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Perioperative Schmerztherapie

Perioperative pain therapy

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Zusammenfassung

Wissenschaftliche Untersuchungen haben zweifelsfrei belegt, dass eine optimierte perioperative Schmerztherapie nicht nur den Patientenkomfort verbessert, sondern auch postoperative Komplikationen vermeidet, die Rekonvaleszenz beschleunigt und den postoperativen Krankenhausaufenthalt verkürzt. Voraussetzung dafür ist die Einbettung der Schmerztherapie in ein perioperatives multimodales und interdisziplinäres Behandlungskonzept. Lokale oder regionale Anästhesieverfahren gewährleisten nach operativen Eingriffen die beste Analgesie und müssen daher immer erwogen werden. Die Optimierung der perioperativen Schmerztherapie durch Peridural- oder Spinalanalgesie und regionale Kathetertechniken wird organisatorisch durch die Etablierung eines Akutschmerzdienstes gewährleistet. Derartige Akutschmerzdienste betreuen aber nur etwa 15–20% aller chirurgischen Fälle. Die Mehrzahl aller Patienten erhält nur dann eine adäquate Schmerztherapie, wenn die behandelnden Chirurgen über gute Kenntnisse in der perioperativen Schmerztherapie verfügen. Die regelmäßige postoperative Messung des Schmerzempfindens ist die unverzichtbare Grundlage einer optimierten perioperativen Schmerztherapie und erlaubt zudem eine verantwortliche Delegation der Applikation von Schmerzmitteln an das Pflegepersonal.

Abstract

Scientific studies have proven without doubt that an optimized perioperative pain therapy will improve patient comfort, reduce postoperative complications, enhance postoperative recovery and shorten the length of postoperative hospital stay. It is necessary to incorporate the acute pain therapy into a perioperative multimodal and interdisciplinary therapeutic concept. Local or regional anesthesia will provide the best analgesic effect after surgery and should be considered in all patients. Optimal treatment of patients with peripheral nerve blocks, spinal or epidural analgesia should be treated by a specialized acute pain service. However, only 15–20% of all surgical cases will be taken care of by such a pain service. Therefore, most surgical patients will only receive adequate analgesia if surgeons are familiar with the principles of postoperative pain therapy. Regular assessment of pain perception is the cornerstone of optimized pain therapy. Furthermore, pain assessment will allow the administration and to some extent dosage of analgesic therapy to be delegated to nursing personnel.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: WS hat für folgende Firmen gegen Honorar Vorträge gehalten: BMS, Pfizer, MSD Sharp & Dohme, Mundipharma.

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  1. Allgemein- und Viszeralchirurgie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland

    W. Schwenk & B. Schinkel

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  1. W. Schwenk
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  2. B. Schinkel
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Correspondence to W. Schwenk.

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Schwenk, W., Schinkel, B. Perioperative Schmerztherapie. Chirurg 82, 539–556 (2011). https://doi.org/10.1007/s00104-010-2051-y

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