Postoperative Schmerztherapie – Der Einsatz von COX–2–Inhibitoren

 

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Zusammenfassung

Antiinflammatorisch wirksame Medikamente sind eine der bestdokumentierten Komponenten multimodaler postoperativer Analgesie. NSAR und COX–2–Inhibitoren sind hier gleichermaßen wirksam, jedoch reduziert der Einsatz der COX–2–Inhibitoren das Risiko gastrointestinaler Ulzerationen, erhöhter Blutungsneigung und Bronchospasmen. Das Risiko kardiovaskulärer und renaler Komplikationen wird durch den Einsatz von COX–2–Inhibitoren gegenüber NSAR nicht erhöht.

Summary

Compounds with anti–inflammatory properties are an important component of multimodal postoperative analgesia. NSAIDs and selective COX–2 inhibitors are of similar analgesic efficacy in this indication. However, the use of COX–2 inhibitors reduces the risk of gastrointestinal ulcers, bleeding complications and bronchospasm in comparison to NSAIDs. In parallel, COX–2 Inhibitors do not carry an increased risk of cardiovascular complications and require the same caution with regard to renal effects as NSAIDs.

Kernaussagen

• Multimodale Analgesie beschreibt den Einsatz einer Kombination mehrerer Analgetika, die verschiedene Wirkmechanismen haben oder an

• verschiedenen Stellen im Nervensystem in die Schmerzleitung eingreifen.

• Medikamente mit antiinflammatorischer Wirkung (NSAR und COX–2–Inhibitoren) sind eine effektive Komponente multimodaler Analgesie. Sie verbessern die Analgesie, sind opioidsparend und reduzieren opioidbedingte Nebenwirkungen.

• NSAR und COX–2–Inhibitoren haben eine ähnliche analgetische Wirksamkeit.

• COX–2–Inhibitoren reduzieren gegenüber NSAR in der postoperativen Schmerztherapie das Risiko von gastrointestinalen Ulzerationen, Blutungen, Asthma und möglicherweise verschlechterter Frakturheilung.

• Der kurzfristige Einsatz von COX–2–Inhibitoren in der perioperativen Phase erhöht des Risiko kardiovaskulärer Komplikationen nicht.

• Bezüglich renaler Nebenwirkungen verhalten sich NSAR und COX–2–Inhibitoren ähnlich.

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Prof. Dr. med. Stephan A. Schug

Email: stephan.schug@uwa.edu.au

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