Zalecenia postępowania w bólu pooperacyjnym AD 2014

On the initiative of the Polish Association of the Study of Pain, Polish Society of Anesthesiology and Intensive Therapy and community of anesthesiologists, a multidisciplinary working group composed of representatives of the above entities reviewed the most recent literature reports regarding acute post-operative pain management in adults and children and prepared recommendations outlined below. The reason of the need for updating the 2011 guidelines was to introduce the newest pain treatment strategy, i.e. multimodal therapy with special emphasis on the use of new drug formulations, another approach to known and commonly used anesthetics and manner of their administration. An attempt was made to adjust the organization of perioperative pain management to the currently recommended trends in safety management within the framework of the unfolding program “Hospital without pain”. The group supported the model of prognostication of post-operative pain developed by specialists in many surgical disciplines, and each model was expanded to include methods of pain management that are to be systematically updated to keep up with scientific progress. The updated guidelines are more “cautious” than the former ones in recommending the extradural techniques of pain control in favor of regional anesthesia with peripheral nerve blockade or the multimodal analgesia. The current recommendations, like the former guidelines, contain references to recent evidence-based medicine resources. Some of them rely on clinical experience and expert opinions but result only from single reports and require further studies. These are only suggestions which are not reflected in characteristics of each individual medicinal product, thus, they are used off label.Z inicjatywy Polskiego Towarzystwa Badania Bólu, Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii oraz środowiska anestezjologów, multidyscyplinarna grupa robocza w składzie jak wyżej, dokonała przeglądu najnowszego piśmiennictwa z zakresu postępowania w ostrym bólu pooperacyjnym w przypadku osób dorosłych i dzieci i przygotowała poniższe zalecenia. Powodem aktualizacji wytycznych z 2011 roku była konieczność przybliżenia nowoczesnej strategii terapii multimodalnej, w zakresie stosowania nowych postaci leków, innego podejścia do znanych i powszechnie stosowanych analgetyków oraz sposobu ich podawania. Dokonano próby dostosowania organizacji przeciwbólowej opieki okołooperacyjnej do obowiązujących trendów w zakresie zarządzania bezpieczeństwem w ramach wciąż rozwijającego się programu Szpital bez bólu. Podtrzymano wypracowaną strategię modelu prognostyki bólu pooperacyjnego, wypracowaną w gronie wielu specjalistów z dyscyplin zabiegowych, którym to modelom przypisane zostały metody postępowania przeciwbólowego, aktualizowane w miarę postępu wiedzy.Zaktualizowane wytyczne są „ostrożniejsze” niż poprzednie w zalecaniu uśmierzania bólu drogą zewnątrzoponową, na rzecz regionalnych blokad obwodowych, bądź też metody multimodalnej. Aktualne zalecenia, wzorem poprzednich, zawierają cytowania prac z ostatnich lat, uwzględniając założenia medycyny opartej na dowodach. Niektóre z zaleceń oparte są na doświadczeniu klinicznym i opiniach ekspertów, a wynikają z pojedynczych doniesień i wymagają dalszych badań. Są to jedynie sugestie, nie mające odzwierciedlenia w treści charakterystyki każdego z produktów leczniczych, zatem stosowane off label

Guidelines for treatment of acute pain in children – the consensus statement of the Section of Paediatric Anaesthesiology and Intensive Therapy of the Polish Society of Anaesthesiology and Intensive Therapy

