Der Schmerz

, Volume 2, Issue 1, pp 19–25 | Cite as

Applikationsverfahren und dosierungsempfehlungen zur postoperativen analgesie

  • W. Dick
  • R. Janik
Übersichten

Zusammenfassung

Die systemische Applikation von Analgetika stellt nach wie vor die häufigste Form der postoperativen Analgesie dar. Kontinuierliche Plasmaspiegel eines Analgetikums können weder durch intermittierende intramuskuläre noch durch intermittierende intravenöse Bolusinjektion garantiert werden. Ganz allgemein haben lipidlösliche Substanzen oder solche mit polarer Bindung, die rasch metabolisiert werden, einen frühen Wirkungsbeginn; eine lange Wirkdauer ist bedingt durch geringe Fettlöslichkeit, hohe Rezeptoraffinität und niedrige Elimination. Die orale Applikation ist charakterisiert durch unsichere Resorptionsbedingungen. Ähnlichen Kriterien unterliegen sublinguale, buccale, aber auch die rektalen Applikationsformen. Die subkutane Applikation von Analgetika zur postoperativen Schmerzbekämpfung ist nur wenig untersucht. Nach intramuskulärer Applikation werden analgetische Blutspiegel innerhalb von 15 bis 60 min erreicht. Randbedingungen können die Resorption jedoch modifizieren. Die intradeltoidale Applikation ist der intraglutealen vorzuziehen. Intravenös können Analgetika als Bolus, als kontinuierliche Infusion oder als patientenkontrollierte Analgesie verabreicht werden. Die Bolusinjektion ist durch kurze Wirkdauer und häufig notwendige Nachinjektionen gekennzeichnet. Vor der kontinuierlichen Infusion muß zur Erreichung eines analgetischen Niveaus ein Bolus appliziert werden. Die Infusion bedingt höheren Überwachungsaufwand. Die vielversprechendste Form ist die patientengesteuerte postoperative Analgesie. Nach Bolusapplikation wird eine kontinuierliche Minimalinfusion aufrechterhalten, zu der sich der Patient bedarfsweise Boli hinzuapplizieren kann. Auch die patientengesteuerte Analgesie bedarf eines erhöhten Überwachungsaufwandes, der für die Zukunft in speziellen Einheiten durch besonders qualifiziertes Personal (Analgesie-Team) erfolgen sollte.

Application procedures and dosage recommendations for postoperative analgesia

Abstract

Systemic application of analgesics is still the most frequently used method of postoperative relief of pain. However, neither intermittent intramuscular nor intermittent intravenous application can provide the patient with a continuous level of analgesia. Lipid-soluble analgesics or those with polar binding that are rapidly metabolized demonstrate an rapid effectiveness. If the analgesia must be administered over a long period, it is due to a low level of lipid solubility, high receptor affinity and low elimination rates. Oral as well as sublingual buccal and rectal applications are characterized by uncertain absorption conditions. There are few investigations on the subcutaneous application of analgesics. After intramuscular administration analgesic levels are achieved within 15 to 60 min, but various conditions may alter the absorption criteria. Intradeltoidal application is preferable to intragluteal injection. Analgesics may be administered intravenously as a bolus, as continuous infusion, or as patient-controlled analgesia. The bolus injection is characterized by a short period of action and the necessity to administer several bolus injections by repeated administration. The continuous infusion of analgesics should begin with the administration of an initial bolus injection. Infusion analgesia should be performed under careful monitoring conditions. The most promising method of pain relief is patient-controlled analgesia (PCA). After an initial bolus injection, the continuous infusion of an analgesic is guaranteed and may be completed by the patient with several bolus injections. PCA requires careful monitoring. We suggest that a special analgesia team to take care of the patient in special analgesia units might be appropriate in the future.

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Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • W. Dick
    • 1
  • R. Janik
    • 1
  1. 1.Klinik für Anästhesiologie der UniversitätMainz

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