Postoperative pain therapy in orthopedics
Orthopedic interventions are often associated with severe pre-existing pain. This is particularly relevant because pre-existing pain is an important risk factor for the development of chronic pain. Adequate peri- and postoperative pain therapy is therefore all the more important.
Preoperatively, gabapentin can be administered, especially in spinal surgery, and intraoperatively, a glucocorticoid can be administered locally for radicular pain. In principle, local-regional procedures are preferable to systemic forms of pain therapy for operations on the extremities. The often easily accessible location of the various nerve plexuses and the general advantages of regional anesthesia often make this possible for peripheral interventions. However, if a regional anesthesia is not feasible, treatment with strong opioids according to level 3 of the WHO step-by-step scheme is recommended.
Postoperative pain therapy for children
Contrary to the strongly outdated opinion newborns cannot yet feel pain, it is known today that children already perceive pain from the 24th week of pregnancy. From this time on, pain in children should be treated. The postoperative pain therapy for children is essentially based on the same fundamentals and principles as the pain therapy for adult patients.
Differences can be found, especially in the first 12 months of life, in terms of the altered distribution, alteration, degradation and excretion (pharmacokinetics) of many drugs. This is particularly true in the first weeks of life. In addition, many drugs are not approved for the first months or years of life.
Nevertheless, this should not lead to the small patients being deprived of analgesics if they are needed – despite the lack of approval! Nevertheless, paracetamol is the most important analgesic for children and is approved for every age group. Ibuprofen is approved from the age of 3 months. In addition to systemic drug-based pain therapy, regional pain management and non-drug treatment concepts should not be neglected in children.