RATIONALE AND SCOPE OF THE GUIDELINES Pain is a subjective unpleasant sensory and emotional experience. Acute pain occurs irrespective of age and has a prevalence of about 5% of the general population. Surgical procedures and painful diagnostic procedures are the main causes of this unpleasant and dangerous phenomenon for hospitalized children. It should be remembered that maintaining homeostasis in a child undergoing surgery is also affected by provision of an adequate level of analgesia and sedation as well as nerve conduction block within the surgical site. Even though both paediatric anaesthesiologists and paediatric surgeons know that the therapeutic activities during the perioperative period should be focused on ensuring sufficient analgesia and haemodynamic stability in surgical patients, as many as 70% of children undergoing surgery may experience moderate to severe pain [1–7]. Moreover, pain management is one of the fundamental human rights, i.e. the right to relief of suffering. According to the declaration of the 13th World Congress on Pain in Montreal (September 2010), this right also includes children [8, 9]. In Poland, the law was amended in 2017, and now each patient is guaranteed the right to relief and treatment of pain (Journal of Laws of 2017, item 836). Unfortunately, this right is not always respected in paediatric patients. Many factors contribute to ineffective analgesia in paediatric patients, mainly insufficient knowledge and lack of experience (concerning the use of opioids in particular), as well as lack of management standards, the negative attitude of the personnel or poor organization [10–13]. In hospitals which, as a result of organizational changes, have implemented analgesic treatment regimens and regularly educate their personnel in these issues, both efficiency and effectiveness of pain relief in children are high [14]. For many years, Polish paediatric anaesthesio­logists have been promoting and streamlining the analgesic management of children, which has led to the development of the present publication. The regimens presented in it are based on both the latest medical reports and many years of the authors’ experience. The classes of recommendations and levels of evidence have been prepared (Tables 1 and 2, respectively). The presented recommendations were formulated based on a survey of medical reports published in the last two decades

Guidelines of the Polish Society of Anaesthesiology and Intensive Therapy defining the rules of qualification and criteria for admitting patients to anaesthesiology and intensive care units

Working Group: Prof. Łukasz Krzych, MD, PhD – Chairman of the Working Group, Chairman of the Intensive Care Section of the Polish Society of Anaesthesiology and Intensive Therapy Assistant Prof. Alicja Bartkowska-Śniatkowska, MD, PhD – Deputy Chairwoman of the Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy Prof. Piotr Knapik, MD, PhD – Chairman of the Scientific and Educational Section of the Polish Society of Anaesthesiology and Intensive Therapy Assistant Prof. Marzena Zielińska, MD, PhD – Chairwoman of the Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy Assistant Prof. Dariusz Maciejewski, MD, PhD – Intensive Therapy Section of the Polish Society of Anaesthesiology and Intensive Therapy Maciej Cettler, MD – Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy Prof. Radosław Owczuk, MD, PhD – President-Elect of the Polish Society of Anaesthesiology and Intensive Therapy Prof. Krzysztof Kusza, MD, PhD – Outgoing President of the Polish Society of Anaesthesiology and Intensive Therapy Expert Group (in alphabetical order): Representatives of the Board of the Society of Anaesthesiology and Intensive Therapy: Alicja Bartkowska-Śniatkowska, Piotr Knapik, Łukasz Krzych, Krzysztof Kusza, Romuald Lango, Agnieszka Misiewska-Kaczur, Mariusz Piechota Representatives of the sections and branches of the Polish Society of Anaesthesiology and Intensive Therapy: Paweł Andruszkiewicz, Maciej Cettler, Tomasz Czarnik, Mirosław Czuczwar, Michał Domagała, Anna Dylczyk-Sommer, Krzysztof Kobylarz, Waldemar Machała, Dariusz Maciejewski, Irena Ożóg-Zabolska, Andrzej Piotrowski, Beata Rybojad, Katarzyna Sierlikakowska, Wojciech Szczek, Bułat Tuyakov, Marzena Zielińska, Maciej Żukowski Regional consultants in the field of anaesthesiology and intensive therapy: Stanisław Lech Czaban, Wojciech Dąbrowski, Tomasz Gaszyński, Beata Kościałkowska, Łukasz Krzych, Andrzej Małek, Dariusz Onichimowski, Wojciech Serednicki, Karina Stefańska-Wronka, Wiesław Świtała, Janusz Trzebick