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Perioperative Atemtherapie und postoperative Schmerztherapie

Prevention of Postoperative Pulmonary Complications and Postoperative Pain

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Deutsche Gesellschaft für Chirurgie

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Summary

Especially patients with preexisting bronchopulmonary diseases or those undergoing operations in the upper abdomen or thoracotomies are suspectible to postoperative pulmonary complications. All patients at risk should learn the prophylactic respiratory maneuvers preoperatively. Perioperative use of incentive spirometers, breathing exercises or IPPB seems to reduce the incidence of postoperative pulmonary complications.

Opioids are used usually for postoperative pain management, but unfortunately they are given mainly as i.m. injections, although an i.v. administration would be far better. If given in an equipotent dose, nearly every opioid provides sufficient postoperative analgesia. Wide interindividual variation in the needed dose requires that opioids be titrated intravenously.

Zusammenfassung

Besonders bei vorbestehenden bronchopulmonalen Funktionseinschränkungen sowie nach Oberbauch- und Thoraxeingriffen drohen postoperativ pulmonale Komplikationen. Gefährdete Patienten müssen bereits präoperativ die Atemtherapie erlernen. Durch Einsatz von incentive Spirometern, Atemübungen oder IPPB kann die Komplikationsrate nach verschiedenen Untersuchungen gesenkt werden.

Zumeist werden in der postoperativen Phase Opioide verabreicht. Unverständlicherweise wird zumeist eine i.m.-Applikation durchgeführt, vorzuziehen ist immer eine i.v.-Injektion. Mit fast jedem Opioid kann eine suffiziente Schmerztherapie erreicht werden, falls es in äquipotenter Dosierung eingesetzt wird. Da der Opioidbedarf interindividuell sehr stark variieren kann, sollte die Dosierung nach Bedarf fraktioniert intravenös titriert werden.

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Literatur

  1. Angell M (1982) The quality of mercy. N Engl J Med 306:98–99

    Article  PubMed  CAS  Google Scholar 

  2. Austin KL, Stapleton JV, Mather LE (1980) Multiple intramuscular injections: a major source of variability in analgesic response to meperidine. Pain 8:47–62

    Article  PubMed  CAS  Google Scholar 

  3. Bach S, Noreng MF, Tjéllden NU (1988) Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain: 33:297–301

    Article  PubMed  CAS  Google Scholar 

  4. Bacon AK (1977) An alternative block for post circumcision analgesia. Anaesth Intens Care 5:63–64

    CAS  Google Scholar 

  5. Bartlett RH, Gazzaniga AB, Geraghty TR (1973) Respiratory maneuvers to prevent postoperative pulmonary complications. JAMA 224:1017–1021

    Article  PubMed  CAS  Google Scholar 

  6. Bartlett RH (1984) Respiratory therapy to prevent pulmonary complications of surgery. Resp Care 29:667–679

    Google Scholar 

  7. Bateman JRM, Newman SP, Daunt KM, Sheahan NF, Pavia D, Clarke SW (1981) Is cough as effective as chest physiotherapy in the removal of excessive tracheobronchial secretions? Thorax 36:683–687

    Article  PubMed  CAS  Google Scholar 

  8. Brandi M (1983) Präoperative Atemtherapie. Anästh. Intensivmed. 24:206–213

    Google Scholar 

  9. Bromage PR (1988) A postoperative pain management service. Anesthesiology 69:435 (Correspondence)

    Article  PubMed  CAS  Google Scholar 

  10. Catley DM, Thornton C, Tech CJB, Lehane JR, Roystone D, Jones JG: Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology 1985, 63:20–28

    Article  PubMed  CAS  Google Scholar 

  11. Catling JA, Pinto DM, Jordan C, Jones JG (1980) Respiratory effects of analgesia after cholecystectomy: comparison of continuous and intermittent papaveretum. Br Med J 281:478–480

    Article  PubMed  CAS  Google Scholar 

  12. Celli BR, Rodriguez KS, Snider GL (1984) A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Resp Dis 130:12–15

    PubMed  CAS  Google Scholar 

  13. Cohen FL (1980) Postsurgical pain relief: Patients status and nurses medication choices. Pain 9:265–274

    Article  PubMed  CAS  Google Scholar 

  14. Cousins MJ, Mather LE (1984) Intrathecal and epidural administration of opioids. Anesthesiology 61:276–310

    Article  PubMed  CAS  Google Scholar 

  15. Craig DB (1981) Postoperative recovery of pulmonary function. Anesth Analg 60:46–52

    PubMed  CAS  Google Scholar 

  16. Cuschieri RJ, Morran CG, Howie JC, McArdle CS (1985) Postoperative pain and pulmonary complications: comparison of three analgesic regimens. Br J Surg 72:495–498

