Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Randomized Controlled Trial Clinical Trial
[Postoperative analgesia after endoscopic abdominal operations. A randomized double-blind study of perioperative effectiveness of metamizole].
In comparison to conventional operating technique endoscopic surgery reveals numerous advantages, particular rapid mobilisation and earlier discharge from observation. For a effective utilization of these advantages, it is desirable to have a efficient postoperative analgesic scheme, which can be continued into the period after discharge from hospital. In a randomised, prospective double-blind study we investigated the analgesic efficacy of dipyrone in 40 patients, scheduled for endoscopic abdominal surgery (mainly endoscopic cholecystectomy). ⋯ After surgery all patients were allowed to self-administer buprenorphine intravenously from a PCA-pump (Bolus 30 micrograms, lockout 5 min in the recovery room, 30 min on the ward). Every hour for the first 6 h and after 24 h, cumulated doses of buprenorphine, pain scores (0-10), pulse, blood pressure and side effects were recorded. Dipyrone-treated patients had significantly less pain immediately after surgery and used a significantly lower cumulated dose of buprenorphine (-67%; 90 micrograms vs. 270 micrograms buprenorphine) in the first 24 h after surgery.
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A high-risk patient is a challenge to the anaesthesiologist. If surgical intervention is indicated the perioperative anaesthesiological management has to be carefully adapted to the requirements of the patient. If the patient is classified a high-risk at the preoperative anaesthesiological assessment, the therapeutic management has to aim at optimizing the patient's preoperative physical status. ⋯ During the postoperative period each high-risk patient has to be observed in the intensive care unit to continue intraoperative monitoring and therapy. Patients at risk of postoperative myocardial ischaemia or infarction should be closely monitored for 3-5 days postoperatively. The perioperative risk of morbidity and mortality associated with elective surgical procedures has to be evaluated for each patient and the risk-benefit analysis discussed in a interdisciplinary dialogue involving the surgeon, the patient and the patient's family.