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Erschienen in: Wiener klinisches Magazin 1/2019

16.10.2018 | Anästhesie

Schmerztherapie bei Intensivpatienten

verfasst von: Dr. Katharina Rose, Prof. Dr. Winfried Meißner

Erschienen in: Wiener klinisches Magazin | Ausgabe 1/2019

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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.
Literatur
1.
Zurück zum Zitat Awissi DK, Begin C, Moisan J et al (2012) I‑SAVE study: impact of sedation, analgesia, and delirium protocols evaluated in the intensive care unit: an economic evaluation. Ann Pharmacother 46:21–28 CrossRef Awissi DK, Begin C, Moisan J et al (2012) I‑SAVE study: impact of sedation, analgesia, and delirium protocols evaluated in the intensive care unit: an economic evaluation. Ann Pharmacother 46:21–28 CrossRef
2.
Zurück zum Zitat Ballantyne JC, Sullivan MD (2015) Intensity of chronic pain—the wrong metric? N Engl J Med 373:2098–2099 CrossRef Ballantyne JC, Sullivan MD (2015) Intensity of chronic pain—the wrong metric? N Engl J Med 373:2098–2099 CrossRef
3.
Zurück zum Zitat Baumbach P, Gotz T, Gunther A et al (2016) Prevalence and characteristics of chronic intensive care-related pain: the role of severe sepsis and septic shock. Crit Care Med 44:1129–1137 CrossRef Baumbach P, Gotz T, Gunther A et al (2016) Prevalence and characteristics of chronic intensive care-related pain: the role of severe sepsis and septic shock. Crit Care Med 44:1129–1137 CrossRef
4.
Zurück zum Zitat Belgrade M, Hall S (2010) Dexmedetomidine infusion for the management of opioid-induced hyperalgesia. Pain Med 11:1819–1826 CrossRef Belgrade M, Hall S (2010) Dexmedetomidine infusion for the management of opioid-induced hyperalgesia. Pain Med 11:1819–1826 CrossRef
5.
Zurück zum Zitat Bernards CM (2002) Understanding the physiology and pharmacology of epidural and intrathecal opioids. Best Pract Res Clin Anaesthesiol 16:489–505 CrossRef Bernards CM (2002) Understanding the physiology and pharmacology of epidural and intrathecal opioids. Best Pract Res Clin Anaesthesiol 16:489–505 CrossRef
6.
Zurück zum Zitat Chanques G, Jaber S, Barbotte E et al (2006) Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 34:1691–1699 CrossRef Chanques G, Jaber S, Barbotte E et al (2006) Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 34:1691–1699 CrossRef
7.
Zurück zum Zitat Chlan LL, Weinert CR, Heiderscheit A et al (2013) Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. JAMA 309:2335–2344 CrossRef Chlan LL, Weinert CR, Heiderscheit A et al (2013) Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. JAMA 309:2335–2344 CrossRef
8.
Zurück zum Zitat De Kock MF, Lavand’homme PM (2007) The clinical role of NMDA receptor antagonists for the treatment of postoperative pain. Best Pract Res Clin Anaesthesiol 21:85–98 CrossRef De Kock MF, Lavand’homme PM (2007) The clinical role of NMDA receptor antagonists for the treatment of postoperative pain. Best Pract Res Clin Anaesthesiol 21:85–98 CrossRef
10.
Zurück zum Zitat Drew DJ, Marie StBJ (2011) Pain in critically ill patients with substance use disorder or long-term opioid use for chronic pain. AACN Adv Crit Care 22:238–254 (quiz 255–236) CrossRef Drew DJ, Marie StBJ (2011) Pain in critically ill patients with substance use disorder or long-term opioid use for chronic pain. AACN Adv Crit Care 22:238–254 (quiz 255–236) CrossRef
11.
Zurück zum Zitat Ehieli E, Yalamuri S, Brudney CS et al (2017) Analgesia in the surgical intensive care unit. Postgrad Med J 93:38–45 CrossRef Ehieli E, Yalamuri S, Brudney CS et al (2017) Analgesia in the surgical intensive care unit. Postgrad Med J 93:38–45 CrossRef
12.
Zurück zum Zitat Elefritz JL, Murphy CV, Papadimos TJ et al (2016) Methadone analgesia in the critically ill. J Crit Care 34:84–88 CrossRef Elefritz JL, Murphy CV, Papadimos TJ et al (2016) Methadone analgesia in the critically ill. J Crit Care 34:84–88 CrossRef
13.
Zurück zum Zitat Finnerup NB, Attal N, Haroutounian S et al (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 14:162–173 CrossRef Finnerup NB, Attal N, Haroutounian S et al (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 14:162–173 CrossRef
