Zusammenfassung
Abdominal- und thoraxchirurgische Eingriffe können mit starken akuten postoperativen Schmerzen einhergehen. Dabei zeigen neueste Untersuchungen, dass die schmerztherapeutische Versorgung gerade nach den häufig durchgeführten mittleren und kleineren Eingriffen noch deutlich verbessert werden muss. Zur effektiven Behandlung postoperativer Schmerzen nach abdominellen und thorakalen Eingriffen steht eine Reihe von Therapiemöglichkeiten (Regionalanästhesieverfahren, systemische Pharmakotherapie) zur Verfügung. In der vorliegenden Arbeit sollen zunächst die pathophysiologischen Grundlagen abdomineller und thorakaler Schmerzen nach einer Operation dargestellt und die verschiedenen Therapieoptionen im Hinblick auf ihre Indikation, Wirksamkeit und Risiko-/Nutzenbewertung diskutiert werden. Insbesondere erörtert wird der in den letzten Jahren z. T. nicht unumstrittene Einsatz einer Epiduralanalgesie sowie der mögliche Einsatz von (Alternativ-)Verfahren wie der „Transversus-abdominis-plane“(TAP)-Blockade, der Paravertebralblockade (PVB), einer lokalen Infiltration von Lokalanästhetika und der systemischen Applikation von Lidocain. Darüber hinaus werden Indikationen und Kontraindikationen einzelner Nichtopioidanalgetikagruppen speziell für abdominelle und thorakale Eingriffe angesprochen. Klare Empfehlungen werden gegeben und auf Zeitpunkt sowie Faktoren für eine individuelle Entscheidung wird hingewiesen. Auch wenn die Evidenzlage in einigen Bereichen noch nicht für einen generellen Einsatz bestimmter Verfahren ausreicht, haben die genannten Verfahren in der Klinik ihre Berechtigung. Zukünftig können sie zur Verbesserung der Ergebnisqualität hinsichtlich schmerztherapeutischer Parameter nach Operationen beitragen.
Abstract
Abdominal and thoracic surgical procedures can result in significant acute postoperative pain. Present evidence shows that postoperative pain management remains inadequate especially after “minor” surgical procedures. Various therapeutic options including regional anesthesia techniques and systemic pharmacotherapy are available for effective treatment of postoperative pain. This work summarizes the pathophysiological background of postoperative pain after abdominal and thoracic surgery and discusses the indication, effectiveness, risks, and benefits of the different therapeutic options. Special focus is given to the controversial debate about the indication for epidural analgesia, as well as various alternative therapeutic options, including transversus abdominis plane (TAP) block, paravertebral block (PVB), wound infiltration with local anesthetics, and intravenous lidocaine. In additional, indications and contraindications of nonopioid analgesics after abdominal and thoracic surgery are discussed and recommendations based on scientific evidence and individual risk and benefit analysis are made. All therapeutic options discussed are eligible for clinical use and may contribute to improve postoperative pain outcome after abdominal and thoracic surgical procedures.
Literatur
Ali M, Winter DC, Hanly AM et al (2010) Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life. Br J Anaesth 104(3):292–297
Amr YM, Yousef AA, Alzeftawy AE et al (2010) Effect of preincisional epidural fentanyl and bupivacaine on postthoracotomy pain and pulmonary function. Ann Thorac Surg 89(2):381–385
Barak M, Iaroshevski D, Poppa E et al (2007) Low-volume interscalene brachial plexus block for post-thoracotomy shoulder pain. J Cardiothorac Vasc Anesth 21(4):554–557
Barden J, Derry S, McQuay HJ, Moore RA (2009) Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 4:CD007355
Benedetti F, Vighetti S, Ricco C et al (1998) Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy. J Thorac Cardiovasc Surg 115(4):841–847
Block BM, Liu SS, Rowlingson AJ et al (2003) Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 290(18):2455–2463
Bolten W (2006) Gastrointestinale Nebenwirkungen durch nichtsteroidale Antirheumatika (NSAR). Gastroenterologe 1:189–196
Bolten WW, Lang B, Wagner AV et al (1999) Consequences and costs of NSAID-induced gastropathy in Germany. Akt Rheumatol 24:127–134
Bong CL, Samuel M, Ng JM, Ip-Yam C (2005) Effects of preemptive epidural analgesia on post-thoracotomy pain. J Cardiothorac Vasc Anesth 19(6):786–793
