Procedure specific multimodal protocols for treatment

1. Procedure specific multimodal protocols for treatment of postoperative pain: standard for gynaecology Postoperative oral/i.v. analgesia Preventive analgesia Regional analgesia Expected pain level Surgical procedure curettage of the uterus hysteroscopy cervical conisation diagnostic breast excision diagnostic and therapeutic laparoscopy, hysterectomy Wertheim hysterectomy, other radical abdominal surgeries piritramide 3-7.5 mg i.v. in ARR acetaminophen max. 4 x 1 g or 4 x 1 g metamizol piritramide 3-7.5 mg i.v. in ARR acetaminophen max. 4 x 1 g or 4 x 1 g metamizol orally and i.v. PCA-pump with piritramide acetaminophen i.v. max. 4 x 1 g or i.v. 4 x 1 g metamizol, oral nonopioids from 3 postOp day NRS 3-5 acetaminophen 1 g NRS 5-7 epidural analgesia or i.v. PCA-pump with piritramide NRS 7-9 NRS – Numeric Rating Scala from 0=no pain to 10=maximal pain; Piritramide – weak opioid analgesic with potency 0.7 of morphine; PCA – patient-controlled analgesia