Schmerztherapie nach thoraxchirurgischen Eingriffen

2018 ◽  
Vol 12 (02) ◽  
pp. 155-165
Author(s):  
Holger Hendrix ◽  
Vladimir Kamlak ◽  
Georgi Prisadov ◽  
Katrin Welcker
Keyword(s):  
Thoracic Surgery ◽  
Pain Therapy ◽  
Pain Treatment ◽  
Internal Standards ◽  
Pain Experience ◽  
Thoracic Surgical Procedures ◽  
Therapeutic Algorithm ◽  
Alternative Procedures ◽  
The Individual ◽  
Documentation Form

The treatment of pain after thoracic surgery is a challenge and takes place in the individual clinics mostly according to clinic internal standards. It exists no currently valid S3 guideline for the treatment of acute perioperative and posttraumatic pain. For an effective pain treatment as well individual pain experience as the pain intensity of the various thoracic surgical procedures must be considered. Regular pain assessment with appropriate methods and their documentation form the basis for adequate and adapted pain therapy.There are a number of different pain therapy methods, non-medicamentous and drug-based methods, whose effectiveness is described in the literature partially different. For the treatment of acute postoperative pain after thoracic surgery, mainly drug-related procedures are used, except for physiotherapy as a non-medicamentous method. Increasingly, alternative procedures for the peridural catheter as a therapeutic gold standard in the treatment of pain after thoracic surgery are used. Their application can be integrated into a therapeutic algorithm.

Stress Associated with Orthopedic Surgery and Feeling Pain

2016 ◽  
pp. 372-392
Author(s):  
Kinga Sobieralska-Michalak ◽  
Maciej Michalak ◽  
Agnieszka Woźniewicz ◽  
Aleksandra Pawlicka
Keyword(s):  
Surgical Treatment ◽  
Learned Helplessness ◽  
Orthopaedic Surgery ◽  
Pain Therapy ◽  
Pain Treatment ◽  
Healing Process ◽  
Stress Reaction ◽  
Pain Experience ◽  
Lack Of Information ◽  
Related Stress

Injuries and degenerative disease of the skeletal and articular systems are the most common reasons for undergoing orthopaedic surgery. Those diseases are often associated with pain, which is experienced by the patient long before the surgical procedure. Strong stress reaction is the main source of adjustment disorders of patients undergoing surgical treatment. Orthopaedic surgery, like any other surgery, upsets body's homeostasis. The results of the surgery are not completely predictable, but are always closely related to life and health. Patients' strong stress reaction is also connected with anaesthesia (emergence from anaesthesia), being worried of complications caused by central neuraxial anaesthesia – the fear of paresis or death. The factor which influences worse adaptation process is the patients' post-surgery mood. Right after the surgery, patients feel worse than before it, they are weak, move less freely, they are anxious about their consciousness being dimmed due to medicine intake and pain. The expectations concerning the ways of controlling the dynamics of the pain one experiences are crucial. According to the researchers, in the central nervous system there exist neural circuits that may cause physiological reactions according to one's expectations, and due to this fact the pain one experiences may become stronger or alleviated depending on one's expectations. The lack of positive pain-reducing experience may lead to the learned helplessness or no sense of one's control over pain, both of which make the pain stronger. The pain-influencing factors include cognitive processes and emotions. The role of attention processes, one's cognitive appraisal and one's attitude towards pain has been emphasised, as well as the pain-modelling influence of emotions, all of which emphasise the complexity of one's pain experience. Patients, when asked to point out the factors that hinder effective pain therapy, indicate frustration caused by the lack of information, numerous worries concerning the treatment and the stereotypical image of pain. Relieving tension influences the patient's mood positively, whilst stress influences it in a negative way. The stress one experiences and one's emotions lower one's pain threshold, which leads to greater pain experience and thus makes the healing process last longer. The quality of pre- and post-operational care is thus crucial, as it influences the level of the experienced stress. The pain components influence one another, there occur interactions of biological, psychological and situational factors, which makes it advisable to personalise one's pain treatment. The need of an interdisciplinary approach towards a person, especially to their health, has been recently emphasised. Pain is a biopsychosocial occurrence, which makes pain therapy an interdisciplinary problem. This chapter discusses the following issues: 1) The characteristics of pain in conditions that require surgical treatment,2) Surgery-related stress reaction, 3) Psychological factors which influence how one feels pain, 4) The consequences of pain in people's functioning, and 5) Postoperative pain, the assessment of pain level and its relieving.

