Download PDF
Neonatologie Scan 2013; 02(01): 61-82
DOI: 10.1055/s-0032-1326197
Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Schmerztherapie bei Früh- und Neugeborenen

Karin Becke
,
Michael Schroth
Further Information

Publication History

Publication Date:
04 March 2013 (online)

Also available at
    Permissions and Reprints

Schmerzdefinition

Eine allgemein gültige Definition des Begriffes „Schmerz“ existiert seit fast 50 Jahren: Harold Merskey formulierte 1964 erstmals:

„Schmerz ist ein unangenehmes Sinnes- oder Gefühlserlebnis, das mit tatsächlicher oder potenzieller Gewebeschädigung einhergeht oder von betroffenen Personen so beschrieben wird, als wäre eine solche Gewebeschädigung die Ursache“ [1].

Diese Definition wurde 1979 von der Internationalen Gesellschaft zum Studium des Schmerzes (International Association for the Study of Pain) übernommen und besitzt noch heute Gültigkeit, auch wenn durch modifizierende Ergänzungen immer wieder versucht wurde, dem rasanten Erkenntnisgewinn des Forschungsgebiets Schmerz der letzten drei Jahrzehnte gerecht zu werden. Unter anderem geht man heute davon aus, dass Schmerz auch unabhängig von einer Gewebeverletzung empfunden werden kann [2].

Merke: Es gilt: Schmerz ist das, was der Patient individuell als Schmerz äußert.

 

