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01.02.2014 | Schwerpunkt

Perioperative systemische Schmerztherapie bei Kindern

Österreichische interdisziplinäre Handlungsempfehlungen zum perioperativen Schmerzmanagement bei Kindern

verfasst von: Dr. B. Messerer, G. Grögl, W. Stromer, W. Jaksch

Erschienen in: Der Schmerz | Ausgabe 1/2014

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Zusammenfassung

Allgemeines

Viele Analgetika aus der Erwachsenenmedizin sind für Kinder nicht zugelassen. Zulassungseinschränkungen rechtfertigen speziell in der perioperativen Schmerztherapie dennoch nicht, dass Kindern eine suffiziente Schmerztherapie vorenthalten wird. Die Behandlung orientiert sich grundsätzlich an der Stärke der Schmerzen. Auf i.m.- und s.c.-Injektionen ist aufgrund der Schmerzhaftigkeit generell zu verzichten.

Nichtopioide

Basis der systemischen Schmerztherapie bei Kindern sind Nichtopioide, zuvorderst nichtsteroidale Antirheumatika (NSAR). Sie sollten prophylaktisch angewendet werden. NSAR sind bei akuten posttraumatischen und postoperativen Schmerzen deutlich wirksamer als Paracetamol. Zudem ermöglichen sie eine Einsparung von Opioiden. Schwere Nebenwirkungen sind bei Kindern selten, der Einsatz sollte aber u. a. bei einer Leber- und Nierendysfunktion oder Gerinnungsstörung wohlüberlegt sein. Paracetamol sollte in der Schwangerschaft und bei Kindern nur bei entsprechender Indikation eingesetzt werden, da möglicherweise ein kausaler Zusammenhang mit dem Auftreten von Asthma bronchiale besteht. Für eine sichere Dosierung müssen Alter, Körpergewicht, Dauer der Therapie, Tageshöchstdosis und Dosierungsintervalle berücksichtigt werden. Metamizol wird bei Kindern zur Behandlung von viszeralen Schmerzen und von Koliken eingesetzt. Die Agranulozytose als seltene, aber schwerwiegende Nebenwirkung rechtfertigt nach aktuellem Wissensstand keine generelle Ablehnung des kurzfristigen, perioperativen Einsatzes.

Opioide

Bei unzureichender Analgesie durch Nichtopioidanalgetika werden auch bei Kindern in allen Altersgruppen ergänzend Opioide eingesetzt. Sie sind die Medikamente der Wahl bei mittleren bis starken Schmerzen. In Orientierung an der Wirkung werden sie titrierend appliziert. Ist mit starken Schmerzen über mehr als 24 h zu rechnen, sollte die patientenkontrollierte Analgesie Anwendung finden. Diese erfordert eine umfassende Überwachung durch das Pflegepersonal.

S-(+)-Ketamin

S-(+)-Ketamin ist in der postoperativen Schmerztherapie als Adjuvans anzusehen. Es wird für den Einsatz bei pädiatrischen Sedierungen bzw. Analgosedierungen empfohlen.

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Titel: Perioperative systemische Schmerztherapie bei Kindern
Österreichische interdisziplinäre Handlungsempfehlungen zum perioperativen Schmerzmanagement bei Kindern
verfasst von: Dr. B. Messerer
G. Grögl
W. Stromer
W. Jaksch
Publikationsdatum: 01.02.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Der Schmerz / Ausgabe 1/2014
Print ISSN: 0932-433X
Elektronische ISSN: 1432-2129
DOI: https://doi.org/10.1007/s00482-013-1384-0

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Perioperative systemische Schmerztherapie bei Kindern

Österreichische interdisziplinäre Handlungsempfehlungen zum perioperativen Schmerzmanagement bei Kindern

Zusammenfassung

Allgemeines

Nichtopioide

Opioide

S-(+)-Ketamin

Neu im Fachgebiet AINS

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Update AINS

Springer Medizin

Zusammenfassung

Allgemeines

Nichtopioide

Opioide

S-(+)-Ketamin

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