Optimale Schmerztherapie nach Tonsillektomie: ein ungelöstes Problem

Zusammenfassung

Die Tonsillektomie gehört zu den schmerzhaftesten operativen Eingriffen überhaupt. Leider bekommen Patienten immer noch Aussagen zu hören wie: „Da müssen Sie durch“ oder „Sie bekommen doch schon genug Schmerzmedikamente“. Fragt man die behandelten Anästhesisten und HNO-Ärzte, so kann man zu hören bekommen: „Schmerzen nach Tonsillektomie seien kein Problem, man habe ein bewährtes Schmerzregime“. Im Widerspruch dazu zeigen klinische Untersuchungen, dass die Patienten nach Tonsillektomie zu einem großen Teil trotz postoperativer Schmerztherapie weiterhin unter starken behandlungsbedürften Schmerzen leiden. Betrachtet man die Studienlage, so wurden zahlreiche Schmerzregime in kontrollierten Studien untersucht, doch gibt es keinen Standard zur Schmerztherapie nach Tonsillektomie mit dem validen Nachweis einer suffizienten Schmerzbehandlung. Die vorliegende Übersicht möchte über den aktuellen Stand der klinischen Forschung zur Schmerzmessung und Schmerzbehandlung nach Tonsillektomie berichten.

Abstract

Tonsillectomy is one of the most painful surgical procedures. Unfortunately, it is not unusual that the patient hear statement like: “There is no way around” or “You receive already enough pain killers”. Asking the anesthetist or the otorhinolaryngologist, one may get to hear: “Pain after tonsillectomy is not a real problem. We have a reliable pain management protocol”. In contradiction, many clinical studies are showing that many patients have persistent and even severe pain after tonsillectomy despite postoperative pain therapy. Considering the results of many controlled clinical trials analyzing manifold varieties of pain management regimes it becomes obvious that there is no standard pain therapy after tonsillectomy with reliable proof of sufficient pain suppression. This review wants to give an overview on the current status of clinical research on pain measurement methods and pain management after tonsillectomy.

Schlüsselwörter

postoperativer Schmerz - Akutschmerz - Schmerzforschung - Tonsillektomie - Qualitätsmanagement

Key words

postoperative pain - acute pain - pain research - tonsillectomy - quality management

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