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Perioperatives Schmerzmanagement – was ist evidenzbasiert?

Perioperative pain management: what is evidence based?

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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.

Abstract

Background

Adequate post-operative acute pain therapy after spinal surgical procedures is essential for many patients. However, patients already receiving chronic opioid therapy pre-operatively present a special challenge for the treating physician during the post-operative period when managing their acute pain. The team must consider multiple approaches of acute pain management and it is important to proceed according to current evidence-based methods.

Therapy

A wide spectrum of options for pain management after spinal surgery is currently available. This includes various therapeutic methods as well as regional anesthesia. Considering the various options, the method of choice for post-operative analgesia depends on the expected pain, therapy effectiveness, and the applicability with regard to potential side-effects.

Method

In addition to the basic analgesic therapy consisting of opioid and non-opioid drugs, chronic pain patients may require co-analgesics or combination analgesics from this class.

Conclusion

Regional anesthesia is currently the predominant method of choice for post-operative acute pain management. Neuraxial blockage is especially important when considering all spinal procedures.

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  1. Abteilung für Anästhesiologie, Intensiv- und Schmerzmedizin, Orthopädische Universitätsklinik Friedrichsheim gGmbH (Stiftung Friedrichsheim), Leiter: Professor P. Kessler, Marienburgstr. 2, 60528, Frankfurt, Deutschland

    D. Meisenzahl, J. Souquet & P. Kessler

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  1. D. Meisenzahl
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Meisenzahl, D., Souquet, J. & Kessler, P. Perioperatives Schmerzmanagement – was ist evidenzbasiert?. Orthopäde 43, 1079–1088 (2014). https://doi.org/10.1007/s00132-014-3039-y

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