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Postoperative Schmerzmessung bei speziellen Patientengruppen

Teil II: Das kognitiv beeinträchtigte Kind

Postoperative pain assessment in special patient groups

Part II. Children with cognitive impairment

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Zusammenfassung

Die postoperative Schmerzerfassung bei Kindern mit intellektueller Beeinträchtigung fordert Ärzte und Pflege gleichermaßen heraus.

Kinder mit mäßiger bis schwerer intellektueller Einschränkung sind im Allgemeinen nicht in der Lage, Schmerz einzuschätzen und ausreichend zu kommunizieren. Schwierigkeiten in der Schmerzerfassung führen dazu, dass diese Kinder nicht in klinische Studien einbezogen werden und daher Gefahr laufen, schmerztherapeutisch insuffizient behandelt zu bleiben.

Das Sichtbarmachen von Schmerz ist ein besonders wichtiger Schritt in Richtung einer verbesserten Betreuung.

Selbstbeurteilungsskalen spielen bei Kindern mit einer intellektuellen Behinderung nur eine begrenzte Rolle. Hier sind Schmerzerfassungstools gefragt, die das Schmerzverhalten evaluieren. Der r-FLACC, der zuverlässig wie valide ist, berücksichtigt individuelle Verhaltensmuster und ist wegen des geringen Zeitaufwands zu seiner Erfassung für den klinischen Alltag tauglich.

Unsere Aufgabe muss es sein, Schmerzerfassung beim intellektuell eingeschränkten Kind zum Routinevorgehen werden zu lassen. Nur so können wir eine bessere Betreuung dieser sensiblen Patientengruppe sicherstellen.

Abstract

Postoperative pain assessment in children with cognitive impairment poses major challenges to healthcare professionals.

Children with moderate to severe cognitive impairment are generally unable to communicate effectively and to self-report the level of pain. Difficulties assessing pain have led to their exclusion from clinical trials and rendered them vulnerable to insufficient treatment of pain.

The realization of pain is a particularly important step forward for a better care of children with cognitive impairment.

Scales based on a child’s own perception of pain and its severity play a limited role in this vulnerable population and pain assessment tools which rely on observing pain behavior are essential. The r-FLACC, which is reliable and valid, includes specific behavioral descriptors and can be used simply and effectively postoperatively in clinical practice. Our task has to be assessing pain as a routine procedure in cognitively impaired children as a keystone for an improved and successful pain management in this very sensitive patient population.

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Authors and Affiliations

  1. Univ. Klinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Austria

    B. Messerer, J. Meschik, A. Gutmann, M. Vittinghoff &  A. Sandner-Kiesling MD

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  1. B. Messerer
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  2. J. Meschik
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Correspondence to A. Sandner-Kiesling MD.

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Messerer, B., Meschik, J., Gutmann, A. et al. Postoperative Schmerzmessung bei speziellen Patientengruppen. Schmerz 25, 256–265 (2011). https://doi.org/10.1007/s00482-011-1061-0

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