[Evaluation of postoperative pain therapy with patient-controlled analgesia from the viewpoint of the patient and nursing staff]. / Bewertung der postoperativen Schmerztherapie mittels PCA aus Sicht der Patienten und des Pflegepersonals.

Patient-controlled analgesia has been proven to be an effective technique in postoperative pain management. The aim of our study was to evaluate PCA on general surgery wards. 311 patients and their nurses were questioned about their experiences in using PCA for postoperative pain management. Satisfaction with pain relief judged by both patients and nursing staff, incidence of negative side effects and technical problems were studied. The great majority of patients and nursing staff rated the quality of pain relief as being satisfactory. Incidence of negative side effects was extraordinarily low. There was no respiratory depression observed, technical problems hardly arose. Most of the patients coped very well with operating their PCA-pumps. We conclude that PCA is a safe and effective method in postoperative pain management on surgical wards. Under the condition of regular monitoring of pain intensity, of analgesic consumption, level of sedation and of side effects by trained medical and nursing staff, monitoring of respiration and vigilance is not necessary for the PCA regimen we used.

[Intravenous versus thoracic-epidural patient-controlled analgesia following extended abdominal or thoracic surgery]. / Intravenöse versus thorakale-epidurale patienten-kontrollierte Analgesie bei ausgedehnten Oberbauch-und Thoraxeingriffen.

BACKGROUND: Intravenous patient-controlled analgesia (PCA-i.v.) has has markedly improved postoperative pain-relief. Alternatively, peridural anesthesia has been used successfully in high risk patients with the disadvantage of a more intense postoperative care. In this study we compared the applicability of intravenous vs. peridural patient-controlled analgesia on a general ward. METHODS: In a prospective double blinded study 40 patients were randomized after extensive thoracic or abdominal surgery in two groups and received either intravenous PCA (n = 20) or epidural PCA (n = 20). Postoperative monitoring was performed on the general ward by specifically trained nurses. Physiological data, neurological status, the effects of the analgesia and complications were registered before and 48 hours after surgery. Pain intensity was determined by using the visual analog scale (VAS). For the evaluation of wellness and cognitive efficacy psychological tests were performed. RESULTS: Our results show that epidural PCA without administration of a basal rate is a safe method and can be performed on a general ward. Relevant postoperative complications or negative side effects were not registered in both groups. Sufficient analgesia was achieved with both methods. Patients treated with PCA-PDK had a significantly better score regarding vigilance and subjective wellness when compared to patients in the PCA-i.v. group. CONCLUSION: This study demonstrates that epidural PCA can be used on a general surgical ward as an alternative method compared to intravenous PCA. PCA-PDK may be advantageous over intravenous PCA since both techniques require similar intense monitoring and side effects in the PCA-PDK group appear to be less.

[Preparation of children for anesthesia]. / Vorbereitung von Kindern zur Anästhesie.

Children are not born as little adults, and more important than the difference in size are psychic, physiological and pharmacological aspects. Intense preparatory information and training will be necessary to avoid or reduce psychic trauma due to hospitalization, narcosis and operation. Basic laboratory findings as hemoglobin, hematocrit, urinalysis and blood-group are supplemented by special examinations if indicated. Preoperative fasting shouldn't be prolonged respecting poor metabolic and fluid reserves. Adequate oral or rectal premedication is as important as careful induction.