Perioperative pain management in dermatosurgery - current practice in Germany: Data analysis of a Germany-wide online survey among dermatosurgeons.
Journal
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
ISSN: 1610-0387
Titre abrégé: J Dtsch Dermatol Ges
Pays: Germany
ID NLM: 101164708
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
03
12
2022
accepted:
21
04
2023
medline:
14
9
2023
pubmed:
14
7
2023
entrez:
14
7
2023
Statut:
ppublish
Résumé
Adequate pain management should be part of the standard of care in surgical procedures. However, there is a paucity of data in the field of dermatosurgery. In a standardized online survey among dermatosurgeons working in Germany, the current practice of perioperative pain management was investigated. Members of the German Society for Dermatosurgery (DGDC) and heads of dermatosurgical departments were asked to participate. Questions were related to practical implementation of perioperative pain management, pain documentation and personal sources of information on the topic. 116 questionnaires were analyzed. While prophylactic analgesia is rarely used, the vast majority (86%) reported the use of postoperative on-demand medication. The majority of surgeons do not have a fixed regimen. Mostly NSAIDs and occasionally low potency opioids are used. Pain is documented by the majority (59.1%) as free text. Personal experience (69%) and in-house standards (51%) are the most important factors in pain management. The use of guidelines (25%) plays a minor role. Perioperative pain management in dermatosurgery is strongly influenced by personal experience and may vary depending on the surgery performed. Consensus-based standardized recommendations are lacking. For adequate perioperative analgesia, the development of demand-oriented pain concepts is desirable. This requires prospective studies that address the specific patient population and surgical procedures in dermatology.
Sections du résumé
BACKGROUND
Adequate pain management should be part of the standard of care in surgical procedures. However, there is a paucity of data in the field of dermatosurgery. In a standardized online survey among dermatosurgeons working in Germany, the current practice of perioperative pain management was investigated.
METHODS
Members of the German Society for Dermatosurgery (DGDC) and heads of dermatosurgical departments were asked to participate. Questions were related to practical implementation of perioperative pain management, pain documentation and personal sources of information on the topic.
RESULTS
116 questionnaires were analyzed. While prophylactic analgesia is rarely used, the vast majority (86%) reported the use of postoperative on-demand medication. The majority of surgeons do not have a fixed regimen. Mostly NSAIDs and occasionally low potency opioids are used. Pain is documented by the majority (59.1%) as free text. Personal experience (69%) and in-house standards (51%) are the most important factors in pain management. The use of guidelines (25%) plays a minor role.
CONCLUSIONS
Perioperative pain management in dermatosurgery is strongly influenced by personal experience and may vary depending on the surgery performed. Consensus-based standardized recommendations are lacking. For adequate perioperative analgesia, the development of demand-oriented pain concepts is desirable. This requires prospective studies that address the specific patient population and surgical procedures in dermatology.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
985-990Informations de copyright
© 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.
Références
Pain Terms and Definitions. Available from: https://www.iasp-pain.org/resources/terminology/ #pain [Last accessed July 12, 2022].
Legrain V, Mancini F, Sambo CF, et al. Cognitive aspects of nociception and pain. Bridging neurophysiology with cognitive psychology. Neurophysiol Clin. 2012;42(5):325-336.
Kröner-Herwig B. Einfluss von kognitiv-emotionalen Prozessen auf Schmerz und Funktionsbeeinträchtigung: Eine psychobiologische Perspektive. Schmerz. 2014;28(5):537-546.
Riecke J, Zerth SF, Schubert AK, et al. Risk factors and protective factors of acute postoperative pain: an observational study at a German university hospital with cross-sectional and longitudinal inpatient data. BMJ Open. 2023 May 8;13(5):e069977.
Di Fabio U, Deutschland, Europäische Union, et al. (eds.). Grundgesetz. 52. Auflage, Stand: 1. Oktober 2021, dtv Verlagsgesellschaft, 2022.
Nashan D, Meiss F, Gralow I. Pain: Basics and relevance in dermatology. J Dtsch Dermatol Ges. 2009;7(8):704-716.
Beiteke U, Bigge S, Reichenberger C, Gralow I. Pain and pain management in dermatology. J Dtsch Dermatol Ges. 2015;13(10):967-987.
Glass JS, Hardy CL, Meeks NM, Carroll BT. Acute pain management in dermatology. J Am Acad Dermatol. 2015;73(4):543-560.
Bialas P, Hubner W, Volk T, et al. Aktuelle Aspekte zum Schmerzmanagement während und nach dermatologischen Operationen. Hautarzt. 2019;70(11):854-863.
Saco M, Golda N. Postoperative pain management in dermatologic surgery. Dermatol Clin. 2019;37(3):341-348.
Beck, Martin, Motsch, Schulte am Esch (eds.). Band 4: Schmerztherapie. Georg Thieme Verlag, 2002:b-001-3178.
Bialas P, Hubner W, Vogt T, et al. [Practice-oriented pain therapy in dermatology : Concept with special emphasis on pain quality]. Hautarzt. 2018;69(1):48-57.
Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514-517.
AWMF. S3-Leitlinie “Behandlung akuter perioperativer und posttraumatischer Schmerzen”. AWMF-Register Nr. 001/025, Version 4.0. Published online September 2021. Available from: https://register.awmf.org/assets/guidelines/001-025l_S3_Behandlung-akuter-perioperativer-posttraumatischer-Schmerzen_2022-11.pdf [Last accessed April 28, 2023]
Müller CSL, Hubner W, Thieme-Ruffing S, et al. Pre- and perioperative aspects of dermatosurgery. J Dtsch Dermatol Ges. 2017;15(2):117-146.
Crisan D, Scharffetter-Kochanek K, Kastler S, et al. Dermatologic surgery in children: an update on indication, anesthesia, analgesia and potential perioperative complications. J Dtsch Dermatol Ges. 2018;16(3):268-276.
Eckardt J, Häfner HM, Kofler K, et al. Post-operative follow-up of 150 patients with sentinel lymph node biopsy under tumescence local anesthesia. J Dtsch Dermatol Ges. 2021;19(4):536-543.
Raffa RB, Pergolizzi JV. A modern analgesics pain ‘pyramid. J Clin Pharm Ther. 2014;39(1):4-6.
Bialas P, Welsch K, Gronwald B, et al. Auswirkung einer stationsweiten Standardisierung der Akutschmerztherapie: Parameter zur Patienten- und Providerzufriedenheit und Kostenstruktur (STANDAKU). Schmerz. 2018;32(6):449-455.
Hilfiker R. Schmerzintensität messen: Assessment: Visuelle Analog- und Numerische Ratingskala. physiopraxis. 2008;6(11/12):46-47.
Bornemann-Cimenti H, Wejbora M, Michaeli K, et al. Schmerzerfassung bei Demenz. Nervenarzt. 2012;83(4):458-466.
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003 Jan-Feb;4(1):9-15.