Der Schmerz
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A short survey about the different methods available for producing postoperative analgesia is given, the goal being to make it clear to the clinician that there are quite a number of techniques to be used although the everyday clinical practice often sticks to simple and not too effective methods of pain treatment following surgery. Initially presenting short informations about the neurophysiology of pain and the pathogenesis and causes of postoperative pain two main groups of producing analgesia are then discussed. Thefirst group deals with the systemic use of analgesics be it nonnarcotic analgesic antipyretics or narcotic analgesics (opioids). ⋯ They present clear advantages over the local anesthetic methods as there are the long lasting analgesia and the selective blockade of pain not touching motor and sympathetic nerve fibers. A delayed respiratory depression however might be a serious danger showing an incidence of 0,3% in the epidural and some 10% in the subarachnoid route. Aiming to inform the clinician once again about the vast field of possibilities available to make the postoperative course painfree it is hoped that this important task in the postoperative period will be handled with more consequence and effectivity in the future.
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As a result of changing public attitudes non-orthodox methods of pain therapy have become widely accepted within everyday health care. The view that non-orthodox methods, even if not overly successful are at least harmless is widely held. ⋯ Patients should be questioned about the use of alternative methods of treatment and physicians should be aware of unwanted effects of acupuncture, cell therapy, Ajurvedic medicines and herbal therapies. In addition, they should know that some drugs sold as herbal products with "no side-effects" are enriched with e.g. phenylbutazone and/or corticoids, for example.