Perioperative Schmerztherapie bei Kindern

Eine effektive und sichere Kinderschmerztherapie ist aus ethischer Sicht und zur Vermeidung von negativen Langzeiteffekten wichtig. Eine qualitativ hochwertige Analgesie zu erreichen, bleibt in dieser vulnerablen Patientenpopulation schwierig. Aktuelle Daten, Entwicklungen, Konzepte und ein kritischer Blick auf die Rolle von Opioiden können helfen, die Therapie zu verbessern.

Abstract

Acute pain therapy in children is highly complex. Already preoperatively, the course for a successful therapy is set in the interaction with the child and parents. The goal of the treatment is a satisfied child. This means the use of empathy and therapy planning aimed at a balance between effect and side effect and functionality. Modern concepts are opioid-sparing and procedure-specific. Regional anaesthesia plays a major role, among other things due to excellent safety data. Knowledge of age- and block-specific local anaesthetic dosages is essential. Little is known about pharmacodynamic data of analgesics in children. Although knowledge about pharmacokinetic characteristics is increasing, off-label use of analgesics is inevitable. International databases such as the Kinderformularium provide up-to-date information. When using opioids, rules for safe handling must be followed both in terms of use and prescribing. Non-opioids and adjuvants – individually or in combination – have an established place in perioperative pain management. Non-pharmacological interventions can reduce anxiety and pain. Anxiety is one of the risk factors for chronic postsurgical pain.

Kernaussagen

• Bereits präoperativ werden in der Interaktion mit Kind und Eltern die Weichen für eine erfolgreiche Analgesie gestellt.

• Behandlungsziel ist ein zufriedenes Kind: Empathie plus Therapie im Gleichgewicht zwischen Wirkung, Nebenwirkung und Funktionalität.

• Moderne Konzepte sind opioidsparende Therapie und prozedurenspezifische Protokolle.

• Regionalanästhesie spielt aufgrund des günstigen Verhältnisses zwischen Sicherheit – Wirkung – NW eine große Rolle. Die Kenntnis von alters- und blockspezifischen LA-Dosierungen ist essenziell.

• Wenig ist bekannt über pharmakodynamische Daten von Analgetika bei Kindern.

• Obwohl das Wissen über pharmakokinetische Werte zunimmt, ist Off-Label-Use von Analgetika unumgänglich. Internationale Datenbanken, wie das Kinderformularium, bieten Up-to-date-Informationen.

• Beim Einsatz von Opioiden sind Regeln zum sicheren Umgang und zur Verschreibung zu beachten.

• Nichtopioide und Adjuvanzien haben – einzeln oder kombiniert – einen festen Platz in der perioperativen Schmerztherapie.

• Nicht pharmakologische Maßnahmen umfassen vor allem psychologische Interventionen. Sie lindern Angst und Schmerz. Angst gilt als Risikofaktor für CPSP.

Schlüsselwörter

perioperativer Schmerz - Kinder - Regionalanästhesie - opioidsparend - Analgetika

Keywords

perioperative pain - paediatric - regional anaesthesia - opioid-sparing - analgesics

Publication History

Article published online:
07 June 2023

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