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Neurologische Komplikationen und Wirkverlust unter intrathekaler Schmerztherapie

Drei Fallberichte und Auswertung der Literatur

Neurological complications and loss of efficacy with intrathecal pain therapy

Three case reports and overview of the literature

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Zusammenfassung

In einer neuen Leitlinie der DGSS wird die intrathekale Opioidtherapie als nachgewiesen effektiv und relativ nebenwirkungsarm beschrieben. Wir überprüften diese Aussage durch eine Literaturauswertung und kritische Sichtung von Krankenverläufen eigener Patienten (n=3). In diesen Fällen (sowie 8 weiteren) führte die Explantation und Umstellung auf orale Opioide zu einer deutlich besseren Schmerzlinderung sowie zum Abklingen der unerwünschten Ereignisse.

Die von uns diskutierten Probleme scheinen keine Raritäten zu sein, sondern Komplikationen, die durchaus häufig beschrieben werden. Die Langzeitwirksamkeit intrathekaler Opioide ist nicht ausreichend belegt, ihre Wirkstärke zudem nicht hoch. Die Häufigkeit unerwünschter Ereignisse ist vergleichbar mit der einer oralen Opioidmedikation, allerdings sind gravierende neurologische Komplikationen möglich. Um Dosiseskalationen zu vermeiden und neurologische Komplikationen rechtzeitig zu erkennen, ist eine konsequente Nachkontrolle durch den Operateur oder durch ein erfahrenes Schmerzzentrum erforderlich.

Abstract

In a new guideline issued by the German Association for the Study of Pain, intrathecal opioid therapy is described as proven to be effective with relatively few side effects. We reviewed this statement by analysis of the available literature and critical evaluation of the clinical course in a few of our own patients (n=3). In these cases (as well as in a further eight patients), explantation and a switch to oral opioids led to distinctly better alleviation of pain and abatement of the unwanted effects.

The problems we discuss do not appear to be rare instances, but by all means complications that are frequently described. The long-term efficacy of intrathecal opioids has not been adequately verified; moreover, their potency is not high. The frequency of undesired events is comparable to that of oral opioid medication, but serious neurological complications are possible. To avoid dose escalations and to recognize neurological complications in time, diligent monitoring by the surgeon or an experienced pain center is essential.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, BG-Kliniken Bergmannsheil der Ruhr-Universität Bochum

    D. Kindler, S. Schulz, T. Weiss & M. Zenz

  2. Institut für Radiologie und Nuklearmedizin, BG-Kliniken Bergmannsheil der Ruhr-Universität Bochum

    T. Kagel

  3. Abteilung für Schmerztherapie, BG-Kliniken Bergmannsheil der Ruhr-Universität Bochum

    C. Maier

  4. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, BG-Kliniken Bergmannsheil der Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789 , Bochum

    D. Kindler

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  1. D. Kindler
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  2. C. Maier
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  3. T. Kagel
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  4. S. Schulz
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  5. T. Weiss
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  6. M. Zenz
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Correspondence to D. Kindler.

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Kindler, D., Maier, C., Kagel, T. et al. Neurologische Komplikationen und Wirkverlust unter intrathekaler Schmerztherapie. Schmerz 19, 144–155 (2005). https://doi.org/10.1007/s00482-004-0327-1

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