CONCEPTION FOR IMPROVEMENT OF POSTOPERATI VE PAIN MANAGEMENT

Many articles in the literature document the fact that postoperative p ain therapy has not improved for decades despite new insights into pai n physiology, the availability of powerful analgesics and the developm ent of new techniques. This project was set up to develop practical, e ffective, safe, and easy to run acute pain therapy. Methods. Postopera tive pain management had to be optimized according to the facilities a vailable today. Therefore, the legal background is presented first. Se cond, several medical and organizational principles were chosen to ser ve as a basis for the new organizational structure: Continuously monit oring the patient's pain during the whole stay in hospital Introductio n of a simple verbal 4-point pain score for determination and document ation 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 ne eds of the patient Partial transfer of the responsibility for pain tre atment to nurses. Plans and algorithms were expanded to allow nurses a nd anaesthesiologists to reach the previously determined goals. Result s. In a small study including 107 patients, it was demonstrated that t he quality of pain treatment improved significantly. Furthermore, pati ents, nurses and physicians are much more content with the new pain tr eatment regimen. Discussion. The difficulties in realizing such a conc ept are described. The importance of thorough teaching is underlined i n 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.