Schmerztherapie in der Notaufnahme – Beispiel: akute Bauchschmerzen

Zusammenfassung

Die präoperative Schmerztherapie bei akuten Bauchschmerzen vor erfolgter Diagnostik ist ein häufiger Diskussionspunkt. Inzwischen konnte nachgewiesen werden, dass sie weder die Diagnosestellung noch die resultierende Therapie negativ beeinflusst. Unter Berücksichtigung der jeweiligen Kontraindikationen sind aktuell Paracetamol, Metamizol und Piritramid – jeweils intravenös verabreicht – die Analgetika der Wahl. Bei mittelstarken und starken Schmerzen sollen Nichtopioide und Opioide kombiniert angewendet werden. Therapieanpassungen aufgrund repetitiver Schmerzmessungen verbessern die Analgesie.

Kernaussagen

• Die präoperative Therapie akuter Bauchschmerzen beeinflusst weder die Diagnosestellung noch die resultierende Therapie negativ.

• In der präoperativen Schmerztherapie sollen Analgetika ausschließlich parenteral verabreicht werden.

• Paracetamol ist das Nichtopioid der Wahl bei älteren Patienten, bei chronischer Niereninsuffizienz, in Schwangerschaft und Stillzeit. Es bedarf keiner Dosisreduktion.

• Bei Leberinsuffizienz ist Paracetamol kontraindiziert.

• Die Agranulozytose unter Anwendung von Metamizol ist sehr selten.

• Zur präoperativen Schmerztherapie mit Opioiden eignet sich Piritramid.

• Bei mittelstarken und starken Schmerzen sollten Opioide mit Nichtopioiden kombiniert werden.

Schlüsselwörter

Schmerztherapie - Opioid-Analgetika - Nichtopioid-Analgetika - Bereitschaftsdienst - akutes Abdomen

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