Ein Konzept zur Verbesserung der postoperativen Schmerzbehandlung

Zusammenfassung

Das Ziel dieser Arbeit bestand darin, mit den heute zur Verfügung stehenden Möglichkeiten eine praktikable, effektive, sichere, kostengünstige Akutschmerztherapie auszuarbeiten. Dazu wurden verschiedene Prinzipien zugrunde gelegt: Kontinuierliche Überwachung des Patienten während des gesamten Krankenhausaufenthalts, Einführung eines einfachen vier Punkte Scores zur Erfassung und Dokumentation des Schmerzes, Einführung eines Sedierungsscores, Anwendung der balancierten Analgesie und der „pre-emptive analgesia“, bedarfsorientierte Verabreichung von Medikamenten sowie das Übertragen einer wesentlich höheren Verantwortung und Befugnis für die Schmerztherapie auf die Pflegekräfte. Diese Prinzipien fanden ihren Niederschlag in Plänen und Algorithmen, die es den Pflegekräften und den Anästhesisten erlauben, die oben genannten Gedanken in die Tat umzusetzen. Abschließend wird die Verbesserung der Schmerzbehandlung mit einer Studie dokumentiert.

Abstract

Many articles in the literature document the fact that postoperative pain therapy has not improved for decades despite new insights into pain physiology, the availability of powerful analgesics and the development of new techniques. This project was set up to develop practical, effective, safe, and easy to run acute pain therapy.

Methods. Postoperative pain management had to be optimized according to the facilities available today. Therefore, the legal background is presented first. Second, several medical and organizational principles were chosen to serve as a basis for the new organizational structure:

– Continuously monitoring the patient's pain during the whole stay in hospital

– Introduction of a simple verbal 4-point pain score for determination and documentation of pain allowing the nurses to differentiate pain that should be treated or not.

– A simple sedation score

– Use of „balanced analgesia“ and „pre-emptive analgesia“

– Drug administration according to the needs of the patient

– Partial transfer of the responsibility for pain treatment to nurses. Plans and algorithms were expanded to allow nurses and anaesthesiologists to reach the previously determined goals.

Results. In a small study including 107 patients, it was demonstrated that the quality of pain treatment improved significantly. Furthermore, patients, nurses and physicians are much more content with the new pain treatment regimen.

Discussion. The difficulties in realizing such a concept are described. The importance of thorough teaching is underlined in a nurse-based system. However, it is not yet clear whether this pain treatment has resulted in reduced morbidity, reduced mortality and a shortened hospital stay of the patients.