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Nichtmedikamentöse Maßnahmen sowie topische Analgetika und orale Zuckerstoffe im Schmerzmanagement

Österreichische interdisziplinäre Handlungsempfehlungen zum perioperativen Schmerzmanagement bei Kindern

Non-pharmaceutical measures, topical analgesics and oral administration of glucose in pain management

Austrian interdisciplinary recommendations on pediatric perioperative pain management

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Zusammenfassung

In der Schmerztherapie von Kindern werden neben medikamentösen zunehmend auch nichtmedikamentöse Verfahren angewendet. Sie haben eine unterstützende Funktion. In diesem Artikel werden nichtmedikamentöse Verfahren mit Einfluss auf perioperative und posttraumatische Schmerzen von Kindern und Jugendlichen dargestellt. Voraussetzung jeder suffizienten Schmerztherapie sind Zuwendung, die Vermittlung von Geborgenheit, Ablenkung und das Schaffen einer kindgerechten Umgebung. Topische Analgetika sind indiziert für die Anwendung auf der intakten Haut zur Oberflächenanästhesie. Altersabhängig müssen zur sicheren Anwendung die Dauer der Applikation, die Dosis und der maximale behandelte Hautbereich beachtet werden. Bei kleineren schmerzhaften Prozeduren hat oral verabreichte Glukose bei Frühgeborenen, Neugeborenen und jungen Säuglingen eine schmerzreduzierende Wirkung. Der positive Effekt ist v. a. für die Anwendung bei einem einmaligen Schmerzreiz gesichert. Nichtnutritives Saugen, „swaddling“, „facilitated tucking“, Kängurupflege u. a. können bei Früh- und Neugeborenen bei nur gering schmerzhaften Maßnahmen unterstützend eingesetzt werden. Für eine schmerzreduzierende Wirkung bei älteren Säuglingen und Kleinkindern besteht keine ausreichende Evidenz. Physikalisch-medizinische Therapieverfahren werden begleitend zur Behandlung akuter Schmerzen eingesetzt. Die Therapie wird individuell angepasst. Zwar lässt die eingeschränkte Datenlage eine kritische wissenschaftliche Beurteilung der einzelnen Maßnahmen derzeit kaum zu. Die Effekte können jedoch im täglichen Einsatz beobachtet werden. Psychologische Methoden können den Umgang mit Schmerzen erleichtern. Bei psychischen bzw. psychiatrischen Komorbiditäten oder psychosozialen Beeinträchtigungen sollte ein Psychologe herangezogen werden. Auch die Akupunktur und Hypnose sind eine sinnvolle Ergänzung im Rahmen einer multimodalen Schmerztherapie.

Abstract

Non-pharmaceutical procedures are increasingly being used in pediatric pain therapy in addition to pharmaceutical procedures and have a supporting function. This article describes the non-pharmaceutical procedures which have an influence on perioperative and posttraumatic pain in children and adolescents. Prerequisites for every adequate pain therapy are affection, imparting a feeling of security, distraction and the creation of a child-oriented environment. Topical analgesics are indicated for application to intact skin for surface anesthesia. For a safe use consideration must be given to the duration of application, the dose and the maximum area of skin treated in an age-dependent manner. For simple but painful procedures in premature infants, neonates and infants, pain can be effectively reduced by the oral administration of glucose. The positive effect is guaranteed particularly for the use in a once only pain stimulation. Non-nutritive sucking, swaddling, facilitated tucking and kangaroo mother care, for example can be used as supportive measures during slightly painful procedures. There is insufficient evidence for a pain reducing effect in older infants and small children. Physical therapeutic procedures can be used as accompanying measures for acute pain and are individually adapted. However, the limited amount of currently available data is insufficient to make a critical scientific assessment of the individual measures. The effects can, however, be observed in the daily routine practice. Psychological methods can facilitate coping with pain. In situations with mental and psychiatric comorbidities or psychosocial impairment, a psychologist should be consulted. Acupuncture and hypnosis are also a meaningful addition within the framework of multimodal pain therapy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. B. Messerer, B. Krauss-Stoisser und B. Urlesberger geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich

    B. Messerer

  2. Universitätsklinik für Kinder- und Jugendchirurgie, Medizinische Universität Graz, Graz, Österreich

    B. Krauss-Stoisser

  3. Klinische Abteilung für Neonatologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich

    B. Urlesberger

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  1. B. Messerer
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  2. B. Krauss-Stoisser
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  3. B. Urlesberger
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Correspondence to B. Messerer.

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Messerer, B., Krauss-Stoisser, B. & Urlesberger, B. Nichtmedikamentöse Maßnahmen sowie topische Analgetika und orale Zuckerstoffe im Schmerzmanagement. Schmerz 28, 31–42 (2014). https://doi.org/10.1007/s00482-014-1391-9

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