Stress Associated with Orthopedic Surgery and Feeling Pain

2020 ◽  
pp. 36-63
Author(s):  
Kinga Sobieralska-Michalak ◽  
Maciej Michalak ◽  
Agnieszka Woźniewicz ◽  
Aleksandra Pawlicka
Keyword(s):  
Surgical Treatment ◽  
Learned Helplessness ◽  
Orthopaedic Surgery ◽  
Pain Therapy ◽  
Pain Treatment ◽  
Healing Process ◽  
Stress Reaction ◽  
Pain Experience ◽  
Lack Of Information ◽  
Related Stress

Injuries and degenerative disease of the skeletal and articular systems are the most common reasons for undergoing orthopaedic surgery. Those diseases are often associated with pain, which is experienced by the patient long before the surgical procedure. Strong stress reaction is the main source of adjustment disorders of patients undergoing surgical treatment. Orthopaedic surgery, like any other surgery, upsets body's homeostasis. The results of the surgery are not completely predictable, but are always closely related to life and health. Patients' strong stress reaction is also connected with anaesthesia (emergence from anaesthesia), being worried of complications caused by central neuraxial anaesthesia – the fear of paresis or death. The factor which influences worse adaptation process is the patients' post-surgery mood. Right after the surgery, patients feel worse than before it, they are weak, move less freely, they are anxious about their consciousness being dimmed due to medicine intake and pain. The expectations concerning the ways of controlling the dynamics of the pain one experiences are crucial. According to the researchers, in the central nervous system there exist neural circuits that may cause physiological reactions according to one's expectations, and due to this fact the pain one experiences may become stronger or alleviated depending on one's expectations. The lack of positive pain-reducing experience may lead to the learned helplessness or no sense of one's control over pain, both of which make the pain stronger. The pain-influencing factors include cognitive processes and emotions. The role of attention processes, one's cognitive appraisal and one's attitude towards pain has been emphasised, as well as the pain-modelling influence of emotions, all of which emphasise the complexity of one's pain experience. Patients, when asked to point out the factors that hinder effective pain therapy, indicate frustration caused by the lack of information, numerous worries concerning the treatment and the stereotypical image of pain. Relieving tension influences the patient's mood positively, whilst stress influences it in a negative way. The stress one experiences and one's emotions lower one's pain threshold, which leads to greater pain experience and thus makes the healing process last longer. The quality of pre- and post-operational care is thus crucial, as it influences the level of the experienced stress. The pain components influence one another, there occur interactions of biological, psychological and situational factors, which makes it advisable to personalise one's pain treatment. The need of an interdisciplinary approach towards a person, especially to their health, has been recently emphasised. Pain is a biopsychosocial occurrence, which makes pain therapy an interdisciplinary problem. This chapter discusses the following issues: 1) The characteristics of pain in conditions that require surgical treatment,2) Surgery-related stress reaction, 3) Psychological factors which influence how one feels pain, 4) The consequences of pain in people's functioning, and 5) Postoperative pain, the assessment of pain level and its relieving.

Postoperative Thoracic Pain Treatment: Serratus Anterior or Erector Spinae Plane Block?

2020 ◽  
Author(s):  
Ayşe Ülgey ◽  
Sibel Seçkin Pehlivan ◽  
Ömer Faruk Demir
Keyword(s):  
Pain Management ◽  
Thoracic Surgery ◽  
Pain Treatment ◽  
Postoperative Pain Management ◽  
Erector Spinae ◽  
Morphine Consumption ◽  
Serratus Anterior ◽  
Thoracic Pain ◽  
Erector Spinae Plane Block ◽  
Pca Method

Abstract Background Thoracic surgery is one of the most painful surgeries. Effective analgesia is important in postoperative pain management. In this study, we aimed to compare the two new fascial block techniques. Methods A total of 107 patients who underwent thoracic surgery between October 2018 and November 2019 were retrospectively evaluated. The study included 59 patients in the serratus anterior plane block (SAPB) group and 48 patients in the erector spinae plane block (ESPB) group. Both groups were administered 30 mL of 0.25% bupivacaine and their morphine consumption was evaluated by a patient-controlled analgesia (PCA) method during the 2nd, 6th, 12th, 24th, and 48th postoperative hours. Pain was measured with the visual analog scale (VAS). Intraoperative mean arterial pressure (MAP) and heart rate (HR) were recorded. Results During the first 24 hours, VAS values were significantly lower in the ESPB group (p < 0.05). Moreover, morphine consumption was significantly lower in the ESPB group in the 24th and 48th hours (p < 0.05). Intraoperative remifentanil consumption was also significantly lower in the ESPB group (p < 0.05). Intraoperative MAP in the ESPB group was found to be significantly lower after the 4th hour. HR was similar in both groups. Conclusion ESPB was more effective compared with SAPB in postoperative thoracic pain management.