14.
Zurück zum Zitat Fletcher D, Stamer UM, Pogatzki-Zahn E et al (2015) Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol 32:725–734 CrossRef Fletcher D, Stamer UM, Pogatzki-Zahn E et al (2015) Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol 32:725–734 CrossRef
15.
Zurück zum Zitat Fredheim OM, Moksnes K, Borchgrevink PC et al (2008) Clinical pharmacology of methadone for pain. Acta Anaesthesiol Scand 52:879–889 CrossRef Fredheim OM, Moksnes K, Borchgrevink PC et al (2008) Clinical pharmacology of methadone for pain. Acta Anaesthesiol Scand 52:879–889 CrossRef
16.
Zurück zum Zitat Hakkarainen TW, Steele SR, Bastaworous A et al (2015) Nonsteroidal anti-inflammatory drugs and the risk for anastomotic failure: a report from Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP). JAMA Surg 150:223–228 CrossRef Hakkarainen TW, Steele SR, Bastaworous A et al (2015) Nonsteroidal anti-inflammatory drugs and the risk for anastomotic failure: a report from Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP). JAMA Surg 150:223–228 CrossRef
17.
Zurück zum Zitat Hamilton TW, Strickland LH, Pandit HG (2016) A meta-analysis on the use of gabapentinoids for the treatment of acute postoperative pain following total knee arthroplasty. J Bone Joint Surg Am 98:1340–1350 CrossRef Hamilton TW, Strickland LH, Pandit HG (2016) A meta-analysis on the use of gabapentinoids for the treatment of acute postoperative pain following total knee arthroplasty. J Bone Joint Surg Am 98:1340–1350 CrossRef
18.
Zurück zum Zitat Herminghaus A, Wachowiak M, Wilhelm W et al (2011) Intravenous administration of lidocaine for perioperative analgesia. Review and recommendations for practical usage. Anaesthesist 60:152–160 CrossRef Herminghaus A, Wachowiak M, Wilhelm W et al (2011) Intravenous administration of lidocaine for perioperative analgesia. Review and recommendations for practical usage. Anaesthesist 60:152–160 CrossRef
19.
Zurück zum Zitat Hole J, Hirsch M, Ball E et al (2015) Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet 386:1659–1671 CrossRef Hole J, Hirsch M, Ball E et al (2015) Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet 386:1659–1671 CrossRef
21.
Zurück zum Zitat Lin TF, Yeh YC, Lin FS et al (2009) Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia. Br J Anaesth 102:117–122 CrossRef Lin TF, Yeh YC, Lin FS et al (2009) Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia. Br J Anaesth 102:117–122 CrossRef
22.
Zurück zum Zitat Maher DP, Chen L, Mao J (2017) Intravenous ketamine infusions for neuropathic pain management: a promising therapy in need of optimization. Anesth Analg 124:661–674 CrossRef Maher DP, Chen L, Mao J (2017) Intravenous ketamine infusions for neuropathic pain management: a promising therapy in need of optimization. Anesth Analg 124:661–674 CrossRef
23.
Zurück zum Zitat Martin J, Franck M, Sigel S et al (2007) Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey. Crit Care 11:R124 CrossRef Martin J, Franck M, Sigel S et al (2007) Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey. Crit Care 11:R124 CrossRef
24.
Zurück zum Zitat Meissner W, Coluzzi F, Fletcher D et al (2015) Improving the management of post-operative acute pain: priorities for change. Curr Med Res Opin 31:2131–2143 CrossRef Meissner W, Coluzzi F, Fletcher D et al (2015) Improving the management of post-operative acute pain: priorities for change. Curr Med Res Opin 31:2131–2143 CrossRef
25.
Zurück zum Zitat Mo Y, Thomas MC, Antigua AD et al (2017) Continuous Lidocaine infusion as adjunctive analgesia in intensive care unit patients. J Clin Pharmacol 57:830–836 CrossRef Mo Y, Thomas MC, Antigua AD et al (2017) Continuous Lidocaine infusion as adjunctive analgesia in intensive care unit patients. J Clin Pharmacol 57:830–836 CrossRef
27.
Zurück zum Zitat Payen JF, Bosson JL, Chanques G et al (2009) Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post Hoc analysis of the DOLOREA study. Anesthesiology 111:1308–1316 CrossRef Payen JF, Bosson JL, Chanques G et al (2009) Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post Hoc analysis of the DOLOREA study. Anesthesiology 111:1308–1316 CrossRef
