment of patients' characteristics, pain parameters, outcome and pain therapy process parameters. RESULTS:Pain management consisted predominately of premedication with midazolam, sufentanil and metamizol intraoperatively, piritramid in the intensive care unit and metamizol, tramadol and fentanyl patches on ward. Nineteen patients (61.3 %) showed inadequate pain management with pain levels ≥4. Among other significant relations, patients exhibiting an age below the median presented significant higher levels of pain under strain (p = .041) and maximum pain (p = .006) as well as rate of breathing (p = .009) and mood (p = .006) disturbance. Performance of pain counselling showed specific impact on pain under strain (p = .008), maximum pain (p = .004) and satisfaction with pain intensity (p = .001). Whether microvascular reconstruction was performed with primary or secondary intention or performance of a neck dissection did not show significant influence. CONCLUSIONS: QUIPS helped us to adequately evaluate the procedure-specific quality of postoperative management following microvascular reconstruction with a radial forearm flap. It helped us to identify a surprisingly high amount of inadequate pain management. Postoperative pain levels seem to be primarily influenced by the performed reconstruction. CLINICAL RELEVANCE: Establishment of a continuous and procedure-specific evaluation of postoperative pain levels should help to avoid inadequate pain management, which is widely prevalent according to the literature and our study. Preoperative pain counselling is essential and should be procedure specific to be its best.
Authors: G Savoia; D Alampi; B Amantea; F Ambrosio; R Arcioni; M Berti; G Bettelli; L Bertini; M Bosco; A Casati; I Castelletti; M Carassiti; F Coluzzi; A Costantini; G Danelli; M Evangelista; G Finco; A Gatti; E Gravino; C Launo; M Loreto; R Mediati; Z Mokini; E Mondello; S Palermo; F Paoletti; A Paolicchi; F Petrini; Q Piacevoli; A Rizza; A F Sabato; E Santangelo; E Troglio; C Mattia Journal: Minerva Anestesiol Date: 2010-08 Impact factor: 3.051
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Authors: Gregor F Raschke; Andre Peisker; Ulrich Rieger; Gabriel Djedovic; Arndt Guentsch; Oliver Schaefer; Eric Venth; Marta Gomez Dammeier; Winfried Meissner Journal: Clin Oral Investig Date: 2014-07-25 Impact factor: 3.573
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