Background and Goals: Surgical intervention in palliative care is common. In a study by Krouse et al. (2001) palliative surgeries comprised 12.5% of surgical procedures in one year at an American surgical department. Many of these patients have a standard medication with strong opioids, but the influence, this medication has on perioperative management, especially on postoperative pain, is still not known. We explored the postoperative pain of patients after palliative surgery and compared them with patient undergoing non-palliative surgical procedures.
Material and Methods: We studied 40 patients after surgery. 20 patients had palliative surgical interventions and a preoperative medication of transdermal fentanyl longer than two weeks. The control group of 20 patients had no opioid standard medication and non-palliative surgery. Both groups received a balanced anaesthesia and a standard patient controlled analgesia (PCA) after surgery. Pain sores (VAS=visual analogue score; 0 -10), presence and intensity of side effects and patient satisfaction was enquired the first three days after surgery, vital parameters and medication (PCA and other) were monitored.
Results: There was a higher postoperative demand of PCA in the palliative group (63+/12 mg piritramide/day vs. 38+/9 mg). Still the palliative patients had higher pain scores (5.7+/-1.8 vs. 3.8+/-1.2 at 1st day, U-test: p < 0.05). There was no difference in the incidence of side effects and in the patients’ satisfaction.
Conclusions: Standard patient controlled analgesia is less effective in palliative patients with a medication of trans-dermal fentanyl, in spite of a higher piritramide-demand in this group. An adjustment of this method for palliative patients is needed.