In Reply

Letters to the Editor regarding the article Pain After Outpatient Surgical Procedures A Survey of 330 000 Patients by Dr. phil. Philipp Baumbach; Dr. med. Johannes Dreiling; Dr. rer. nat. Christin Arnold; Claudia Weinmann, MA; Dr.-Ing. Marcus Komann; Dr. med. Klaus Bäcker; Dr. med. Axel Neumann; Dr. med. Jörg Karst; and Prof. Dr. med. Winfried Meißner in issue 3/2024

We thank Prof. Holzheimer for his comments on our article (1). In the subgroup of patients with herniotomies (n=19 973/330 008; 6.1%), 89.0% of procedures were carried out under general anesthesia (n=17 772/19 973), 1.1% under exclusively regional/local anesthesia (n=220/19 973), and 7.4% under combined anesthesia (n=1 482/19 973). We fully support his view that local analgesia as the main approach or as an add-on in herniotomy (and actually pretty much in all surgical procedures) should be undertaken as a matter of routine.

The current guidelines for treating acute perioperative and post-traumatic pain recommend perioperative local anesthesia in certain procedures with A—the top category of recommendation (2).

The present study of observational data did not aim to investigate the effectiveness of analgesic approaches. But registry data also showed that the introduction of local anesthesia into routine clinical practice (in this case in the context of laparoscopic hysterectomies) the intensity of pain in the affected patients declined significantly (3). All surgical sectors—inpatient as all as outpatient surgery and anesthesia—would benefit from comparing and documenting randomly selected results from the patient perspective, which is easily possible using the tools AQS1 and QUIPS.

DOI: 10.3238/arztebl.m2024.0106

On behalf of the authors

Apl. Prof. Dr. med. Winfried Meißner

Klinik für Anästhesiologie und Intensivmedizin
Universitätsklinikum Jena

Conflict of interest statement

WM received consulting fees from Tafalgie, Grünenthal, Ethypharm, Mundipharma, Sanofi, and Merck. He received lecture fees from Grünenthal, Mundipharma, Spectrum Therapeutics, and Kyowa. He is a member of the executive committee of the German Pain Society (Deutsche Schmerzgesellschaft).

References

1. Baumbach P, Dreiling J, Arnold C, Weinmann C, Komann M, Bäcker K, Neumann A, Karst J, Meißner W: Pain after outpatient surgical procedures—a survey of 330 000 patients. Dtsch Arztebl Int 2024; 121: 71–8

2. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI): Behandlung akuter perioperativer und posttraumatischer Schmerzen, Version 4.1 vom 25.11.2022 https://register.awmf.org/de/leitlinien/detail/001-025 (last accessed on 28 May 2024).

3. Jiménez Cruz J, Diebolder H, Dogan A,et al.: Combination of pre-emptive port-site and intraoperative intraperitoneal ropivacaine for reduction of postoperative pain: a prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2014; 179: 11–16