Opioid Pharmacology

2008 ◽  
Vol 2s;11 (3;2s) ◽  
pp. S133-S153 ◽  
Author(s):  
Andrea M. Trescot
Keyword(s):  
Side Effects ◽  
Pain Treatment ◽  
Volume Of Distribution ◽  
Opiate Withdrawal ◽  
Pharmacokinetic Parameters ◽  
Intractable Pain ◽  
Advantages And Disadvantages ◽  
Withdrawal Syndromes ◽  
The Individual ◽  
Mu Agonists

Background: Mu agonists have been an important component of pain treatment for thousands of years. The usual pharmacokinetic parameters (half-life, clearance, volume of distribution) of opioids have been known for some time. However, the metabolism has, until recently, been poorly understood, and there has been recent interest in the role of metabolites in modifying the pharmacodynamic response in patients, in both analgesia and adverse effects. A number of opioids are available for clinical use, including morphine, hydromorphone, levorphanol, oxycodone, and fentanyl. Advantages and disadvantages of various opioids in the management of chronic pain are discussed. Objective: This review looks at the structure, chemistry, and metabolism of opioids in an effort to better understand the side effects, drug interactions, and the individual responses of patients receiving opioids for the treatment of intractable pain. Conclusion: Mu receptor agonists and agonist-antagonists have been used throughout recent medical history for the control of pain and for the treatment of opiate induced side effects and even opiate withdrawal syndromes. Key words: Opioid metabolism, opioid interactions, morphine, codeine, hydrocodone, oxycodone, hydromorphone, methadone, intractable pain, endorphins, enkephalins, dynorphins, narcotics, pharmacology, propoxyphene, fentanyl, oxymorphone, tramadol

Friendly Fire

2016 ◽  
Author(s):  
Lynn R. Webster
Keyword(s):  
Pain Treatment ◽  
Pain Experience ◽  
Cultural Attitudes ◽  
Friendly Fire ◽  
Pain Medications ◽  
The U.S ◽  
The Way

“Friendly Fire” tells the story of Jason Bing, a soldier who became dependent on pain medications prescribed for a service-related injury and who faced the stigma placed upon pain treatment and addiction within the U.S. military. His story illustrates the way that nearly all people in pain have to deal with prejudice and ignorance surrounding pain and opioids, regardless of what part of society they belong to. Chapter key idea: Cultural attitudes toward pain too often make a pain experience worse than it has to be.

scholarly journals Managerial strategies of the personal values, used to improve engineers communication

2019 ◽  
Vol 290 ◽  
pp. 07004
Author(s):  
Mihaela Laura Bratu ◽  
Lucian-Ionel Cioca
Keyword(s):  
Employee Performance ◽  
Personal Values ◽  
Management Strategies ◽  
Well Being ◽  
Workplace Communication ◽  
Individual Values ◽  
Internal Standards ◽  
The Everyday ◽  
Managerial Strategies ◽  
The Individual

Every person can be described by his behavior in certain situations, but also by the motivation of his actions, a motivation that reflects the individual values. The set of values of each individual is reflected in the everyday tasks, the way of communication, the degree of success of his actions. The higher the values apply in a wider area of life, the higher the personal satisfaction of the individual. Personal values are the internal standards and, at the same time, the inner force that determines us to learn, work and live in a certain way. The paper presents a study of a group of 116 engineers from different fields who sought to identify personal values in order to improve communication at the workplace. It was used The Inventory of Personal Values that measured the analyzed variable. The findings of the research are that management strategies that value the practical and organizational spirit of engineers improve workplace communication, increase employee performance and improve their well-being.

scholarly journals The Effectiveness of Sterile Wound Drapes in the Prevention of Surgical Site Infection in Thoracic Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Kemal Karapınar ◽  
Celalettin İbrahim Kocatürk
Keyword(s):  
Thoracic Surgery ◽  
Surgical Site Infection ◽  
Operation Time ◽  
Surgical Site Infections ◽  
Control Group ◽  
Site Infection ◽  
Wound Debridement ◽  
Thoracic Surgical Procedures ◽  
Hospitalization Costs ◽  
The Cost

