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01.12.2014 | Leitthema

Perioperatives Schmerzmanagement – was ist evidenzbasiert?

verfasst von: Dr. D. Meisenzahl, J. Souquet, P. Kessler

Erschienen in: Die Orthopädie | Ausgabe 12/2014

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Zusammenfassung

Hintergrund

Eine suffiziente Akutschmerztherapie ist nach Wirbelsäuleneingriffen für viele Patienten essentiell. Bereits präoperativ bestehende chronische Schmerzen und eine Opioiddauertherapie stellen eine besondere Herausforderung für das behandelnde Team dar. Dabei ist unbestritten, dass die postoperative Schmerztherapie ein multimodales Konzept verfolgen sollte. Bei der Umsetzung von perioperativen Schmerzkonzepten ist es wichtig, nach evidenzbasierten Systemen vorzugehen.

Therapie

Zur Schmerztherapie nach Wirbelsäulenoperationen steht ein breites Spektrum zur Verfügung. Dieses beinhaltet sowohl regionalanästhesiologische als auch systemische Verfahren. Dabei erfolgt die Auswahl der analgetischen Verfahren nach Ausmaß des zu erwartenden Schmerzes, sowie nach Effektivität und Anwendbarkeit der Therapie unter Beachtung potentieller Nebenwirkungen.

Methode

Die Behandlung chronischer Schmerzpatienten erfordert neben einer Basisanalgesie aus Opioiden und Nichtopioidanalgetika den Einsatz von Koanalgetika oder Kombinationen dieser Substanzklassen.

Schlussfolgerung

Regionalanästhesiologische Verfahren sind allen systemischen Schmerzverfahren überlegen, wobei im Rahmen der Wirbelsäulenchirurgie den rückenmarksnahen Verfahren ein besonderer Stellenwert zukommt.

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Titel: Perioperatives Schmerzmanagement – was ist evidenzbasiert?
verfasst von: Dr. D. Meisenzahl
J. Souquet
P. Kessler
Publikationsdatum: 01.12.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Die Orthopädie / Ausgabe 12/2014
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI: https://doi.org/10.1007/s00132-014-3039-y

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