  • Literatur

  • 1 Merskey H. An Investigation of Pain in Psychological Illness. Oxford: DM Thesis; 1964
    Google Scholar
  • 2 Price DD. Psychological mechanisms of pain and analgesia. In: Progress in pain research and management. 15. Seattle: IASP Press; 1999
    Google Scholar
  • 3 Walker SM. Pain in children: recent advances and ongoing challenges. Br J Anaesth 2008; 101: 101-110
    CrossrefGoogle Scholar
  • 4 Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci 2005; 6: 507-520
    CrossrefPubMedGoogle Scholar
  • 5 Johnston CC, Fernandes AM, Campbell-Yeo M. Pain in neonates is different. Pain 2011; 152: 65-73
    CrossrefGoogle Scholar
  • 6 Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971-979
    CrossrefPubMedGoogle Scholar
  • 7 Andrews K, Fitzgerald M. Cutaneous flexion reflex in human neonates: a quantitative study of threshold and stimulus-response characteristics after single and repeated stimuli. Dev Med Child Neurol 1999; 41: 696-703
    CrossrefGoogle Scholar
  • 8 Taddio A, Katz J, Ilersich AL et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997; 349: 599-603
    CrossrefPubMedGoogle Scholar
  • 9 Hohmeister J, Kroll A, Wollgarten-Hadamek I et al. Cerebral processing of pain in school-aged children with neonatal nociceptive input: an exploratory fMRI study. Pain 2010; 150: 257-267
    CrossrefGoogle Scholar
  • 10 Swafford LI, Allan D. Pain relief in the pediatric patient. Med Clin N Am 1968; 52: 131-136
    Google Scholar
  • 11 Anand KJ, Hickey PR. Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. N Engl J Med 1992; 326: 1-9
    CrossrefGoogle Scholar
  • 12 Wolfe J, Grier HE, Klar N et al. Symptoms and suffering at the end of life in children with cancer. N Engl J Med 2000; 342: 326-333
    CrossrefGoogle Scholar
  • 13 Stevens B, Anand KJ. An overview of neonatal pain. In: Anand KJ, Stevens B, McGrath P, (Hrsg.) Pain in neonates. Amsterdam: Elsevier Science; 2000
    Google Scholar
  • 14 Fitzgerald M, Beggs S. The neurobiology of pain: developmental aspects. Neuroscientist 2001; 7: 246-257
    CrossrefGoogle Scholar
  • 15 Fitzgerald M, Millard C, MacIntosh N. Hyperalgesia in premature infants. Lancet 1988; 1: 292
    Google Scholar
  • 16 Carbajal R, Rousset A, Danan C et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 2008; 300: 60-70
    CrossrefGoogle Scholar
  • 17 Anand KJ, Sippell WG, Aynsley-Green A. Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. Lancet 1987; 1: 62-66
    CrossrefPubMedGoogle Scholar
  • 18 Anand KJ, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med 1987; 317: 1321-1329
    CrossrefPubMedGoogle Scholar
  • 19 Stevens BJ, Johnston CC. Physiological responses of premature infants to a painful stimulus. Nurs Res 1994; 43: 226-231
    Google Scholar
  • 20 Pokela ML, Koivisto M. Physiological changes, plasma beta-endorphin and cortisol responses to tracheal intubation in neonates. Acta Paediatr 1994; 83: 151-156
    CrossrefGoogle Scholar
  • 21 Grunau R. Early pain in preterm infants. A model of long-term effects. Clin Perinatol 2002; 29: 373-394
    CrossrefGoogle Scholar
  • 22 Fitzgerald M, Millard C, McIntosh N. Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia. Pain 1989; 39: 31-36
    CrossrefPubMedGoogle Scholar
  • 23 Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med 2006; 11: 268-275
    CrossrefGoogle Scholar
  • 24 American Academy of Pediatrics. Prevention and management of pain in the neonate: an update. Pediatrics 2006; 118: 2231-2241
    CrossrefGoogle Scholar
  • 25 Anand KJ. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001; 155: 173-180
    CrossrefGoogle Scholar
  • 26 Bellu R, de Waal K, Zanini R. Opioids for neonates receiving mechanical ventilation. Cochrane Database Syst Rev 2008; 1 CD004212
    Google Scholar
  • 27 Anand KJ, Ingraham J. Tolerance, dependence, and strategies for compassionate withdrawal of analgesics and anxiolytics in the pediatric ICU. Crit Care Nurse 1996; 16: 87-93
    Google Scholar
  • 28 Anand KJ, Craig KD. New perspectives on the definition of pain. Pain 1996; 67: 3-6 ; discussion 209 – 211
    CrossrefGoogle Scholar
