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Postoperative Schmerztherapie in der Orthopädie

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Zusammenfassung

Die systemische Analgetikatherapie der postoperativen Phase folgt dem WHO-Stufenschema. Dieses sieht die Gabe eines Basis-Nicht-Opioids (Stufe I) in Kombination mit einem schwachen (Stufe II) oder starken Opioid (Stufe III) vor. Werden in der Schmerztherapie Nichtopioid und Opioid kombiniert eingesetzt, so erfolgt zuerst die Gabe des Nicht-Opioids.

Während die i.v.-Medikation aufgrund des raschen Wirkeintritts die Applikationsform der Wahl unmittelbar postoperativ ist, sollte frühestmöglich postoperativ auf eine orale Darreichung der Schmerzmedikation gewechselt werden. Bei oraler Therapie mit Opioiden sollten retardierte Präparate Anwendung finden. Intramuskuläre Applikationen sind in der postoperativen Schmerztherapie zu vermeiden. Regionale Verfahren in der postoperativen Schmerztherapie, etwa Peridural- oder Plexuskatheter, senken den Schmerzmittelbedarf und können bereits präoperativ eingeleitet werden. Ein ungewöhnlich hoher oder gar ansteigender Schmerzmittelbedarf in der postoperativen Phase weißt auf Komplikationen der durchgeführten Operation hin.

Aus Sicht des Behandelnden erscheint es sinnvoller, wenige unter der Vielzahl zugelassener Substanzen einzusetzen, diese dafür aber um so besser hinsichtlich Wirkung und Nebenwirkung zu kennen.

Abstract

Postoperative pain management adheres to the principles of a three-step routine according to the WHO recommendations. This routine suggests the combination of a basic non-opioid (step I) with an opioid of low potency (step II) or high potency (step III). Non-opioids are routinely administered prior to an opioid.

While i.v. application is the treatment of choice in the immediate postoperative course, a switch to oral pain medication is preferred as early as possible. With oral opioid therapy preference should be given to slow release drugs. Intramuscular application of pain medication has little place in postoperative pain management. In order to lower the need for systemic pain medication, postoperative pain management is supplemented by regional anesthesia administered pre- or intraoperatively. Requirement for pain medication beyond normal or increasing with postoperative time is suggestive of a postsurgical complication.

Among the numerous drugs available for postoperative pain management, the physician is advised to confine his selection of pain medication to a limited number in order to gain superior knowledge of effects and side effects of the drugs administered.

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Authors and Affiliations

  1. Schmerzambulanz Klinik für Anästhesiologie Intensivmedizin und Schmerztherapie, Johann-Wolfgang-Goethe-Universität, Frankfurt/M.

    M. Zimmermann

  2. Abteilung für Rheumaorthopädie, Johann-Wolfgang-Goethe-Universität, Frankfurt/M.

    M. Rittmeister

  3. Schmerzambulanz Klinik für Anästhesiologie Intensivmedizin und Schmerztherapie, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60528, Frankfurt/M.

    M. Zimmermann

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Zimmermann, M., Rittmeister, M. Postoperative Schmerztherapie in der Orthopädie. Orthopäde 32, 1110–1119 (2003). https://doi.org/10.1007/s00132-003-0562-7

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  • DOI: https://doi.org/10.1007/s00132-003-0562-7

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