POSTOPERATIVE ON DEMAND ANALGESIA FOR REC ONSTRUCTIVE EAR SURGERY WITH RESECTION OF RIB CARTILAGE

Background: The individual experience of postoperative pain varies con siderably. It is the patient who can best evaluate the intensity of pa in and the effect of a given analgesic substance. Patient-controlled a nalgesia (PCA) enables the patient to self-administer an i.v. analgesi c bolus by pressing a button of an electronic pump device within a pre viously set range, if needed. The resection of rib cartilage to be use d for ear reconstructions is associated with intense postoperative pai n. This could result in unfavorable stress responses such as impaired cough and clearance of lung secretions carrying a greater risk of bron chitis or pneumonia, prolonged mobilization, and complications of woun d healing. Therefore, individually adapted pain therapy is of great im portance and technically feasible with modern PCA devices. Method: Inf ormed and cooperative children aged five years and older and adults wi thout severe health risks are suitable for PCA. Management, handling, monitoring and documentation of the PCA device are discussed. A 24-hou r counselling service is maintained for occuring problems. Results: Al most all patients expressed their great satisfaction with this means o f pain therapy. Few patients were apprehensive. The initial scepticism of the involved personnel concerning opioid abuse, over-dosage, or te chnical problems gave way for a support of the PCA once the great sati sfaction of the patients in absence of side effects was witnessed. No patient had to be antagonized for respiratory depression. Nausea and v omiting were rare events. Conclusion: Patient-controlled analgesia pro ved to be an excellent answer to postoperative pain after resections o f rib cartilage.