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Die Anaesthesiologie

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01.05.2004 | Schmerztherapie

Opioid-induzierte Hyperalgesie

Pathophysiologie und Klinik

verfasst von: Priv.-Doz. Dr. med. W. Koppert

Erschienen in: Die Anaesthesiologie | Ausgabe 5/2004

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Zusammenfassung

Opioide sind Mittel der ersten Wahl in der Therapie mittelschwerer bis starker akuter und chronischer Schmerzzustände. Allerdings können Opioide auch zu einer Schmerzverstärkung führen, die auf einer Aktivierung pronozizeptiver Systeme beruht. Es konnte gezeigt werden, dass neben einer akute Rezeptordesensibilisierung und einer Hochregulation der Adenylylzyklaseaktivität insbesondere die Aktivierung des N-Methyl-D-Aspartat- (NMDA-)Rezeptor-Systems und die deszendierende Fazilitierung den antinozizeptiven Eigenschaften des Opioids entgegengerichtet sind. So können schon nach kurzzeitiger Anwendung Sensibilisierungsprozesse induziert werden, die einen Teil der analgetischen Wirkung des Opioids maskieren und noch viele Tage nach dem Absetzen nachweisbar sein können. Klinische Relevanz erhalten diese Befunde aus Studien, in denen nach der intraoperativen Anwendung hoher Dosen von μ-Agonisten vermehrte Schmerzen und ein erhöhter postoperativer Schmerzmittelverbrauch beobachtet wurde. Weiterhin werden nach länger dauernder Anwendung von μ-Agonisten oftmals neben einem ansteigenden Bedarf an Schmerzmitteln paradoxe Schmerzzustände beobachtet. Durch eine Kombination der Opioide mit Substanzen anderer Klassen, wie NMDA-Rezeptor-Antagonisten, α₂-Agonisten oder nichtsteroidalen antiinflammatorischen Analgetika (NSAIDs), durch Opioidrotationen oder Kombinationen von Opioiden mit unterschiedlicher Rezeptorselektivität können diese Sensibilisierungsprozesse unterdrückt und die Schmerztherapie optimiert werden.

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Titel: Opioid-induzierte Hyperalgesie
Pathophysiologie und Klinik
verfasst von: Priv.-Doz. Dr. med. W. Koppert
Publikationsdatum: 01.05.2004
Verlag: Springer-Verlag
Erschienen in: Die Anaesthesiologie / Ausgabe 5/2004
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-004-0669-1

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Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update AINS

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Ähnliche Überlebensraten nach Reanimation während des Transports bzw. vor Ort

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Fehlerkultur in der Medizin – Offenheit zählt!

Mehr Frauen im OP – weniger postoperative Komplikationen

Update AINS

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Zusammenfassung

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Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

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Mehr Frauen im OP – weniger postoperative Komplikationen

Update AINS