Der Orthopäde

, Volume 37, Issue 10, pp 970–976

Schmerztherapie in der Schulter-, Ellenbogen- und Handchirurgie

  • P. Kasten
  • J.P.S. Christian
  • T. Volk
  • N. Schmelzer-Schmied
Leitthema

Zusammenfassung

Eingriffe an der Schulter, am Ellenbogen und an der Hand können sehr schmerzhaft sein. Eine optimal abgestimmte Schmerztherapie ist entscheidend für den Erfolg einer Operation. Entsprechend einer Metaanalyse von in erster Linie randomisierten und kontrollierten Studien ist bei Eingriffen an der Schulter der interskalenäre Block zur peri- und postoperativen Schmerztherapie zu empfehlen. Wenn möglich sollte am Ellenbogengelenk ebenfalls ein lokoregionales Verfahren gewählt werden, da über dieses im Anschluss an die Operation gleichzeitig eine effektive Schmerztherapie und Übungsbehandlung möglich ist. Eingriffe am Unterarm, Handgelenk und der Hand sollten vorzugsweise mit einem regionalen Analgesieverfahren behandelt werden.

In der postoperativen Phase können nichtsteroidale Antirheumatika (NSAR) häufig nicht die notwendige Schmerzreduktion alleine leisten, sodass in der Frühphase zusätzlich Opiode eingesetzt werden sollten. Eine periphere Nervenblockade kann im Rahmen der multimodalen Analgesie hilfreich sein. Darüber hinaus sind kühlende und physiotherapeutische Maßnahmen in der postoperativen Phase sinnvoll.

Schlüsselwörter

Schmerzen Interskalenärer Block Schulterchirurgie Handchirurgie Multimodale Schmerztherapie 

Analgesia in shoulder, elbow and hand surgery

Abstract

Surgery of the shoulder, elbow, and hand can cause considerable pain. According to data from randomized controlled trials, local or regional anesthesia is recommended for analgesia during and after surgery of the upper extremity. This treatment can be supplemented with potent opioids and nonsteroidal anti-inflammatory drugs in a multimodal analgesia approach.

According to a metaanalysis of randomized controlled trials, an interscalene block is recommended for analgesia during and after surgery of the shoulder. For the elbow joint, a peripheral block is also recommended to allow for effective analgesia and physiotherapy postoperatively. In addition, cooling and physiotherapeutic techniques are beneficial in postoperative management.

Keywords

Pain Nerve block Shoulder surgery Hand surgery Multimodal pain management 

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  • P. Kasten
    • 1
  • J.P.S. Christian
    • 2
  • T. Volk
    • 3
  • N. Schmelzer-Schmied
    • 1
  1. 1.Stiftung Orthopädische UniversitätsklinikUniversität HeidelbergHeidelbergDeutschland
  2. 2.Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie Köln-MerheimLehrstuhl für Unfallchirurgie und Orthopädie der Universität Witten-HerdeckeKölnDeutschland
  3. 3.Klinik für Anästhesiologie und operative Intensivmedizin, Charité Campus Mitte und Campus Virchow-KlinikumCharité-UniversitätsmedizinBerlinDeutschland

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