    Article  PubMed  CAS  Google Scholar 

  17. Dick W, Knoche E, Grundlach G, Klein I (1983) Klinisch experimentelle Untersuchungen zur postoperativen Infusionsanalgesie. Anaesthesist 32:272–278

    PubMed  CAS  Google Scholar 

  18. El-Baz N, Faber LP, Ivankovich AD (1988) Intrapleural infusion of local anesthetic: a word of caution. Anesthesiology 68:809–810

    Article  PubMed  CAS  Google Scholar 

  19. Engberg G, Wiklund L (1988) Pulmonary complications after upper abdominal surgery: their prevention with intercostal blocks. Acta Anaesthesiol Scand 32:1–9

    Article  PubMed  CAS  Google Scholar 

  20. Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41:242–255

    Article  PubMed  CAS  Google Scholar 

  21. George RJD, Johnson MA, Pavia D, Agnew JE, Clarke SW, Geddes DM (1985) Increase in mucociliary clearance in normal man induced by oral high frequency oscillation. Thorax 40:433–437

    Article  PubMed  CAS  Google Scholar 

  22. Giebel O (1962) Der Einfluß künstlicher Totraumvergrößerung auf Ventilation und Blutgase. 79. Tagung Verhandlungen der Deutschen Gesellschaft für Chirurgie, Langenbecks Arch. und Dtsch. Z. f. Chirurgie 301:543–548

    Article  Google Scholar 

  23. Giebel O (1963) Ursachen und Behandlung postoperativer arterieller Hypoxie. 80. Tagung Verhandlungen der Deutschen Gesellschaft für Chirurgie, Langenbecks Arch. und Dtsch. Z. f. Chirurgie 304:212–215

    Article  CAS  Google Scholar 

  24. Giebel O (1964) Das Verhalten der alveolo-arteriellen Sauerstoffdruck-Differenz bei Spontanatmung mit Totraumvergrößerung. Anästhesist 13:337–340

    CAS  Google Scholar 

  25. Graber JN, Schulte WJ, London RE, Cowles VE (1982) Relationship of duration of postoperative ileus to extent and site of operative dissection. Surgery 92:87–92

    PubMed  CAS  Google Scholar 

  26. Groth S, Stafanger G, Dirksen H, Andersen JB, Falk M, Kelstrup M (1985) Bull Eur Physiopathol Respir 21:339–343

    PubMed  CAS  Google Scholar 

  27. Grund KE, Jügelt U, Raulf F (1982) Sympathicolyse: Alternatives Konzept zur Therapie funktioneller Ileuszustände. Anaesthesist 31:498

    Google Scholar 

  28. Hasenbos M, van Egmond J, Gielen M, Crul JF (1987) Postoperative analgesia by high thoracic epidural versus intramuscular nicomorphine after thoracotomy. Part III. Acta Anaesthesiol Scand 31:608–615

    Article  PubMed  CAS  Google Scholar 

  29. Hendolin H, Lahtinen J, Länsimies E, Tuppurainen T, Partenen K (1987) The effect of thoracic epidural analgesia on respiratory function after cholecystectomy. Acta Anaesthesiol Scand 31:645–651

    Article  PubMed  CAS  Google Scholar 

  30. Hengstum van M, Festen J, Beurskens C, Hankel M, Van Den Broek W, Buijs W, Corstens F (1988) The effect of positive exspiratory pressure versus forced expiration technique on tracheobronchial clearance in chronic bronchitics. Scand J Gastroenterol 23 (Suppl 143):114–118

    Article  Google Scholar 

  31. Hofmeyer JL, Webber BA, Hodson ME (1986) Evaluation of positive exspiratory pressure as an adjunct to chest physiotherapie in the treatment of cystic fibrosis. Thorax 41:951–954

    Article  Google Scholar 

  32. Hjortso NC, Neumann P, Frosig F, Andersen T, Lindhard A, Rogon E, Kehlet H (1985) A controlled study on the effect of epidural analgesia with local anaesthetics and morphine on morbidity after abdominal surgery. Acta Anaesthesiol Scand 29:790–796

