Zusammenfassung
Für eine effektive Akutschmerztherapie im Kindesalter stehen zahlreiche Optionen zur Verfügung: nicht-medikamentöse/supplementierende Maßnahmen, Regional- und Lokalanästhesieverfahren sowie Opioide, Nichtopioidanalgetika und Koanalgetika. Die Anwendung eines multimodalen Ansatzes zur Prävention und Therapie von Schmerzen ist hilfreich, um Nebenwirkungen zu minimieren. Essenziell für die konsequente Durchführung einer kompetenten Akutschmerztherapie ist ein gut organisierter Akutschmerzdienst auf der Basis transparenter klinikinterner Standards.
Abstract
Acute pain therapy in children can be achieved by numerous modalities: non-medicamentous supportive measures, regional and local anesthesia, systemic opioids, non-opioids and co-analgesics. The multimodal approach for prevention and therapy of acute pain in children helps minimizing side effects. A well-organized pediatric pain service based on transparent standard operating procedures seems to be essential for the successful treatment of pain in children.
Schlüsselwörter:
Postoperativer Schmerz - Schmerztherapie im Kindesalter - Analgetika im Kindesalter - Regionalanästhesie im Kindesalter - PCA/PCEA im Kindesalter
Keywords:
postoperative pain - pediatric pain treatment - pain medication in children - pediatric regional anesthesia - pca and pcea in children
Kernaussagen
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Mangelnde Kenntnis der Thematik führt oft zu unzureichender Behandlung, daraus resultieren erhöhtes Schmerzempfinden und steigende Inzidenz chronischer Schmerzsyndrome.
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Nicht medikamentöse Verfahren bilden die unerlässliche Grundlage eines jeden perioperativen Schmerzkonzepts.
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Unter den Nichtopioidanalgetika hat Paracetamol eine geringere analgetische Potenz als Metamizol, Diclofenac und Ibuprofen.
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Starke Schmerzen erfordern die frühe Gabe von Opioiden unter adäquatem Monitoring. Nebenwirkungen müssen therapiert werden.
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Adjuvanzien wie Ketamin, Dexamethason und Clonidin werden supplementierend eingesetzt, um unerwünschte Nebenwirkungen durch Reduktion der Opioiddosis, Verbesserung der Analgesiequalität und Verlängerung der Wirkdauer zu senken.
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Wann immer möglich und sinnvoll sollen Lokal-/Regionalanästhesieverfahren zum Einsatz kommen.
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Standard-Operating-Procedures erleichtern das therapeutische Vorgehen für alle Beteiligten und sichern den Erfolg der multimodalen Schmerztherapie.
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Dr. med. Natascha Kammerbauer
Dr. med. Karin Becke
eMail: Natascha.Kammerbauer@diakonieneuendettelsau.de
eMail: Karin.Becke@diakonieneuendettelsau.de
