Ulrike M Stamer1,2, Joachim Erlenwein3,4, Stephan M Freys5,6, Thomas Stammschulte7,8, Dirk Stichtenoth9, Stefan Wirz10,11. 1. Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz. ulrike.stamer@dbmr.unibe.ch. 2. Arbeitskreis Akutschmerz, Deutsche Schmerzgesellschaft e.V., Berlin, Deutschland. ulrike.stamer@dbmr.unibe.ch. 3. Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland. 4. Wissenschaftlicher Arbeitskreis Schmerzmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V., Nürnberg, Deutschland. 5. Chirurgische Klinik, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Deutschland. 6. Chirurgische Arbeitsgemeinschaft Akutschmerz, Deutsche Gesellschaft für Chirurgie e.V., Berlin, Deutschland. 7. , Bern, Schweiz. 8. ehemalige Institution Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland. 9. Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Hannover, Deutschland. 10. Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin, Zentrum für Schmerzmedizin, Weaningzentrum, CURA - GFO-Kliniken Bonn, Bad Honnef, Deutschland. 11. Arbeitskreis Tumorschmerz, Deutsche Schmerzgesellschaft e.V., Berlin, Deutschland.
Abstract
BACKGROUND: Nonopioid analgesics are frequently used for perioperative analgesia; however, insufficient research is available on several practical issues. Often hospitals have no strategy for how to proceed, e.g., for informing patients or for the timing of perioperative administration of nonopioid analgesics. METHODS: An expert panel representing the German national societies of pain, anaesthesiology and intensive care medicine and surgery developed recommendations for the perioperative use of nonopioid analgesics within a formal, structured consensus process. RESULTS: The panel agreed that nonopioid analgesics shall be part of a multimodal analgesia concept and that patients have to be informed preoperatively about possible complications and alternative treatment options. Patients' history of pain and analgesic intake shall be evaluated. Patients at risk of severe postoperative pain and possible chronification of postsurgical pain shall be identified. Depending on the duration of surgery, nonopioid analgesics can already be administered preoperatively or intraoperatively so that plasma concentrations are sufficient after emergence from anesthesia. Nonopioid analgesics or combinations of analgesics shall be administered for a limited time only. An interdisciplinary written standard of care, comprising the nonopioid analgesic of choice, possible alternatives, adequate dosing and timing of administration as well as surgery-specific policies, have to be agreed upon by all departments involved. At discharge, the patient's physician shall be informed of analgesics given and those necessary after discharge. Patients shall be informed of possible side effects and symptoms and timely discontinuation of analgesic drugs. CONCLUSION: The use of nonopioid analgesics as part of a perioperative multimodal concept should be approved and established as an interdisciplinary and interprofessional concept for the adequate treatment of postoperative pain.
BACKGROUND: Nonopioid analgesics are frequently used for perioperative analgesia; however, insufficient research is available on several practical issues. Often hospitals have no strategy for how to proceed, e.g., for informing patients or for the timing of perioperative administration of nonopioid analgesics. METHODS: An expert panel representing the German national societies of pain, anaesthesiology and intensive care medicine and surgery developed recommendations for the perioperative use of nonopioid analgesics within a formal, structured consensus process. RESULTS: The panel agreed that nonopioid analgesics shall be part of a multimodal analgesia concept and that patients have to be informed preoperatively about possible complications and alternative treatment options. Patients' history of pain and analgesic intake shall be evaluated. Patients at risk of severe postoperative pain and possible chronification of postsurgical pain shall be identified. Depending on the duration of surgery, nonopioid analgesics can already be administered preoperatively or intraoperatively so that plasma concentrations are sufficient after emergence from anesthesia. Nonopioid analgesics or combinations of analgesics shall be administered for a limited time only. An interdisciplinary written standard of care, comprising the nonopioid analgesic of choice, possible alternatives, adequate dosing and timing of administration as well as surgery-specific policies, have to be agreed upon by all departments involved. At discharge, the patient's physician shall be informed of analgesics given and those necessary after discharge. Patients shall be informed of possible side effects and symptoms and timely discontinuation of analgesic drugs. CONCLUSION: The use of nonopioid analgesics as part of a perioperative multimodal concept should be approved and established as an interdisciplinary and interprofessional concept for the adequate treatment of postoperative pain.
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Authors: A Althaus; A Hinrichs-Rocker; R Chapman; O Arránz Becker; R Lefering; C Simanski; F Weber; K-H Moser; R Joppich; S Trojan; N Gutzeit; E Neugebauer Journal: Eur J Pain Date: 2011-12-23 Impact factor: 3.931
Authors: N Bhala; J Emberson; A Merhi; S Abramson; N Arber; J A Baron; C Bombardier; C Cannon; M E Farkouh; G A FitzGerald; P Goss; H Halls; E Hawk; C Hawkey; C Hennekens; M Hochberg; L E Holland; P M Kearney; L Laine; A Lanas; P Lance; A Laupacis; J Oates; C Patrono; T J Schnitzer; S Solomon; P Tugwell; K Wilson; J Wittes; C Baigent Journal: Lancet Date: 2013-05-30 Impact factor: 79.321