[A concept for the improvement of postoperative pain management]

Many articles in the literature document the fact that postoperative pain therapy has not improved for decades despite new insights into pain physiology, the availability of powerful analgesics and the development of new techniques. This project was set up to develop practical, effective, safe, and easy to run acute pain therapy. METHODS. Postoperative pain management had to be optimized according to the facilities available today. Therefore, the legal background is presented first. Second, several medical and organizational principles were chosen to serve as a basis for the new organizational structure: Continuously monitoring the patient's pain during the whole stay in hospital, Introduction of a simple verbal 4-point pain score for determination and documentation of pain allowing the nurses to differentiate pain that should be treated or not, A simple sedation score, Use of "balanced analgesia" and "pre-emptive analgesia", Drug administration according to the needs of the patient, Partial transfer of the responsibility for pain treatment to nurses. Plans and algorithms were expanded to allow nurses and anaesthesiologists to reach the previously determined goals. RESULTS. In a small study including 107 patients, it was demonstrated that the quality of pain treatment improved significantly. Furthermore, patients, nurses and physicians are much more content with the new pain treatment regimen. DISCUSSION. The difficulties in realizing such a concept are described. The importance of thorough teaching is underlined in a nurse-based system. However, it is not yet clear whether this pain treatment has resulted in reduced morbidity, reduced mortality and a shortened hospital stay of the patients.