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01.06.2014 | Schwerpunkt

Perioperative Schmerztherapie bei abdominellen und thorakalen Operationen

verfasst von: J.S. Englbrecht, Prof. Dr. E.M. Pogatzki-Zahn

Erschienen in: Der Schmerz | Ausgabe 3/2014

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Zusammenfassung

Abdominal- und thoraxchirurgische Eingriffe können mit starken akuten postoperativen Schmerzen einhergehen. Dabei zeigen neueste Untersuchungen, dass die schmerztherapeutische Versorgung gerade nach den häufig durchgeführten mittleren und kleineren Eingriffen noch deutlich verbessert werden muss. Zur effektiven Behandlung postoperativer Schmerzen nach abdominellen und thorakalen Eingriffen steht eine Reihe von Therapiemöglichkeiten (Regionalanästhesieverfahren, systemische Pharmakotherapie) zur Verfügung. In der vorliegenden Arbeit sollen zunächst die pathophysiologischen Grundlagen abdomineller und thorakaler Schmerzen nach einer Operation dargestellt und die verschiedenen Therapieoptionen im Hinblick auf ihre Indikation, Wirksamkeit und Risiko-/Nutzenbewertung diskutiert werden. Insbesondere erörtert wird der in den letzten Jahren z. T. nicht unumstrittene Einsatz einer Epiduralanalgesie sowie der mögliche Einsatz von (Alternativ-)Verfahren wie der „Transversus-abdominis-plane“(TAP)-Blockade, der Paravertebralblockade (PVB), einer lokalen Infiltration von Lokalanästhetika und der systemischen Applikation von Lidocain. Darüber hinaus werden Indikationen und Kontraindikationen einzelner Nichtopioidanalgetikagruppen speziell für abdominelle und thorakale Eingriffe angesprochen. Klare Empfehlungen werden gegeben und auf Zeitpunkt sowie Faktoren für eine individuelle Entscheidung wird hingewiesen. Auch wenn die Evidenzlage in einigen Bereichen noch nicht für einen generellen Einsatz bestimmter Verfahren ausreicht, haben die genannten Verfahren in der Klinik ihre Berechtigung. Zukünftig können sie zur Verbesserung der Ergebnisqualität hinsichtlich schmerztherapeutischer Parameter nach Operationen beitragen.

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Titel: Perioperative Schmerztherapie bei abdominellen und thorakalen Operationen
verfasst von: J.S. Englbrecht
Prof. Dr. E.M. Pogatzki-Zahn
Publikationsdatum: 01.06.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Der Schmerz / Ausgabe 3/2014
Print ISSN: 0932-433X
Elektronische ISSN: 1432-2129
DOI: https://doi.org/10.1007/s00482-014-1420-8

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