Bouman EA, Theunissen M, Bons SA et al (2014) Reduced incidence of chronic postsurgical pain after epidural analgesia for abdominal surgery. Pain Pract 14(2): E76–E84
Brodner G, Mertes N, Buerkle H et al (2000) Acute pain management: analysis, implications and consequences after prospective experience with 6349 surgical patients. Eur J Anaesthesiol 17(9):566–575
Bujedo BM (2013) Spinal opioid bioavailability in postoperative pain. Pain Pract. doi:10.1111/papr.12099 (Epub ahead of print)
Byhahn C, Meininger D (2009) Thoracic paravertebral block. Anasthesiol Intensivmed Notfallmed Schmerzther 44(7–8):530–542
Cervero F (2009) Visceral versus somatic pain: similarities and differences. Dig Dis 27(Suppl 1):3–10
Chan FK, Lanas A, Scheiman J et al (2010) Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet 376(9736):173–179
Chan VW, Chung F, Cheng DC et al (1991) Analgesic and pulmonary effects of continuous intercostal nerve block following thoracotomy. Can J Anaesth 38(6):733–739
Chang AK, Bijur PE, Meyer RH et al (2006) Safety and efficacy of hydromorphone as an analgesic alternative to morphine in acute pain: a randomized clinical trial. Ann Emerg Med 48(2):164–172
Chaparro LE, Smith SA, Moore RA et al (2013) Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev 7:CD008307
Charlton S, Cyna AM, Middleton P, Griffiths JD (2010) Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. Cochrane Database Syst Rev 12:CD007705
Dahl JB, Mathiesen O, Kehlet H (2010) An expert opinion on postoperative pain management, with special reference to new developments. Expert Opin Pharmacother 11(15):2459–2470
Dahl JB, Møiniche S (2009) Relief of postoperative pain by local anaesthetic infiltration: efficacy for major abdominal and orthopedic surgery. Pain 143(1–2):7–11
Danelli G, Berti M, Casati A et al (2007) Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2 %wt/vol ropivacaine. Eur J Anaesthesiol 24(7):596–601
Davies RG, Myles PS, Graham JM (2006) A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy – a systematic review and meta-analysis of randomized trials. Br J Anaesth 96(4):418–426
Detterbeck FC (2005) Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy. Ann Thorac Surg 80(4):1550–1559
Dryden CM, McMenemin I, Duthie DJ (1993) Efficacy of continuous intercostal bupivacaine for pain relief after thoracotomy. Br J Anaesth 70(5):508–510
Eason MJ, Wyatt R (1979) Paravertebral thoracic block-a reappraisal. Anaesthesia 34(7):638–642
Edwards JE, McQuay HJ (2002) Dipyrone and agranulocytosis: what is the risk? Lancet 360:1438
Garcia Rodriguez LA, Barreales Tolosa L (2007) Risk of upper gastrointestinal complications among users of traditional NSAIDs and COXIBs in the general population. Gastroenterology 132(2):498–506
Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S et al (2013) Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology (Epub ahead of print)
Gerner P (2008) Postthoracotomy pain management problems. Anesthesiol Clin 26(2):355–367
Giamberardino MA, Costantini R, Affaitati G et al (2010) Viscero-visceral hyperalgesia: characterization in different clinical models. Pain 151:307–322
Gogarten W, Van Aken H, Büttner J et al (2007) Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. 2. überarbeitete Empfehlung der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin. Anästh Intensivmed 48:S109–S124
Gogarten W, Van Aken HK (2012) Antiplatelet drugs – implications for the anesthesiologist. Anasthesiol Intensivmed Notfallmed Schmerzther 47(4):242–251
Gogarten W, Vandermeulen E, Van Aken H et al (2010) Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology. Eur J Anaesthesiol 27:999–1015
Gorissen KJ, Benning D, Berghmans T et al (2012) Risk of anastomotic leakage with non-steroidal anti-inflammatory drugs in colorectal surgery. Br J Surg 99(5):721–727
Gosch M, Böhmdorfer B, Benvenuti-Falger U et al (2010) Polypharmacy and pain treatment. Wien Med Wochenschr 160(11–12):286–292
Gottschalk A, Gottschalk A (2010) Continuous wound infusion of local anesthetics: importance in postoperative pain therapy. Anaesthesist 59(12):1076–1082
