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Perioperative Maßnahmen zur Prävention von Phantomschmerz: ein evidenzbasierter Ansatz zur Risikoreduktion

Perioperative measures for prevention of phantom pain: an evidence-based approach to risk reduction

  • Schmerztherapie
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Zusammenfassung

Die Prävention von Phantomschmerzen ist eine der größten, noch weitgehend ungelösten Herausforderungen in der perioperativen Medizin. Trotz vieler Studienbemühungen ist es in den letzten 30 Jahren kaum gelungen, über die Optimierung der postoperativen Schmerztherapie hinaus eine deutliche Reduktion der Phantomschmerzinzidenz zu erreichen. Auch aktuelle Studien zeigen, dass zumindest etwa 50 % der Patienten nach 6 Monaten einen Phantomschmerz entwickeln. Ein Ansatz könnte darin bestehen, multiple synergistische Interventionen zu kombinieren und als perioperatives Phantomschmerzmanagementbündel zusammenzufassen. Neben der Regionalanästhesie könnten NMDA-Antagonisten, Gabapentinoide, Antidepressiva sowie systemisches Lidocain eine Rolle spielen. Ziel dieser pharmakologischen Intervention ist die Modifikation der pathophysiologischen Veränderungen am peripheren Nerv und am Zentralnervensystem nach Amputation.

Abstract

Prevention of phantom limb pain is one of the biggest and still largely unsolved challenges in perioperative medicine. Despite many study efforts and optimization of postoperative pain treatment over the last 30 years, a significant reduction in the incidence of phantom limb pain has not been achieved. Current studies have also shown that at least 50% of patients develop phantom pain after 6 months. A possible approach could be to combine multiple synergistic interventions and implement them as a perioperative phantom pain management strategy bundle. In addition to regional anesthesia, NMDA antagonists, gabapentinoids, antidepressants and systemic lidocaine could play a relevant role. The aim of this pharmacological intervention was the modification of the pathophysiological changes in peripheral nerves and in the central nervous system after amputation.

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  1. Schmerzambulanz der Klinik für Anästhesiologie mit S. op. Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland

    S. Tafelski

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S. Tafelski gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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S. Tafelski ist Mitglied des Wissenschaftlichen Arbeitskreises Wissenschaftlicher Nachwuchs (WAKWiN) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e. V. (DGAI), und das Minireview basiert auf einem Vortrag aus der wissenschaftlichen Sitzung des WAKWiN auf dem HAI 2018.

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Tafelski, S. Perioperative Maßnahmen zur Prävention von Phantomschmerz: ein evidenzbasierter Ansatz zur Risikoreduktion. Anaesthesist 69, 665–671 (2020). https://doi.org/10.1007/s00101-020-00810-w

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