Holthausen U, Troidl H
Chirurigische Klinik Köln-Merheim, II. Lehrstuhl für Chirurgie, Universität zu Köln.
Chirurg. 1996 Jul;67(7):671-80.
Pain therapy is a central medical task and a legal duty. Not the anaesthetist but the pain-causing surgeon is responsible for therapy of pain. Pain as a negative sensation is subjective and individual. Postoperative pain is an essential aspect of the topic "pain in surgery". Therapy starts with the awareness of the problem. Effective pain therapy requires clinical competence and application of available therapeutic options. Initial steps of successful pain treatment include: an informative dialogue with the patient, conveying of confidence, and skillful choice of diagnostic and/or therapeutic options. Application of drugs presupposes detailed knowledge of their specific effects. For convincing therapeutic results, one has to analyse different causes of pain. Acute surgical pain is classified and treated according to a three-step scheme: intense pain with strong opioids, intermediate pain with weaker opioids or non-opioids, and slight pain with non-steroidal anti-inflammatory drugs. Opioids are used with caution in abdominal surgery because of their negative effects (obstipation), the same is the case with Novalgin in trauma patients because of its effect on temperature and leukopenia. Patient-controlled analgesia with appropriate devices means further progress for suitable patients. Effective pain therapy within the framework of successful surgery is feasible and influences patients' comfort and possibly even their morbidity and mortality.
疼痛治疗是一项核心医疗任务，也是一项法定义务。疼痛治疗的责任在于引发疼痛的外科医生，而非麻醉医生。疼痛作为一种负面感觉，具有主观性和个体差异性。术后疼痛是“外科手术中的疼痛”这一主题的重要方面。治疗始于对问题的认识。有效的疼痛治疗需要临床能力以及运用现有的治疗方法。成功进行疼痛治疗的初步步骤包括：与患者进行信息交流、给予信心，并巧妙选择诊断和/或治疗方法。药物的应用以对其具体作用的详细了解为前提。为了获得令人信服的治疗效果，必须分析疼痛的不同成因。急性外科疼痛按照三步方案进行分类和治疗：剧痛使用强效阿片类药物，中度疼痛使用较弱的阿片类药物或非阿片类药物，轻度疼痛使用非甾体抗炎药。由于阿片类药物的副作用（便秘），在腹部手术中应谨慎使用；同样，由于诺瓦经对体温和白细胞减少的影响，在创伤患者中也应谨慎使用。使用适当设备进行患者自控镇痛对于合适的患者而言意味着进一步的进展。在成功手术的框架内进行有效的疼痛治疗是可行的，并且会影响患者的舒适度，甚至可能影响其发病率和死亡率。