28.
Zurück zum Zitat Puntillo KA, Max A, Timsit JF et al (2014) Determinants of procedural pain intensity in the intensive care unit. The Europain(R) study. Am J Respir Crit Care Med 189:39–47 PubMed Puntillo KA, Max A, Timsit JF et al (2014) Determinants of procedural pain intensity in the intensive care unit. The Europain(R) study. Am J Respir Crit Care Med 189:39–47 PubMed
29.
Zurück zum Zitat Ramasubbu C, Gupta A (2011) Pharmacological treatment of opioid-induced hyperalgesia: a review of the evidence. J Pain Palliat Care Pharmacother 25:219–230 CrossRef Ramasubbu C, Gupta A (2011) Pharmacological treatment of opioid-induced hyperalgesia: a review of the evidence. J Pain Palliat Care Pharmacother 25:219–230 CrossRef
31.
Zurück zum Zitat Rothaug J, Weiss T, Meissner W (2012) External validity of pain-linked functional interference: are we measuring what we want to measure? Schmerz 26:396–401 CrossRef Rothaug J, Weiss T, Meissner W (2012) External validity of pain-linked functional interference: are we measuring what we want to measure? Schmerz 26:396–401 CrossRef
32.
Zurück zum Zitat Stueber T, Buessecker L, Leffler A et al (2017) The use of dipyrone in the ICU is associated with acute kidney injury: a retrospective cohort analysis. Eur J Anaesthesiol 34:673–680 CrossRef Stueber T, Buessecker L, Leffler A et al (2017) The use of dipyrone in the ICU is associated with acute kidney injury: a retrospective cohort analysis. Eur J Anaesthesiol 34:673–680 CrossRef
33.
Zurück zum Zitat Szumita PM, Baroletti SA, Anger KE et al (2007) Sedation and analgesia in the intensive care unit: evaluating the role of dexmedetomidine. Am J Health Syst Pharm 64:37–44 CrossRef Szumita PM, Baroletti SA, Anger KE et al (2007) Sedation and analgesia in the intensive care unit: evaluating the role of dexmedetomidine. Am J Health Syst Pharm 64:37–44 CrossRef
34.
Zurück zum Zitat Tobias JD, Leder M (2011) Procedural sedation: a review of sedative agents, monitoring, and management of complications. Saudi J Anaesth 5:395–410 CrossRef Tobias JD, Leder M (2011) Procedural sedation: a review of sedative agents, monitoring, and management of complications. Saudi J Anaesth 5:395–410 CrossRef
35.
Zurück zum Zitat Von Dincklage F (2015) Monitoring of pain, nociception, and analgesia under general anesthesia: relevance, current scientific status, and clinical practice. Anaesthesist 64:758–764 CrossRef Von Dincklage F (2015) Monitoring of pain, nociception, and analgesia under general anesthesia: relevance, current scientific status, and clinical practice. Anaesthesist 64:758–764 CrossRef
36.
Zurück zum Zitat Wanzuita R, Poli-De-Figueiredo LF, Pfuetzenreiter F et al (2012) Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial. Crit Care 16:R49 CrossRef Wanzuita R, Poli-De-Figueiredo LF, Pfuetzenreiter F et al (2012) Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial. Crit Care 16:R49 CrossRef
37.
Zurück zum Zitat Weibel S, Jokinen J, Pace NL et al (2016) Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis. Br J Anaesth 116:770–783 CrossRef Weibel S, Jokinen J, Pace NL et al (2016) Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis. Br J Anaesth 116:770–783 CrossRef
38.
Zurück zum Zitat Whipple JK, Lewis KS, Quebbeman EJ et al (1995) Analysis of pain management in critically ill patients. Pharmacotherapy 15:592–599 CrossRef Whipple JK, Lewis KS, Quebbeman EJ et al (1995) Analysis of pain management in critically ill patients. Pharmacotherapy 15:592–599 CrossRef
39.
Zurück zum Zitat Wieseler-Frank J, Maier SF, Watkins LR (2005) Immune-to-brain communication dynamically modulates pain: physiological and pathological consequences. Brain Behav Immun 19:104–111 CrossRef Wieseler-Frank J, Maier SF, Watkins LR (2005) Immune-to-brain communication dynamically modulates pain: physiological and pathological consequences. Brain Behav Immun 19:104–111 CrossRef
Metadaten
Titel
Schmerztherapie bei Intensivpatienten
verfasst von
Dr. Katharina Rose
Prof. Dr. Winfried Meißner
Publikationsdatum
16.10.2018
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 1/2019
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-018-0259-5