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The quality of postoperative pain therapy in Germany shows a heterogeneous treatment practice and large differences in quality between individual institutions, The patient representatives in the Federal Joint Committee (G-BA) have therefore decisively campaigned for many years that instruments of non-legislative standards are employed in order to noticeably improve the quality of perioperative pain therapy for patients in Germany. As a result of these efforts, in October 2020 a binding specification for internal quality management was included in the quality management guidelines (QM-RL) by the G‑BA. This describes in concrete terms the structural and procedural requirements for an internal quality management of acute pain for all institutions in which operations and comparable potentially painful interventions are carried out. This article describes the content of this regulation and the resulting consequences for the institutions, the medical and administrative management and especially the role of anesthesia.

Additional file 1: Supplementary Figure 1. Missing value analysis of the primary outcome measure and the 14 predictor variables included sequentially into the multiple regression analysis. A. The table displays the descriptives (mean and standard deviation), the percentage of missing values per variable, the number of imputed values (missing values x number of imputations) and the type of model used for multiple imputation. For the dependent variable “global effectiveness of total hip arthroplasty” the data set was complete. More than 10% missing values were identified for the rating instrument measuring hip function and mobility (WOMAC), its symptom change score (quotient of postoperative and preoperative WOMAC score) and the calculated expectations-actuality discrepancy scores (fulfillment of expectations) of physical exercise and social interactions. B. The variable chart shows that for 93% of the predictors included at step 4 of the regression model at least 1 value is missing. The cases chart shows that 40% (N = 36) of the study participants has at least one missing value on a variable. The values chart shows that 6% of the 1260 values (cases × variables) are missing. C. The bar graph displays the percentage of study participants having none to six missing predictors. Subjects with more than three missing predictors were excluded from the analysis on the imputed data set.

Additional file 3: Supplementary Table 2. Correlations between preoperative expectations, change in symptoms and calculated expectations-actuality discrepancy scores with the patient-rated global effectiveness of THA.

Additional file 4: Supplementary Table 3. Results of the sequential multiple regression analysis: Variance explained in the global effectiveness of total hip arthroplasty at 12 months follow-up by sociodemographic and medical variables, preoperative expectations, change in symptoms and the fulfilment of expectations (complete case analysis).

Additional file 2: Supplementary Table 1. Correlations between baseline variables and patient-rated global effectiveness of THA.

Hintergrund Nichtopioidanalgetika werden bei vielen Patienten zur perioperativen Analgesie eingesetzt. Zu einigen praktischen Fragen beim Einsatz von Nichtopioidanalgetika liegen z. T. nur wenig Informationen aus Studien vor, und in Krankenhäusern existieren häufig keine Konzepte zum Vorgehen, z. B. zur Patientenaufklärung und zum Zeitpunkt der perioperativen Gabe. Methodik Eine Expertengruppe der beteiligten Fachgesellschaften hat konsensbasierte Empfehlungen zum perioperativen Einsatz von Nichtopioidanalgetika erarbeitet und in einem strukturierten formalen Konsensusprozess verabschiedet. Ergebnisse Die Arbeitsgruppe stimmt überein, dass Nichtopioidanalgetika Bestandteil eines perioperativen multimodalen Analgesiekonzepts sein sollen und Patienten präoperativ über Nutzen, Risiken und alternative Behandlungsmöglichkeiten aufgeklärt werden sollen. Die präoperative Patienteninformation und -edukation soll auch eine Schmerz- und Analgetikaanamnese umfassen und Patienten mit Risikofaktoren für starke Schmerzen und eine Schmerzchronifizierung sollen identifiziert werden. Unter Berücksichtigung von Kontraindikationen können Nichtopioidanalgetika abhängig von der Operationsdauer auch schon prä- oder intraoperativ gegeben werden, um nach Beendigung der Anästhesie ausreichende Plasmakonzentrationen zu erzielen. Nichtopioidanalgetika oder Kombinationen von (Nichtopioid‑)Analgetika sollen nur für einen begrenzten Zeitraum gegeben werden. Ein gemeinsam erarbeiteter abteilungsübergreifender Behandlungsstandard mit dem Nichtopioidanalgetikum erster Wahl, weiteren Therapieoptionen sowie adäquaten Dosierungen, ergänzt durch eingriffsspezifische Konzepte, soll schriftlich hinterlegt werden. Bei Entlassung aus dem Krankenhaus soll der nachbehandelnde Arzt zu perioperativ gegebenen und aktuell noch eingenommenen Analgetika schriftliche Informationen erhalten. Patienten sollen zu möglichen Nebenwirkungen der Analgetika und ihrer Symptome, die auch nach Krankenhausentlassung auftreten können, und die befristete Einnahmedauer informiert werden.

Purpose The development of persistent postoperative pain may occur following surgery, including total hip replacement. Yet, the prevalence may depend on the definition of persistent pain. This observational cohort study explored whether the prevalence of persistent pain after total hip replacement differs depending on the definition of persistent pain and evaluated the impact of ongoing pain on the patient’s quality of life 6 months after surgery. Patients and methods Pre- and postoperative characteristics of 125 patients undergoing elective total hip replacement were assessed and 104 patients were available for the follow-up interview, 6 months after surgery. Results Six months after surgery, between 26% and 58% of patients still reported hip pain – depending on the definition of persistent pain. Patients with moderate-to-severe persistent pain intensity (>3 on a numerical rating scale) were more restricted in their daily life activities (Chronic Pain Grade – disability score) but did not differ in reported quality of life (Short-Form 12) from those with no pain or milder pain intensity. Maximal preoperative pain intensity and body mass index were the only independent factors influencing daily function 6 months after total hip replacement. Conclusion These findings support a high prevalence of persistent postoperative pain after total hip replacement and a large variability depending on the definition used. There was a close relation between physical functioning and pain as well as relevance of the patient’s psychological state at the time of the operation.