    Article  PubMed  CAS  Google Scholar 

  33. King M, Phillips DM, Gross D, Vartian V, Chang HK, Zidulka A (1983) Enhanced tracheal mucus clearance with high frequency chest wall compression. Am Rev Respir Dis 128:511–515

    PubMed  CAS  Google Scholar 

  34. Krimmer H, Pfeiffer H, Arbogast R, Sprotte G (1986) Die kombinierte Infusionsanalgesie — Ein alternatives Konzept zur postoperativen Schmerztherapie. Chirurg 57:327–329

    PubMed  CAS  Google Scholar 

  35. Latimer RG, Dickmann M, Day WC, Gunn ML, Schmidt CDuD (1971) Ventilatory patterns and pulmonary complications after upper abdominal surgery determined by preoperative and postoperative computerized spirometry and blood gas analysis. Am J Surg 122:622–632

    Article  PubMed  CAS  Google Scholar 

  36. Lehmann KA, Henn C (1987) Zur Lage der postoperativen Schmerztherapie in der Bundesrepublik Deutschland. Ergebnisse einer Repräsentativumfrage. Anaesthesist 36:400–406

    PubMed  CAS  Google Scholar 

  37. Lehmann KA (1988) Postoperative Schmerztherapie. Refresher-Kurs Mannheim. Stemmler, Köln

    Google Scholar 

  38. Lehmann KA, Gördes B, Hoeckle W (1985) Postoperative On-demand-Analgesie mit Morphin. Anaesthesist 34:494–501

    PubMed  CAS  Google Scholar 

  39. Levack ID, Holmes JD, Robertson GS (1986) Abdominal wound perfusion for the relief of postoperative pain. Br J Anaesth 58:615–619

    Article  PubMed  CAS  Google Scholar 

  40. Mackenzie CF, Shin B, McAslan TC (1978) Chest Physiotherapy: The effect on arterial oxygenation. Anesth Analg 57:28–30

    Article  PubMed  CAS  Google Scholar 

  41. Mang H, Weindler J, Zapf ChL (1989) Postoperative Atemtherapie mit Incentive Spirometry. Anaesthesist 38:200–205

    PubMed  CAS  Google Scholar 

  42. Mead J, Collier C (1959) Relation of volume history of lungs to respiratory mechanics in anesthetized dogs. J Appl Physiol 14:669–678

    Google Scholar 

  43. Modig J (1982) Thromboembolism and blood loss. Continuous epidural block versus general anesthesia with controlled ventilation. Regional Anesth (Suppl) 7:S84–88

    Google Scholar 

  44. Moss G, Regal ME, Lichtig L (1986) Reducing postoperative pain, narcotics, and length of hospitalization. Surgery 99:206–210

    PubMed  CAS  Google Scholar 

  45. Nimmo WS, Duthie DJR (1987) Pain relief after surgery. Anaesth Intens Care 15:68–71

    CAS  Google Scholar 

  46. O’Donohue WJ (1985) National survey of the usage of lung expansion modalities for the prevention and treatment of postoperative atelectasis following abdominal and thoracic surgery. Chest 87:76–80

    Article  PubMed  Google Scholar 

  47. O’Donohue WJ (1985) Prevention and treatment of postoperative atelectasis. Chest 87:1–2

    Article  PubMed  Google Scholar 

  48. Owen H, Galloway DJ (1984) The effect of incisional infiltration of 0,5% bupivacaine on pain after surgery. Br J Anaesth 56 (Suppl): 1292–1293

    Google Scholar 

  49. Patel JM, Lanzafame RJ, Williams JS, Mullen BV, Hinshaw JR (1983) The effect of incisional infiltration of bupivacaine hydrochloride upon pulmonary functions, atelectasis and narcotic need following elective cholecystectomy. Surg Gynecol Obstet 157:338–340

    PubMed  CAS  Google Scholar 

  50. Pontoppidan H (1980) Mechanical aids to lung expansion in non-intubated surgical patients. Am Rev Resp Dis 122:109–119

    PubMed  CAS  Google Scholar 

  51. Rawal N, Sjöstrand U, Christoffersson E, Dahlström B, Arvill A, Rydman H (1984) Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function. Anesth Analg 63:583–592