Gupta A, Favaios S, Perniola A et al (2011) A meta-analysis of the efficacy of wound catheters for post-operative pain management. Acta Anaesthesiol Scand 55(7):785–796
Haroutiunian S, Nikolajsen L, Finnerup NB, Jensen TS (2013) The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain 154(1):95–102
Hebbard P, Fujiwara Y, Shibata Y, Royse C (2007) Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care 35(4):616–617
Hebbard PD, Barrington MJ, Vasey C (2010) Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique. Reg Anesth Pain Med 35(5):436–441
Hedenmalm K, Spigset O (2002) Agranulocytosis and other blood dyscrasias associated with dipyrone (metamizole). Eur J Clin Pharmacol 58:265–274
Hennekens CH, Borzak S (2008) Cyclooxygenase-2 inhibitors and most traditional nonsteroidal anti-inflammatory drugs cause similar moderately increased risks of cardiovascular disease. J Cardiovasc Pharmacol Ther 13(1):41–50
Herminghaus A, Wachowiak M, Wilhelm W et al (2011) Intravenous administration of lidocaine for perioperative analgesia. Review and recommendations for practical usage. Anaesthesist 60(2):152–160
Herroeder S, Pecher S, Schönherr ME et al (2007) Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg 246(2):192–200
Hinz B, Cheremina O, Brune K (2008) Acetaminophen (paracetamol) is a selective cyclooxygenase-2 inhibitor in man. FASEB J 22(2):383–390
Holte K, Andersen J, Jakobsen DH, Kehlet H (2009) Cyclo-oxygenase 2 inhibitors and the risk of anastomotic leakage after fast-track colonic surgery. Br J Surg 96(6):650–654
Hotta K, Endo T, Taira K et al (2011) Comparison of the analgesic effects of continuous extrapleural block and continuous epidural block after video-assisted thoracoscopic surgery. J Cardiothorac Vasc Anesth 25(6):1009–1013
http://akdae.de/Arzneimittelsicherheit/RHB/Archiv/2013/20130715.pdf. Zugegriffen: 21.01.2014
http://www.akdae.de/Arzneimittelsicherheit/Bekanntgaben/Archiv/2011/201108191.pdf. Zugegriffen: 21.01.2014
http://www.bfarm.de/SharedDocs/Downloads/DE/Arzneimittel/Pharmakovigilanz/Bulletin/2011/3-2011.pdf?__blob=publicationFile&v=2. Zugegriffen: 21.01.2014
Huber M, Andersohn F, Bronder E et al (2013) Drug-induced agranulocytosis in the Berlin case-control surveillance study. Eur J Clin Pharmacol (Epub ahead of print)
Jänig W, Häbler HJ (2002) Physiology and pathophysiology of visceral pain. Schmerz 16(6):429–446
Johns N, O’Neill S, Ventham NT et al (2012) Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Dis 14(10):e635–e642
Jørgensen H, Wetterslev J, Møiniche S, Dahl JB (2000) Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev 4:CD001893
Joshi GP, Bonnet F, Shah R et al (2008) A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 107(3):1026–1040
Karmakar MK, Chung DC (2000) Variability of a thoracic paravertebral block. Are we ignoring the endothoracic fascia? Reg Anesth Pain Med 25(3):325–327
Katz J, Schmid R, Snijdelaar DG et al (2004) Pre-emptive analgesia using intravenous fentanyl plus low-dose ketamine for radical prostatectomy under general anesthesia does not produce short-term or long-term reductions in pain or analgesic use. Pain 110(3):707–718
Klein M, Gögenur I, Rosenberg J (2012) Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. BMJ 345:e6166
Koppert W, Weigand M, Neumann F et al (2004) Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg 98(4):1050–1055
Kotzé A, Scally A, Howell S (2009) Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression. Br J Anaesth 103(5):626–636
Lavand’homme P, De Kock M, Waterloos H (2005) Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology 103(4):813–820
Lee WM (2012) Acute liver failure. Semin Respir Crit Care Med 33(1):36–45
Liu SS, Carpenter RL, Mackey DC et al (1995) Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 83(4):757–765
Liu SS, Richman JM, Thirlby RC, Wu CL (2006) Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg 203:914–932
Loop T (2012) Systemic and regional analgesia in patients undergoing major thoracic surgery. Anasthesiol Intensivmed Notfallmed Schmerzther 47(9):576–582
Lloyd R, Derry S, Moore RA, McQuay HJ (2009) Intravenous or intramuscular parecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 2:CD004771
MacDougall P, Slinger P (2008) Post-thoracotomy shoulder pain and gabapentin: a tale of two enigmas. Can J Anaesth 55(6):323–327
