Schmerztherapie in der Notaufnahme – Beispiel: akute Bauchschmerzen

Claudius Falch; Benedikt Brantner; Helene Häberle; Andreas Kirschniak; Sven Müller; Björn Brücher; Alfred Königsrainer

doi:10.1055/s-0032-1325311

Lege artis - Das Magazin zur ärztlichen Weiterbildung, Inhaltsverzeichnis

Lege artis - Das Magazin zur ärztlichen Weiterbildung 2012; 2(4): 250-257
DOI: 10.1055/s-0032-1325311

Fachwissen

Übersicht

Schmerztherapie in der Notaufnahme – Beispiel: akute Bauchschmerzen

Claudius Falch

,

Benedikt Brantner

,

Helene Häberle

,

Andreas Kirschniak

,

Sven Müller

,

Björn Brücher

,

Alfred Königsrainer

Abstract

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.

Schlüsselwörter

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

Volltext

Referenzen

Literaturverzeichnis
1 The Federation of State Medical Boards of The United States, Inc. Model guidelines for the use of controlled substances for the treatment of pain. S D J Med 1999; 52: 25-27
2 Stork B, Hofmann-Kiefer K. Analgesia as an important component of emergency care. Der Anaesthesist 2009; 58: 639-650
3 Carr DB, Goudas LC. Acute pain. Lancet 1999; 353: 2051-2058
4 Gallacchi G, Pilger B Hrsg. Schmerzkompendium: Schmerzen verstehen und behandeln. Stuttgart: Thieme; 2001
5 Kehlet H. Effect of postoperative pain treatment on outcome-current status and future strategies. Langenbecks Arch Surg 2004; 389: 244-249
6 Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001; 87: 62-72
7 Reichl S, Pogatzki-Zahn E. Concepts for perioperative pain therapy. A critical stocktaking. Anaesthesist 2009; 58
8 Wilder-Smith OH, Mohrle JJ, Martin NC. Acute pain management after surgery or in the emergency room in Switzerland: a comparative survey of Swiss anaesthesiologists and surgeons. Eur J Pain 2002; 6: 189-201
9 Giesa M, Decking J, Roth KE et al. Acute pain management after orthopaedic surgery. Schmerz 2007; 21: 73-83
10 Biermann. Regionalanästhesie, periphere Nervenblockaden und rückenmarksnahe Verfahren zur post operativen Schmerztherapie – Juristische Aspekte. Schmerz 1999; 13: 175-175
11 Grundmann RT, Petersen M, Lippert H et al. The acute (surgical) abdomen - epidemiology, diagnosis and general principles of management. Z Gastroenterol 2010; 48: 696-706
12 Siewert J-R, Brauer RB. Basiswissen Chirurgie. Heidelberg: Springer; 2007
13 Attard AR et al. Safety of early pain relief for acute abdominal pain. BMJ 1992; 305: 554-556
14 de Dombal FT. The OMGE acute abdominal pain survey. Progress report, 1986. Scand J Gastroenterol Suppl 1988; 144: 35-42
15 Miettinen P et al. Acute abdominal pain in adults. Ann Chir Gynaecol 1996; 85: 5-9
16 Stromberg C, Johansson G, Adolfsson A. Acute abdominal pain: diagnostic impact of immediate CT scanning. World J Surg 2007; 31: 2347-2358
17 Lankisch PG, Mahlke R, Lübbers H. Das akute Abdomen aus internistischer Sicht. Dtsch Arztebl 2006; 103: 2179-2188
18 Trentzsch H, Werner J, Jauch KW. Acute abdominal pain in the emergency department - a clinical algorithm for adult patients. Zentralbl Chir 2011; 136: 118-128
19 Saur P et al. Implementierung eines standardisierten perioperativen Schmerzmanagementkonzepts in drei Krankenhäusern eines Klinikverbundes. Der Schmerz 2008; 22: 34-42
20 Marinsek M et al. Analgesic treatment and predictors of satisfaction with analgesia in patients with acute undifferentiated abdominal pain. Eur J Pain 2007; 11: 773-778
21 Jawaid M, Masood Z, Ayubi TK. Pre-operative analgesia in the accident and emergency department. J Coll Physicians Surg Pak 2009; 19: 350-353
22 Nissman SA, Kaplan LJ, Mann BD. Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation. Am J Surg 2003; 185: 291-296
23 LoVecchio F et al. The use of analgesics in patients with acute abdominal pain. J Emerg Med 1997; 15: 775-779
