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Schmerztherapie bei Intensivpatienten

Pain therapy in intensive care patients

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Zusammenfassung

Schmerzen gehören zu den Erinnerungen an eine intensivmedizinische Behandlung, die Patienten am meisten belasten, und haben eine Reihe negativer physiologischer Konsequenzen. Mehr als die Hälfte aller Patienten berichten von mäßigen oder starken Schmerzen während ihrer Intensivbehandlung, insbesondere im Zusammenhang mit diagnostischen oder therapeutischen Prozeduren. Schmerzen und ihre funktionellen Konsequenzen bei Intensivpatienten sollten daher konsequent erfasst und behandelt werden. Im Mittelpunkt der pharmakologischen Schmerztherapie stehen Opioide wegen ihrer hohen analgetischen Potenz, nachteilig sind jedoch gastrointestinale Motilitätsstörungen und Toleranzentwicklungen. Bei Nichtopioiden ist die potenzielle Organtoxizität von nichtsteroidalen Antirheumatika (NSAR) bzw. Paracetamol zu beachten. Ketamin und α2-Agonisten können das analgetische Konzept ergänzen. In Analogie zur perioperativen Anwendung erscheint die i. v.-Gabe von Lidocain aufgrund eines reduzierten Opioidbedarfs und einer verbesserten gastrointestinalen Motilität auch in der Intensivmedizin vertretbar. Bei Regionalanalgesieverfahren sollte eine sorgfältige Abwägung zwischen ihrer oft guten Wirksamkeit und potenziellen Komplikationen durchgeführt werden. Nichtmedikamentöse Verfahren – insbesondere die transkutane elektrische Nervenstimulation (TENS) – haben sich in der postoperativen Schmerztherapie sehr bewährt. Auch wenn kaum Daten aus der Intensivmedizin vorliegen, erscheint ein Therapieversuch wegen ihrer geringen Komplikationsträchtigkeit gerechtfertigt.

Abstract

After intensive care unit (ICU) treatment, the recollection of experienced pain is one of the most burdensome aftermaths. In addition, pain has several negative physiological consequences. The majority of patients report moderate to severe pain while being treated on an ICU, often caused by diagnostic or therapeutic procedures. Pain and its functional consequences during ICU treatment should therefore be systematically recorded and treated. Due to their high analgesic potency, pharmacological pain therapy focuses on opioids; however, gastrointestinal motility disturbance and development of tolerance are disadvantages. When applying non-opioids, such as non-steroidal anti-inflammatory drugs (NSAID) and paracetamol, attention should be paid to their possible organ toxicity. Ketamine and α2-antagonists can complement the analgesic concept. Analogous to its perioperative administration, intravenous lidocaine in intensive care seems acceptable because of a favorable impact on opioid requirements and gastrointestinal motility. When using regional anesthesia the positive therapeutic effect and the possible complications need to be carefully weighed. Non-pharmaceutical procedures, especially transcutaneous electrical nerve stimulation (TENS), have proven successful in postoperative pain management. Even if only limited data from intensive care are available, a therapeutic attempt seems justifiable because of the low risk of complications.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland

    Katharina Rose &  Winfried Meißner

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  1. Katharina Rose
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  2. Winfried Meißner
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Correspondence to Winfried Meißner.

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Interessenkonflikt

W. Meißner hat Forschungsunterstützung von der EU, dem BMBF, den Firmen Grünenthal und Pfizer sowie Honorare für Beratungs- und Vortragstätigkeiten von den Firmen Mundipharma, Grünenthal, AxelRXPharmaceutics, Menarini und BioQPharma erhalten. K. Rose gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Rose, K., Meißner, W. Schmerztherapie bei Intensivpatienten. Anaesthesist 67, 401–408 (2018). https://doi.org/10.1007/s00101-018-0458-x

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