Maier C, Nestler N, Richter H et al (2010) The quality of pain management in German hospitals. Dtsch Arztebl Int 107(36):607–614
Majid AA, Hamzah H (1992) Pain control after thoracotomy. An extrapleural tunnel to provide a continuous bupivacaine infusion for intercostal nerve blockade. Chest 101(4):981–984
Manion SC, Brennan TJ (2011) Thoracic epidural analgesia and acute pain management. Anesthesiology 115(1):181–188
Mann V, Mann S, Hecker A et al (2011) Continuous local wound infusion with local anesthetics: for thoracotomy and major abdominal interventions. Chirurg 82(10):906–912
Marret E, Rolin M, Beaussier M, Bonnet F (2008) Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg 95(11):1331–1338
McCarthy GC, Megalla SA, Habib AS (2010) Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs 70(9):1149–1163
McGettigan P, Henry D (2011) Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med 8(9):e1001098
Mercadante S (2010) Intravenous patient-controlled analgesia and management of pain in post-surgical elderly with cancer. Surg Oncol 19(3):173–177
Møiniche S, Mikkelsen S, Wetterslev J, Dahl JB (1998) A qualitative systematic review of incisional local anaesthesia for postoperative pain relief after abdominal operations. Br J Anaesth 81(3):377–383
Moisset X, Bouhassira D, Denis D et al (2010) Anatomical connections between brain areas activated during rectal distension in healthy volunteers: a visceral pain network. Eur J Pain 14(2):142–148
Momeni M, Crucitti M, De Kock M (2006) Patient-controlled analgesia in the management of postoperative pain. Drugs 66(18):2321–2337
Moore RA, Derry S, McQuay HJ, Wiffen PJ (2011) Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Syst Rev 9:CD008659
Moore RA, Barden J (2008) Systematic review of dexketoprofen in acute and chronic pain. BMC Clin Pharmacol 8:11
Naliboff BD, Berman S, Suyenobu B et al (2006) Longitudinal change in perceptual and brain activation response to visceral stimuli in irritable bowel syndrome patients. Gastroenterology 131(2):352–365
Niraj G, Kelkar A, Jeyapalan I et al (2011) Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery. Anaesthesia 66(6):465–471
Nishimori M, Low JH, Zheng H, Ballantyne JC (2012) Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev 7:CD005059
Pennefather SH, Akrofi ME, Kendall JB et al (2005) Double-blind comparison of intrapleural saline and 0.25 % bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia. Br J Anaesth 94(2):234–238
Perttunen K, Nilsson E, Heinonen J et al (1995) Extradural, paravertebral and intercostal nerve blocks for post-thoracotomy pain. Br J Anaesth 75(5):541–547
Petersen PL, Mathiesen O, Torup H, Dahl JB (2010) The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand 54(5):529–535
Pogatzki-Zahn E (2010) Prevention and therapy of prolonged, chronic pain after surgery. Anasthesiol Intensivmed Notfallmed Schmerzther 45(7–8):496–503
Pogatzki-Zahn EM, Englbrecht JS, Pöpping D et al (2013) Oral therapy algorithm for the treatment of postoperative pain. A prospective observational study. Schmerz 27(1):26–37
Pogatzki-Zahn EM, Schnabel A, Zahn PK (2012) Room for improvement: unmet needs in postoperative pain management. Expert Rev Neurother 12(5):587–600
Pogatzki-Zahn EM, Wenk M, Wassmann H et al (2007) Complications of regional anesthesia: diagnostic and management. Anasthesiol Intensivmed Notfallmed Schmerzther 42(1):42–52
Pöpping DM, Elia N, Van Aken HK et al (2013) Impact of epidural analgesia on mortality and morbidity after surgery: systematic review and Meta-analysis of randomized controlled trials. Ann Surg (Epub ahead of print)
Pöpping DM, Zahn PK, Van Aken HK et al (2008) Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 101(6):832–840
PROSPECT („Procedure-Specific Postoperative Pain Management“). http://www.postoppain.org/frameset.htm. Zugegriffen: 20.01.2014
Rafi AN (2001) Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 56(10):1024–1026
Rao Kadam V, Van Wijk RM, Moran JI, Miller D (2013) Epidural versus continuous transversus abdominis plane catheter technique for postoperative analgesia after abdominal surgery. Anaesth Intensive Care 41(4):476–481
