Patienten mit einem komplexen regionalen Schmerzsyndrom (CRPS) – Perioperatives Management und schmerztherapeutische Therapieformen

Zusammenfassung

Das komplexe regionale Schmerzsyndrom (complex regional painsyndrome, CRPS) ist eine äußerst komplexe Schmerzerkrankung und stellt an alle Involvierten hohe Ansprüche. Ein Sonderfall ist ein Patient mit einem floriden CRPS oder einem Zustand nach CRPS, der sich einer Operation unterziehen muss. Der Beitrag erläutert Empfehlungen bezüglich des idealen Zeitpunkts der Operation sowie zum perioperativen Management solcher Patienten.Hohe Evidenz für die Prophylaxe eines CRPS nach einem Trauma besteht nur für langfristig verabreichte, hochdosierte Vitamin C-Gaben.

Abstract

The complex regional pain syndrome (CRPS) is indeed a very complex pain situation. The treatment of CRPS is challenging. Patients with an acute CRPS or a CRPS in the past, who have to undergo surgery, provide a special situation. Recommendations for the management of such patients will be described in the article. High degree of evidence exists for high doses of vitamin C to prevent the development of a CRPS in trauma patients.

Kernaussagen

• Das optimale perioperative Management von Patienten mit einem CRPS stellt an alle involvierten Fachdisziplinen hohe Anforderungen.

• Operationen bei Patienten mit einem CRPS oder Zustand nach CRPS sollten, wenn immer möglich, vermieden werden.

• Ist eine Operation bei einem Patienten unumgänglich, sollte möglichst ein Regionalanästhesieverfahren gewählt werden.

• 500 mg Vitamin C per os während 50 Tagen ist eine effektive Prophylaxe zur Vermeidung eines CRPS nach chirurgisch versorgter Radiusfraktur.

• Über mehrere Tage verabreichtes hochdosiertes Ketamin scheint beim klinisch aktiven CRPS therapeutisch wirksam zu sein.

• Die Anwendung von GLOA-Infiltrationen (GLOA = ganglionäre lokale Opioidanalgesie) sowie die Gabe von Calcitonin zur Therapie des CRPS ist umstritten.

• Viele Fragen bleiben unbeantwortet.

Schlüsselwörter:

komplexes regionales Schmerzsyndrom - complexregional pain syndrome (CRPS) - Operation - Regionalanästhesie - Vitamin C

Keywords:

complexregional pain syndrome (CRPS) - surgery - regional anaesthesia - Vitamin C

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