Background. The rate of surgical site infections (SSIs) has decreased in parallel to advances in sterilization techniques. Such infections increase morbidity and hospitalization costs. The use of iodine-impregnated sterile wound drapes (SWDs) is recommended to prevent or reduce the incidence of these infections. However, there is a paucity of data regarding their use in thoracic surgical procedures. The aim of the present study was to evaluate the effectiveness of sterile wound drapes in the prevention of these infections and the effects on hospitalization costs. Methods. Perioperative iodine-impregnated SWDs have been used since January 2015 in the Thoracic Surgery Clinic of our hospital. A retrospective evaluation was made of patients who underwent anatomic pulmonary resection via thoracotomy with SWD in the period January 2015–2017, compared with a control group who underwent the same surgery without SWD in the 2-year period before January 2015. Factors that may have increased the risk of surgical site infection were documented and the occurrence of SSI was recorded from postoperative follow-up data. The cost analysis was performed as an important criterion to investigate the benefits of SWD. Results. Evaluation was made of 654 patients in the study group (n:380) using SWD, the operation time was significantly longer, and perioperative blood transfusion was significantly higher, whereas treatment costs (p=0.0001) and wound culture positivity (p=0.004) were significantly lower and less surgical wound debridement was performed (p=0.002). Conclusion. The findings suggest that the use of sterile wound draping in thoracic surgery procedures reduces surgical site infections and hospitalization costs.

scholarly journals Postoperative Pain, an Unmet Problem in Day or Overnight Italian Surgery Patients: A Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Sara Campagna ◽  
Maria Delfina Antonielli D’Oulx ◽  
Rosetta Paradiso ◽  
Laura Perretta ◽  
Silvia Re Viglietti ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Surgical Procedures ◽  
Pain Therapy ◽  
Pain Treatment ◽  
Day Surgery ◽  
North West ◽  
Local Practices ◽  
Surgery Rates ◽  
A Prospective Study ◽  
Postoperative Pain Treatment

Background. Because of economic reasons, day surgery rates have steadily increased in many countries and the trend is to perform around 70% of all surgical procedures as day surgery. Literature shows that postoperative pain treatment remains unfulfilled in several fields such as orthopedic and general surgery patients. In Italy, the day surgery program is not yet under governmental authority and is managed regionally by local practices. Aim. To investigate the trends in pain intensity and its relation to type of surgeries and pain therapy protocols, in postoperative patients, discharged from three different Ambulatory Surgeries located in North West Italy (Piedmont region). Method. The present study enrolled 276 patients who undergone different surgical procedures in ambulatory regimen. Patients recorded postoperative pain score twice a day, compliance with prescribed drugs, and pain related reasons for contacting the hospital. Monitoring lasted for 7 days. Results. At discharge, 72% of patients were under weak opioids, 12% interrupted the treatment due to side effects, 17% of patients required extra drugs, and 15% contacted the hospital reporting pain problems. About 50% of patients experienced moderate pain during the first day after surgery. Results from our study show that most of the patients experienced avoidable pain after discharge.

The relationship between personality and pain experience after thoracic surgery

Pain ◽  
1987 ◽  
Vol 30 ◽  
pp. S178
Author(s):  
V. Bachiocco ◽  
R. Bragaglia ◽  
M. Mastrolilli ◽  
A. G. Rusticali ◽  
Morselli M.M. Labate ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Pain Experience ◽  
The Relationship

A method for the quantitative determination of individual free fatty acids in milk by ion exchange resin adsorption and gas-liquid chromatography

1983 ◽  
Vol 50 (3) ◽  
pp. 321-329 ◽  
Author(s):  
Eric C. Needs ◽  
Graeme D. Ford ◽  
A. Jane Owen ◽  
Brian Tuckley ◽  
Malcolm Anderson
Keyword(s):  
Fatty Acids ◽  
Liquid Chromatography ◽  
Free Fatty Acids ◽  
Exchange Resin ◽  
Ion Exchange Resin ◽  
Gas Liquid Chromatography ◽  
Internal Standards ◽  
Resin Adsorption ◽  
The Individual

SummaryA quantitative method for rapid routine analysis of individual free fatty acids (FFA) in milk was developed. Lipid was extracted from milk in ether and FFA were recovered by shaking the extract with anion exchange resin Amberlyst 26. The resin-bound FFA were methylated directly and the individual acids quantified, using internal standards, by gas-liquid chromatography. The properties of the resin were measured. The validity of the method was established by extraction of FFA mixtures and milk. Individual acids were, on average, found to be within 6% of the actual concentration present in the mixture. An average coefficient of variation of 4·3% was achieved for the major individual fatty acids on repeated extraction of a single milk sample.

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