24 Cope Z. The Prevention and Early Diagnosis of the Acute Abdomen. BMJ 1929; 1: 6-9
25 McHale PM, LoVecchio F. Narcotic analgesia in the acute abdomen - a review of prospective trials. Eur J Emerg Med 2001; 8: 131-136
26 Mills AM et al. The association between emergency department crowding and analgesia administration in acute abdominal pain patients. Acad Emerg Med 2009; 16: 603-608
27 Graber MA et al. Informed consent and general surgeons' attitudes toward the use of pain medication in the acute abdomen. Am J Emerg Med 1999; 17: 113-116
28 Manterola C et al. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev CD 005660 2007;
29 Manterola C et al. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev CD 005660 2011;
30 Pace S., Burke TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med 1996; 3: 1086-1092
31 Vermeulen B et al. Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate - a randomized trial. Radiology 1999; 210: 639-43
32 Mahadevan M, Graff L. Prospective randomized study of analgesic use for ED patients with right lower quadrant abdominal pain. Am J Emerg Med 2000; 18: 753-756
33 Thomas SH et al. Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg 2003; 196: 18-31
34 Gallagher EJ et al. Randomized clinical trial of morphine in acute abdominal pain. Ann Emerg Med 2006; 48: 1-4
35 Amoli HA et al. Morphine analgesia in patients with acute appendicitis: a randomised double-blind clinical trial. Emerg Med J 2008; 25: 586-589
37 Striebel HW, Hackenberger J, Wessel A. Postoperative pain: patient's self-report versus observer's rating. Schmerz 1992; 6: 199-203
38 Mantyselka P et al. Patients' versus general practitioners' assessments of pain intensity in primary care patients with non-cancer pain. Br J Gen Pract 2001; 51: 995-997
39 Davoudi N et al. A comparison of patients' and nurses' assessments of pain intensity in patients with coronary artery disease. Int J Nurs Pract 2008; 14: 347-356
40 Todd KH et al. Clinical significance of reported changes in pain severity. Ann Emerg Med 1996; 27: 485-489
41 Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain?. Acad Emerg Med 1998; 5: 1086-1090
42 Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med 2001; 38: 633-638
43 Daoust R et al. Estimation of pain intensity in emergency medicine: a validation study. Pain 2008; 138: 565-570
44 Sharwood LN, Babl FE. The efficacy and effect of opioid analgesia in undifferentiated abdominal pain in children: a review of four studies. Paediatr Anaesth 2009; 19: 445-451
45 Aubrun F et al. What pain scales do nurses use in the postanaesthesia care unit?. Eur J Anaesthesiol 2003; 20: 745-749
46 Gagliese L et al. The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients. Pain 2005; 117: 412-420
47 Herr KA et al. Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain 2004; 20: 207-219
48 Laubenthal H, Neugebauer E. S3-Leitlinie "Behandlung akuter perioperativer und posttraumatischer Schmerzen", D.I.V.f. Schmerztherapie, Editor. 2007; 376-376
49 Feifel G. Pathophysiology and morbidity of mechanical ileus. Langenbecks Arch Chir 1985; 366: 279-284
50 Greenblatt DJ, Koch-Weser J. Intramuscular injection of drugs. N Engl J Med 1976; 295: 542-546
51 Muller-Vahl H. Adverse reactions after intramuscular injections. Lancet 1983; 1: 1050-1050
52 Tong HC, Haig A. Posterior femoral cutaneous nerve mononeuropathy: a case report. Arch Phys Med Rehabil 2000; 81: 1117-1118
53 Edwards JE et al. Single dose dipyrone for acute renal colic pain. Cochrane Database Syst Rev CD 003867 2002;
54 Tytgat GN. Hyoscine butylbromide - a review on its parenteral use in acute abdominal spasm and as an aid in abdominal diagnostic and therapeutic procedures. Curr Med Res Opin 2008; 24: 3159-3173
55 Hofmann-Kiefer K et al. Quality of pain management in preclinical care of acutely ill patients. Anaesthesist 1998; 47: 93-101
