Postoperative pain therapy using on-demand analgesia after external ear reconstruction with rib cartilage harvesting

Abstract

The individual experience of postoperative pain values considerably. It is the patient who can best evaluate the intensity of pain and the effect of a given analgesic substance. Patient-controlled analgesia (PCA) enables the patient to self-administer an i.v. analgesic bolus by pressing a button of an electronic pump device within a previously set range. If needed. The resection of rib cartilage to be used for ear reconstructions is associated with intense postoperative pain. This could result in unfavorable stress responses such as impaired cough and clearance of lung secretions carrying a greater risk of bronchitis or pneumonia, prolonged mobilization, and complications of wound healing. Therefore, individually adapted pain therapy is of great importance and technically feasible with modern PCA devices. Informed and cooperative children aged five years and older and adults without severe health risks are suitable for PCA. Management, handling, monitoring and documentation of the PCA device are discussed. A 24-hour counselling service is maintained for occurring problems. Almost all patients expressed their great satisfaction with the means of pain therapy. Few patients were apprehensive. The initial scepticism of the involved personnel concerning opioid abuse, over-dosage, or technical problems gave way for a support of the PCA once the great satisfaction of the patients in absence of side effects was witnessed. No patient had to be antagonized for respiratory depression. Nausea and vomiting were rare events. Patient-controlled analgesia proved to be an excellent answer to postoperative pain after resections of rib cartilage.