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Erschienen in: Wiener klinisches Magazin 2/2014

01.04.2014 | Anaesthesie

Durchbruchschmerzen und kurz wirksame Opioide

verfasst von: T. Beutlhauser, J. Oeltjenbruns, Prof. Dr. M. Schäfer

Erschienen in: Wiener klinisches Magazin | Ausgabe 2/2014

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Zusammenfassung

Die bisherige Opioidtherapie besteht in der Gabe retardierter Opioide nach fixem Zeitschema und einer zusätzlich möglichen Bedarfsmedikation. Bei der Notwendigkeit einer Bedarfsmedikation unterscheiden neuere Untersuchungen die nichtausreichende Einstellung der Tagesdosierung oder des Zeitintervalls („end-of-dose failure“) von sog. Durchbruchschmerzen, deren Attacken trotz optimaler Einstellung plötzlich – ereignisabhängig („incident pain“) oder ereignisunabhängig („spontaneous pain“) – auftreten können und üblicherweise nur kurze Zeit andauern. Entsprechend dieser Zeitdynamik scheint eine schnelle und kurzzeitige Erhöhung der Opioidplasmakonzentration sinnvoll zu sein. Obwohl in einer aktuellen europäischen Umfrage die Durchbruchschmerzen der Mehrheit von Tumorpatienten mit nichtretardierten Opioiden zufriedenstellend behandelt wurden, untersucht ein Großteil momentaner klinischer Studien, ob die Anwendung transmukosal- bzw. intranasal-verabreichten Fentanyls aufgrund der verkürzten Zeit bis zur maximalen Plasmakonzentration einen möglichen Vorteil bietet. In diesen Studien zeigt sich zwar ein statistisch signifikanter Unterschied in der Schmerzlinderung und der Anzahl an Schmerzattacken im Vergleich zu nichtretardierten Opioiden, dessen Ausmaß jedoch einen klinischen Vorteil nicht erkennen lässt. Dies mag u. a. daran liegen, dass die Patienten, die möglicherweise davon profitieren könnten, bisher noch nicht eindeutig identifiziert worden sind.
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Metadaten
Titel
Durchbruchschmerzen und kurz wirksame Opioide
verfasst von
T. Beutlhauser
J. Oeltjenbruns
Prof. Dr. M. Schäfer
Publikationsdatum
01.04.2014
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 2/2014
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-014-0212-1