56 Brune K, Zeilhofer K. Antipyretic (non-narcotic) analgesics. In: Wall PD, Melzack R, Hrsg. Textbook of pain. Aufl. London: Churchill Livingstone; 1999. 4.
57 Brack A, Rittner HL, Schafer M. Non-opioid analgesics for perioperative pain therapy. Risks and rational basis for use. Anaesthesist 2004; 53: 263-280
58 Toussaint K et al. What do we (not) know about how paracetamol (acetaminophen) works?. J Clin Pharm Ther 2010; 35: 617-638
59 McGettigan P, Henry D. Cardiovascular risk and inhibition of cyclooxygenase: a systematic review of the observational studies of selective and nonselective inhibitors of cyclooxygenase 2. JAMA 2006; 296: 1633-1644
60 Zahn PK et al. Paracetamol for perioperative analgesia. Old substance - new insights. Anaesthesist 2010; 59: 940-952
61 Elia N, Lysakowski C, Tramer MR. Does multimodal analgesia with acetaminophen, 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
62 Dahl JB et al. Prevention of postoperative pain by balanced analgesia. Br J Anaesth 1990; 64: 518-520
63 Marret E et al. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology 2005; 102: 1249-1260
64 Lange H et al. Combined analgesics for postoperative pain therapy. Review of effectivity and side-effects. Anaesthesist 2007; 56: 1001-1016
65 Bannwarth B, Pehourcq F. Pharmacologic basis for using paracetamol: pharmacokinetic and pharmacodynamic issues. Drugs 2003; 63: 5-13
66 Abu-Kishk I et al. Transient renal insufficiency following dipyrone overdose. Arch Dis Child 233-234
67 Ibanez L et al. Agranulocytosis associated with dipyrone (metamizol). Eur J Clin Pharmacol 2005; 60: 821-829
68 Harris JD. Management of expected and unexpected opioid-related side effects. Clin J Pain 2008; 24 (Suppl. 01)
69 Schug SA, Zech D, Grond S. Adverse effects of systemic opioid analgesics. Drug Saf 1992; 7: 200-213
70 Tramer MR. A rational approach to the control of postoperative nausea and vomiting: evidence from systematic reviews. Part II. Recommendations for prevention and treatment, and research agenda. Acta Anaesthesiol Scand 2001; 45: 14-19
71 Kanowitz A et al. Safety and effectiveness of fentanyl administration for prehospital pain management. Prehosp Emerg Care 2006; 10: 1-7
72 Buttner M et al. Is low-dose haloperidol a useful antiemetic? A meta-analysis of published and unpublished randomized trials. Anesthesiology 2004; 101: 1454-1463
73 Apfel CC et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004; 350: 2441-2451
74 Wallenborn J et al. Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial. BMJ 2006; 333: 324-324
75 Rittner H, Brack A. Acute pain therapy for non opioid-naive patients. Anasthesiol Intensivmed Notfallmed Schmerzther 2011; 46: 112-116
76 Ostensen M, Forger F. Management of RA medications in pregnant patients. Nat Rev Rheumatol 2009; 5: 382-390
77 Briggs GG. Medication use during the perinatal period. J Am Pharm Assoc (Wash) 1998; 38: 717-727
78 Scialli AR et al. A review of the literature on the effects of acetaminophen on pregnancy outcome. Reprod Toxicol 2010; 30: 495-507
79 Dal Pizzol TD et al. Dipyrone use during pregnancy and adverse perinatal events. Archives of Gynecology and Obstetrics 2009; 279: 293-297
80 Wilffert B et al. Pharmacogenetics of drug-induced birth defects: what is known so far?. Pharmacogenomics 2011; 12: 547-558
81 Risser A et al. NSAID prescribing precautions. Am Fam Physician 2009; 80: 1371-1378
82 Schaefer C, Weber-Schöndorfer C. Medikamentöse Therapie in der Schwangerschaft. Deutsches Ärzteblatt 2009; 102: 2480-2489
83 McCarthy JJ. Intrauterine abstinence syndrome (IAS) during buprenorphine inductions and methadone tapers: can we assure the safety of the fetus?. J Matern Fetal Neonatal Med 2012; 25: 109-112

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