Protocol for postoperative analgesia

The postoperative analgesia was standardized on the basis of a protocol for adjusting the analgesic level: immediately after surgery in the recovery area, patients received a 10–20 mg slow-release oxycodone per os (p.o.) (age and/or weight adapted: 10 mg if weight <60 kg and/or age >70 years, all others 20 mg) and 600 mg ibuprofen p.o. In the recovery area, intravenous piritramide was titrated until the intensity was ≤3 on the NRS. In the ward, oral slow-release oxycodone (1-0-1) and ibuprofen (1-1-1) started in the recovery area were continued for the following days and adapted according to pain intensity following an algorithm on the basis of routine pain measurement. If the NRS was >3, patients were offered 1.3–2.6 mg hydromorphone p.o. (age and weight adjusted). If the NRS remained >3 after 60 min, a second dose was offered. If hydromorphone was necessary three times within 24 h, slow-release oxycodone was increased. If the patients’ chart revealed that the pain intensity was <3 on the NRS over the past 24 h, slow-release oxycodone was reduced step wise.