  • 29 Craig KD, Whitfield MF, Grunau RVE et al. Pain in the preterm neonate: behavioural and physiological indices. Pain 1993; 52: 287-299
    CrossrefGoogle Scholar
  • 30 Grunau RVE, Johnston CC, Craig KD. Neonatal facial and cry responses to invasive and non- invasive procedures. Pain 1990; 42: 295-305
    CrossrefGoogle Scholar
  • 31 Peters JW, Koot HM, Grunau RE et al. Neonatal Facial Coding System for assessing postoperative pain in infants: item reduction is valid and feasible. Clin J Pain 2003; 19: 353-363
    CrossrefGoogle Scholar
  • 32 Sweet SD, McGrath PJ. Physiological measures of pain. In: Finley GA, McGrath PJ. Measurement of pain in infants and children. Progress in pain research and management. Seattle: IASP Press; 1998: 59-81
    Google Scholar
  • 33 van Dijk M, de Boer JB, Koot HM et al. The association between physiological and behavioral pain measures in 0- to 3-year-old infants after major surgery. J Pain Symptom Manage 2001; 22: 600-609
    CrossrefGoogle Scholar
  • 34 Morton NS. The pain-free ward: myth or reality. Paediatr Anaesth 2012; 22: 527-529
    CrossrefGoogle Scholar
  • 35 Büttner W, Finke W, Hilleke M et al. Entwicklung eines Fremdbeobachtungsbogens zur Beurteilung des postoperativen Schmerzes bei Säuglingen. Anaesthesiol Intensivmed Notfallmed Schmerzther 1998; 33: 353-361
    Article in Thieme ConnectGoogle Scholar
  • 36 Büttner W, Finke W. Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies. Pediatr Anesth 2008; 10: 303-318
    Google Scholar
  • 37 Stevens B, Johnston C, Petryshen P et al. Premature Infant Pain Profile: Development and initial validation. Clinical Journal of Pain 1996; 12: 13-22
    CrossrefGoogle Scholar
  • 38 Krechel SW, Bildner J. CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth 1995; 5: 53-61
    CrossrefGoogle Scholar
  • 39 Lawrence J, Alcock D, McGrath P et al. The development of a tool to assess neonatal pain. Neonatal Netw 1993; 12: 59-66
    Google Scholar
  • 40 Gessler P, Cignacco E. Vorgehensweisen zur Schmerzerfassung bei Neugeborenen sowie Vergleich des Berner Schmerzscores für Neugeborene (BSN) mit dem Premature Infant Pain Profile (PIPP). Klin Padiatr 2004; 216: 16-20
    Article in Thieme ConnectGoogle Scholar
  • 41 Merkel SI, Voepel-Lewis T, Shayevitz JR et al. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997; 23: 293-297
    PubMedGoogle Scholar
  • 42 Hünseler C, Roth B. Analgosedierung in der pädiatrischen Intensivmedizin. Intensivmed.up2date 2009; 5: 229-255
    Google Scholar
  • 43 van Dijk M, Simons S, Tibboel D. Pain assessment in neonates. Paediatr Perinat Drug Ther 2004; 6: 97-103
    Google Scholar
  • 44 Williams N, Foster BK, Cundy PJ. Is swaddling damaging our babies' hips?. Med J Aust 2012; 197: 272
    Google Scholar
  • 45 Cignacco E, Axelin A, Stoffel L et al. Facilitated tucking as a non-pharmacological intervention for neonatal pain relief: is it clinically feasible?. Acta Paediatr 2010; 99: 1763-1765
    CrossrefGoogle Scholar
  • 46 Warnock FF, Castral TC, Brant R et al. Brief report: Maternal kangaroo care for neonatal pain relief: a systematic narrative review. J Pediatr Psychol 2010; 35: 975-984
    CrossrefGoogle Scholar
  • 47 Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2010; 20 CD001069
    Google Scholar
  • 48 Simonse E, Mulder PG, van Beek RH. Analgesic effect of breast milk versus sucrose for analgesia during heel lance in late preterm infants. Pediatrics 2012; 129: 657-663
    CrossrefGoogle Scholar
  • 49 Bellieni CV, Cordelli DM, Marchi S et al. Sensorial saturation for neonatal analgesia. Clin J Pain 2007; 23: 219-221
    CrossrefGoogle Scholar
  • 50 Gitto E, Pellegrino S, Manfrida M et al. Stress response and procedural pain in the preterm newborn: the role of pharmacological and non-pharmacological treatments. Eur J Pediatr 2012; 171: 927-933
    CrossrefGoogle Scholar
  • 51 Anderson BJ. Paracetamol (Acetaminophen): mechanisms of action. Paediatr Anaesth 2008; 18: 915-921
    Google Scholar
  • 52 Andersson DA, Gentry C, Alenmyr L et al. TRPA1 mediates spinal antinociception induced by acetaminophen and the cannabinoid Δ(9)-tetrahydrocannabiorcol. Nat Commun 2011; 2: 551
