Observationsstudie der klinischen Auswirkungen der Umstellung von individueller Schmerztherapie auf einen Algorithmus in der Hals-Nasen-Ohrenheilkunde
Loading...
Files
Date
Authors
Publisher
Philipps-Universität Marburg
Supervisors
Abstract
Introduction: Postoperative pain may be managed adequately by structured concepts. Recommendations are available for a number of surgical procedures. However, for ENT- surgery a stepwise algorithm is lacking so far. In a prospective observational study we investigated pain control after implementation of an algorithm.
Methods: We started an observational clinical trial after approval of our ethics committee. In phase 1 we documented pain after tonsillectomy in patients receiving pain killers as required. In phase 2 we observed patients who received a standardized pain treatment. Patients reported pain in standardized questionnaires with a numerical analogue scale (0= no pain, 10= maximum pain). Cognitive deficits were tested using a Montreal- Test. The primary endpoint was pain over time. Other data were extracted from patient chart. Statistical analysis included an ANOVA. The tests were performed with GraphPad.
Results: In phase 1 45 of 63 patients and in phase 2 51/ 117 patients were analyzed. The implementation of our algorithm was associated with a reduced use of cyclooxycenase-1-inhibitores and increased utilization of opioids (p<0.0001). We found a statistically significant reduction in postoperative pain in phase 2 compared to phase 1 (p<0.0001). Pain at rest of less than 3 (NRS 0-10) was increased in phase 2 (p=0.0014), but not pain <5 (NRS 0-10) on movement (p=0.225). We found no significant difference in cognitive deficits in phase 1 or 2 (p>0.05). Patients in phase 2 reported more often signs of sedation (p<0.0001). In our patients, we observed a trend to reduced hemorrhage after tonsillectomy.
Conclusion: Our algorithm provided better pain control with increased sedation, but perhaps a reduction in hemorrhage after tonsillectomy. The latter observation needs further evaluation.
Review
Metadata
Contributors
Supervisor:
Dates
Created: 2020Issued: 2020-06-08Updated: 2020-06-08
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
DDC-Numbers
610
show more
Bezas, Vasileios: Observationsstudie der klinischen Auswirkungen der Umstellung von individueller Schmerztherapie auf einen Algorithmus in der Hals-Nasen-Ohrenheilkunde. : Philipps-Universität Marburg 2020-06-08. DOI: https://doi.org/10.17192/z2020.0217.