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Beeinflußt die Schmerztherapie postoperative Morbidität und Letalität?

Influence of postoperative pain on morbidity and mortality

Der Schmerz volume 7, pages 85–96 (1993)Cite this article

Zusammenfassung

Postoperative Schmerzen können die Ausprägung der sympathoadrenergen Reaktion nach Operationen verstärken und damit zur Bahnung von Komplikationen beitragen, wie Angina pectoris, Myokardinfarkt, Bronchopneumonie, Ileus, Infektion, Sepsis, Thrombose, Embolie, Elektrolyt- und Stoffwechselentgleisungen, u.a. mehr. Wenn das so ist, müßte sich die Güte der Analgesie auf den postoperativen Outcome auswirken. Bei der Untersuchung einzelner Organfunktionen (Atmung, Kreislauf, Gastrointestinaltrakt, Stoffwechsel) konnte wahrscheinlich gemacht werden, daß sehr gute und aufwendige Analgesieverfahren postoperative Funktionseinschränkungen oder Organinsuffizienzen günstig beeinflussen. Es ist aber nicht zu verkennen, daß eine bessere Qualität der Analgesie mit stärkeren Nebenwirkungen verbunden sein kann, die wiederum den postoperativen Verlauf ungünstig beeinflussen können. Außerdem ist manchmal schwer zu entscheiden, ob die Analgesie per se oder eine Begleitwirkung wie die Sympathikusblockade bei der Epiduralanästhesie mit Lokalanästhetika für bestimmte, erwünschte Wirkungen verantwortlich war. Untersucht man die Frage, ob sich die postoperative Gesamtmorbidität durch die Qualität der Schmerztherapie beeinflussen läßt, so stehen wenige Studien mit kleinen Fallzahlen, die dieses bejahen, mehreren großen gegenüber, die einen solchen Einfluß nicht bestätigen konnten. Somit muß man leider feststellen, daß die postoperative Analgesie einen nicht sicher definierbaren Anteil an der Genesung eines operierten Patienten hat.

Abstract

Postoperative pain can intensify the sympathoadrenergic reaction, which is commonly seen after surgery, and thus possibly pave the way for certain complications, such as coronary ischemia, bronchopneumonia, intestinal stasis, thromboembolism, infection, sepsis, and metabolic disturbances. Investigations of cardiovascular, respiratory, gastrointestinal, metabolic, and immunologic function indicate that high-quality pain relief can diminish postoperative organ impairment and failure. Some aspects of the improvements attributed to the quality of analgesia, such as prevention of tachycardia and hypertension, attenuation of hyperglycemia and catabolism, improvement of gastrointestinal motility and cellular immunity cannot be definitely distinguished from the effects of sympathetic blockade due to epidural analgesia with local anesthetics, however. There is another aspect of the problem. The better the quality of postoperative pain relief, the more likely it is that analgesia-related complications, such as respiratory depression (opioids), cardiovascular depression (epidural local anesthetics), renal failure (NSAIDs) and bladder dysfunction (epidural opioids and local anesthetics) will occur. The question of whether postoperative morbidity and mortality can be reduced by effective analgesia has been investigated in the past few years. Some studies indicate that better analgesia is advantageous for the patient, especially with respect to postoperative complications, hospital stay, long-term well being, and costs. In other clinical trials incorporating more patients, however, this hypothesis had to be rejected. At present, therefore, we cannot state that effective pain relief influences postoperative morbidity and mortality.

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  1. Universitätsklinik für Anästhesiologie, Klinikum der Universität Ulm, Steinhövelstraße 9, W-7900, Ulm

    W. Seeling & M. Rockemann

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Seeling, W., Rockemann, M. Beeinflußt die Schmerztherapie postoperative Morbidität und Letalität?. Schmerz 7, 85–96 (1993). https://doi.org/10.1007/BF02527865

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Schlüsselwörter

  • Postoperative Schmerz
  • Morbidität
  • Mortalität
  • Analgesie
  • Epidurale Opioide
  • Lokalanästhetika

Key words

  • Postoperative pain
  • Morbidity
  • Mortality
  • Analgesia
  • Epidural opioids
  • Local anesthetics