    CrossrefGoogle Scholar
  • 53 Shah PS, Herbozo C, Aliwalas LL et al. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2012; 12 CD004950
    Google Scholar
  • 54 Jöhr M. Pharmakotherapie in der Kinderanästhesie. Anästh Intensivmed 2012; 53: 330-347
    Google Scholar
  • 55 Im Internet: http://www.emea.europa.eu/docs/en_GB/document_library/Report/2010/04/WC500088721.pdf (Zugriff am 08.01.2013)
  • 56 Anderson BJ, Woolard GA, Holford NHG. Pharmacokinetics of rectal paracetamol aftre major surgery in children. Pediatr Anesth 1995; 5: 237-242
    CrossrefGoogle Scholar
  • 57 Birmingham PK, Tobin MJ, Fisher DM et al. Initial and subsequent dosing of rectal acetaminophen in children. Anesthesiology 2001; 94: 385-389
    CrossrefGoogle Scholar
  • 58 Beasley R, Clayton T, Crane J. ISAAC Phase Three Study Group et al. Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6 to 7 years: analysis from Phase Three of the ISAAC programme. Lancet 2008; 372: 1039-1048
    Google Scholar
  • 59 Kristensen DM, Hass U, Lesné L et al. Intrauterine exposure to mild analgesics is a risk factor for development of male reproductive disorders in human and rat. Human Reprod 2011; 26: 235-244
    CrossrefGoogle Scholar
  • 60 Schultz ST. Can autism be triggered by acetaminophen activation of the endocannabinoid system. Acta Neurobiol Exp 2010; 70: 227-231
    Google Scholar
  • 61 Elia N, Lysakowski C, Tramer MR. Does multimodal analgesia with acetamino- phen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology 2005; 103: 1296-1304
    CrossrefPubMedGoogle Scholar
  • 62 Ohlsson A, Walia R, Shah S. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2008; 1 CD003481
    Google Scholar
  • 63 Aranda JV, Thomas R. Systematic review: intravenous ibuprofen in preterm newborns. Semin Perinatol 2006; 30: 114-120
    CrossrefGoogle Scholar
  • 64 Kramer MS, Lane DA, Hutchinson TA. The International Agranulocytosis and Aplastic Anemia Study (IAAAS). J Clin Epidemiol 1988; 41: 613-616
    CrossrefGoogle Scholar
  • 65 Hedenmalm K, Spigset O. Agranulocytosis and other blood dyscrasias associated with dipyrone (metamizole). Eur J Clin Pharmacol 2002; 58: 265-274
    CrossrefGoogle Scholar
  • 66 Meyer O, Gaedicke G, Salama A. Demonstration of drug-dependent antibodies in two patients with neutropenia and successful treatment with granulocyte-colony-stimulating factor. Transfusion 1999; 39: 527-530
    CrossrefPubMedGoogle Scholar
  • 67 Rakow H, Finke W, Mutze K et al. Handlungsempfehlung zur perioperativen Schmerztherapie bei Kindern. Anästh Intensivmed 2007; 48: 99-103
    Google Scholar
  • 68 Anand KJ, Anderson BJ, Holford NH. NEOPAIN Trial Investigators Group et al. Morphine pharmacokinetics and pharmacodynamics in preterm and term neonates: secondary results from the NEOPAIN trial. Br J Anaesth 2008; 101: 680-689
    CrossrefGoogle Scholar
  • 69 Marsh DF, Hatch DJ, Fitzgerald M. Opioid systems and the newborn. Br J Anaesth 1997; 79: 787-795
    CrossrefGoogle Scholar
  • 70 Penido MG, Garra R, Sammartino M et al. Remifentanil in neonatal intensive care and anaesthesia practice. Acta Paediatr 2010; 99: 1454-1463
    CrossrefGoogle Scholar
  • 71 Müller C, Kremer W, Harlfinger S et al. Pharmacokinetics of piritramide in newborns, infants and young children in intensive care units. Eur J Pediatr 2006; 165: 229-239
    CrossrefGoogle Scholar
  • 72 Mader T, Hornung M, Boos K et al. Handlungsempfehlungen zur Regionalanästhesie bei Kindern. Anästh Intensivmed 2007; 48: 78-85
    Google Scholar
  • 73 Essink-Tebbes CM, Wuis EW, Liem KD et al. Safety of lidocaine-prilocaine cream application four times a day in premature neonates: a pilot study. Eur J Pediatr 1999; 158: 421-423
    CrossrefPubMedGoogle Scholar
  • 74 Cignacco E, Hamers JP, Stoffel L et al. Routine procedures in NICUs: factors influencing pain assessment and ranking by pain intensity. Swiss Med Wkly 2008; 138: 484-491
    Google Scholar
  • 75 Benis MM, Suresh GK. Frequency of invasive procedures in very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU) (abstract). Pediatr Res 2001; 49: 392
    Google Scholar