    PubMed  CAS  Google Scholar 

  52. Ready LB, Oden R, Chadwick HS, Benedetti C, Rooke GA, Caplan R, Wild LM (1988) Development of an anesthesiology-based postoperative pain management service. Anesthesiology 68:100–106

    Article  PubMed  CAS  Google Scholar 

  53. Ricksten SE, Bengtsson A, Soderberg C, Thorden M, Kvist H (1986) Chest 89:774–781

    Article  PubMed  CAS  Google Scholar 

  54. Rosenberg PH, Renkonen OV (1985) Antimicrobial activity of bupivacaine and morphine. Anesthesiology 62:178–179

    Article  PubMed  CAS  Google Scholar 

  55. Rosenberg PH, Scheinin BMA, Lepäntalo MJA, Lindfors O (1987) Continuous intrapleural infusion of bupivacaine for analgesie after thoracotomy. Anesthesiology 67:811–813

    Article  PubMed  CAS  Google Scholar 

  56. Rügheimer E (1987) Postoperative Atemtherapie. In: Lawin P (Hrsg) Aktuelle Aspekte und Trends in der respiratorischen Therapie. Springer, Berlin Heidelberg New York Tokyo, S. 23–45

    Chapter  Google Scholar 

  57. Scheinin B, Lindgren L, Rosenberg PH (1989) Treatment of postthoracotomy pain with intermittent instillations of intrapleural bupivacaine. Acta Anaesthesiol Scand 33:156–159

    Article  PubMed  CAS  Google Scholar 

  58. Schlosser D (1972) Die Auswirkungen einmaliger Atemgymnastik mit Totraumvergrößerern auf Lungenvolumina, Ventilation und Blutgase vor und nach Oberbauchoperationen. Anaesthesist 21:311–314

    PubMed  CAS  Google Scholar 

  59. Seeling W, Bruckmooser KP, Hüfner C, Kneitinger E, Rigg C, Rockemann M (1990) Keine Verminderung postoperativer Komplikationen durch Katheterperiduralanalgesie nach großen abdominalen Eingriffen. Anaesthesist 39:33–40

    PubMed  CAS  Google Scholar 

  60. Tamsen A, Hartvig P, Dahlström B, Lindström B, Holmdahl MH (1979) Patient controlled analgesic therapy in the early postoperative period. Acta Anaesthesiol Scand 23:462–470

    Article  PubMed  CAS  Google Scholar 

  61. Thoren L (1975) Postoperative pulmonary complications: Observation on their prevention by means of physiotherapy. Acta Chir Scand 107:193

    Google Scholar 

  62. Tokics L, Hedenstierna G, Strandberg A, Brismar B, Lundquist H (1987) Lung collapse and gas exchance during general anesthesia: effects of spontaneous breathing, muscle paralysis, and positive end-exspiratory pressure. Anesthesiology 66:157–167

    Article  PubMed  CAS  Google Scholar 

  63. Tree-Trakarn T, Pirayavaraporn S, Lertakyamanee J (1987) Topical analgesia for relief of post-circumcision pain. Anesthesiology 67:395–399

    Article  PubMed  CAS  Google Scholar 

  64. Yanda RL (1974) Quality control of inhalation therapy: the results of therapy, with and without control, and methods of developing such control, in a community hospital. Chest 66:61–66

    Article  PubMed  CAS  Google Scholar 

  65. Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T (1987) Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 66:729–736

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik für Anaesthesiologie und operative Intensivmedizin, Klinikum Steglitz der FU Berlin, Deutschland

    H. W. Striebel & K. Reinhart

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  1. H. W. Striebel
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  2. K. Reinhart
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  1. Generalsekretär d. Deutschen Gesellschaft f. Chirurgie, Steinbacher Hohl 28, D-6000, Frankfurt a.M. 90, Deutschland

    E. Ungeheuer

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Striebel, H.W., Reinhart, K. (1990). Perioperative Atemtherapie und postoperative Schmerztherapie. In: Ungeheuer, E. (eds) Deutsche Gesellschaft für Chirurgie. Langenbecks Archiv für Chirurgie Gegründet 1860 Kongreßorgan der Deutschen Gesellschaft für Chirurgie, vol 1990. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-48163-5_228

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  • DOI: https://doi.org/10.1007/978-3-642-48163-5_228

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