Rawal N (2012) Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med 37(3):310–317
Reichl S, Pogatzki-Zahn E (2009) Concepts for perioperative pain therapy. A critical stocktaking. Anaesthesist 58(9):914–916, 918–920, 922–926
S3-Leitlinien zur Behandlung akuter perioperativer und posttraumatischer Schmerzen. (AWMF-Register Nr. 041/001) Stand: 21.05.2007, inkl. Änderungen vom 20. 04. 2009. Deutsche Interdisziplinäre Vereinigung für Schmerztherapie (DIVS) e. V. (Präsident: Prof. Dr. Heinz Laubenthal). http://www.awmf.org/leitlinien/detail/ll/001-025.html. Zugegriffen: 20.01.2014
Scarci M, Joshi A, Attia R (2010) In patients undergoing thoracic surgery is paravertebral block as effective as epidural analgesia for pain management? Interact Cardiovasc Thorac Surg 10(1):92–96
Scawn ND, Pennefather SH, Soorae A et al (2001) Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine. Anesth Analg 93(2):260–264
Schjerning Olsen AM, Fosbol EL, Lindhardsen J et al (2011) Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation 123(20):2226–2235
Schnabel A, Pogatzki-Zahn E (2010) Predictors of chronic pain following surgery. What do we know? Schmerz 24(5):517–531
Schönfeld S (2013) Transversus abdominis plane block: anesthesia procedure for abdominal wall surgery only. Anaesthesist 62(5):389–391
Schug SA, Joshi GP, Camu F et al (2009) Cardiovascular safety of the cyclooxygenase-2 selective inhibitors parecoxib and valdecoxib in the postoperative setting: an analysis of integrated data. Anesth Analg 108(1):299–307
Scott NB (2010) Wound infiltration for surgery. Anaesthesia 65(Suppl 1):67–75
Sengupta JN (2009) Visceral pain: the neurophysiological mechanism. Handb Exp Pharmacol 194:31–74
Shontz R, Karuparthy V, Temple R, Brennan TJ (2009) Prevalence and risk factors predisposing to coagulopathy in patients receiving epidural analgesia for hepatic surgery. Reg Anesth Pain Med 34(4):308–311
Sikandar S, Dickenson AH (2012) Visceral pain: the ins and outs, the ups and downs. Curr Opin Support Palliat Care 6(1):17–26
Steegers MA, Snik DM, Verhagen AF et al (2008) Only half of the chronic pain after thoracic surgery shows a neuropathic component. J Pain 9(10):955–961
Steffen P, Krinn E, Möller A et al (2002) Metamizol and diclofenac profoundly reduce opioid consumption after minor trauma surgery. Acute Pain 4:71–75
Tan N, Agnew NM, Scawn ND et al (2002) Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with thoracic epidural analgesia: a double-blind comparison of 0.5 % bupivacaine and 0.9 % saline. Anesth Analg 94(1):199–202
Tiippana E, Nilsson E, Kalso E (2003) Post-thoracotomy pain after thoracic epidural analgesia: a prospective follow-up study. Acta Anaesthesiol Scand 47(4):433–438
Van Oudenhove L, Aziz Q (2009) Recent insights on central processing and psychological processes in functional gastrointestinal disorders. Dig Liver Dis 41(11):781–787
Volk T, Wolf A, Van Aken H et al (2012) Incidence of spinal haematoma after epidural puncture: analysis from the German network for safety in regional anaesthesia. Eur J Anaesthesiol 29(4):170–176
Warner DO (2000) Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiology 92(5):1467–1472
Werawatganon T, Charuluxanun S (2005) Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 1:CD004088
Wu CL, Raja SN (2011) Treatment of acute postoperative pain. Lancet 377(9784):2215–2225
Yoshioka M, Mori T, Kobayashi H et al (2006) The efficacy of epidural analgesia after video-assisted thoracoscopic surgery: a randomized control study. Ann Thorac Cardiovasc Surg 12(5):313–318
Zöllner C, Schäfer M (2008) Opioids in anesthesia. Anaesthesist 57(7):729–740
Einhaltung ethischer Richtlinien
Interessenkonflikt. E.M. Pogatzki-Zahn, Beratungs- und/oder Referententätigkeiten für B. Braun, Mundipharma, MSD, Pfizer, Eli Lilly, Janssen-Cilag, Grünenthal und medupdate GmbH auszuüben. E.M. Pogatzki-Zahn bezieht Forschungsgelder von Mundipharma GmbH. J. Englbrecht gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Englbrecht, J., Pogatzki-Zahn, E. Perioperative Schmerztherapie bei abdominellen und thorakalen Operationen. Schmerz 28, 265–281 (2014). https://doi.org/10.1007/s00482-014-1420-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00482-014-1420-8