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Der Schmerz
Erschienen in: Der Schmerz 3/2021

18.12.2020 | Pädiatrie | Pain Clinical Updates

Pädiatrische Schmerztherapie und -prävention bei hospitalisierten Kindern

verfasst von: Stefan J. Friedrichsdorf, Liesbet Goubert

Erschienen in: Der Schmerz | Ausgabe 3/2021

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Zusammenfassung

Einleitung

Schmerzprävention und -therapie sind bei pädiatrischen Patienten im Vergleich zu Erwachsenen häufig nicht nur mangelhaft, sie werden auch umso seltener umgesetzt, je jünger die Kinder sind. Kinder und Jugendliche von 0 bis 17 Jahren sind eine vulnerable Gruppe.

Zielsetzung

Der vorliegende Beitrag befasst sich mit der Prävention und Therapie von akutem und chronischem Schmerz bei Kindern, einschließlich des Schmerzes bei Nadelstichen. In diesem Rahmen werden auch empfohlene analgetische Anfangsdosen angegeben.

Methoden

Dieses klinische Update basiert auf einem Datenblatt zur Schmerztherapie bei Kindern („Factsheet Pain in Children: Management“) der IASP-Kampagne Global Year Against Pain in the Vulnerable von 2019 und fasst die beste Evidenz sowie das beste praktische Vorgehen zusammen.

Ergebnisse

Im Rahmen der multimodalen Schmerztherapie können Arzneimittel (z. B. Basisanalgetika, Opioide und Koanalgetika), Regionalanästhesie, Rehabilitation, psychologische Ansätze, Spiritualität und integrative Verfahren eingesetzt werden, die synergistisch eine wirksamere akute pädiatrische Schmerzkontrolle mit weniger Nebenwirkungen ermöglichen als die einzelnen Analgetika oder Therapieverfahren. Bei chronischem Schmerz hat sich ein interdisziplinärer rehabilitativer Ansatz mit Physiotherapie, Psychotherapie, integrativen Mind-body-Verfahren und Normalisierung der Lebensführung als am wirksamsten erwiesen. In Bezug auf elektive Verfahren, die mit einem Nadelstich verbunden sind, wie Blutentnahmen, venöser Zugang, Injektionen oder Impfungen, führt die Studienlage zu der Forderung, dass jedem Kind in jeder solchen Situation ein Bündel von vier Maßnahmen geboten werden soll, um den Schmerz vollständig oder teilweise zu lindern: (1) topische Anästhesie, z. B. mit Lidocaincreme 4 %, (2) behaglich-beruhigende Positionierung, z. B. Haut-zu-Haut-Kontakt bei Säuglingen, keine Fixierung von Kindern, (3) Saccharose oder Stillen von Säuglingen und (4) altersgerechte Ablenkung. Eine mögliche Ausweichlösung (Plan B) ist die Lachgasanalgesie und -sedierung.

Schlussfolgerung

Die ausbleibende Implementierung einer evidenzbasierten Schmerzprävention und -therapie für Kinder in medizinischen Einrichtungen gilt heute als unzulässig und zeugt von einer schlechten Versorgungsqualität.
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Metadaten
Titel
Pädiatrische Schmerztherapie und -prävention bei hospitalisierten Kindern
verfasst von
Stefan J. Friedrichsdorf
Liesbet Goubert
Publikationsdatum
18.12.2020
Verlag
Springer Medizin
Erschienen in
Der Schmerz / Ausgabe 3/2021
Print ISSN: 0932-433X
Elektronische ISSN: 1432-2129
DOI
https://doi.org/10.1007/s00482-020-00519-0

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