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Nichtopioidanalgetika zur perioperativen Schmerztherapie

Risiken und rationale Grundlagen für den Einsatz bei Erwachsenen

  • Schmerztherapie
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Zusammenfassung

Nichtopioidanalgetika sind wesentlicher Bestandteil der perioperativen Schmerztherapie. In dieser Arbeit werden pharmakologische Aspekte, analgetische Wirksamkeit und unerwünschte Arzneimittelwirkungen der Nichtopioidanalgetika dargestellt. Im ersten Teil wird die Pharmakologie der Substanzen Diclofenac und Acetylsalicylsäure als saure und Metamizol, Paracetamol und die COX-2-Inhibitoren als nichtsaure antiphlogistische Analgetika beschrieben. Im zweiten Teil wird die analgetische Wirksamkeit der Nichtopioidanalgetika bei geringgradigen (z. B. ambulante Eingriffe) sowie als Kombinationstherapie mit Opioiden bei höhergradigen Schmerzen (z. B. Abdominalchirurgie) diskutiert. Der mögliche Nutzen einer Kombinationstherapie aus 2 Nichtopioidanalgetika wird dargestellt. Im dritten Teil werden die unerwünschten Arzneimittelwirkungen anhand Pathophysiologie, Häufigkeit und klinischer Relevanz beschrieben. Schwerpunkte sind die Wirkungen auf den Gastrointestinaltrakt (Ulkusbildung), die Blutgerinnung (Blutungsrisiko und Thromboseentstehung), das renale (Niereninsuffizienz), das pulmonale (Bronchospasmus) und das blutbildende System (Agranulozytose). Abschließend werden Empfehlungen zum klinischen Einsatz der Nichtopioidanalgetika in der postoperativen Schmerztherapie gegeben.

Abstract

Non-opioid analgesics play a central role in the management of postoperative pain. In this review, the pharmacology, the analgesic efficacy and the side-effects of non-opioid analgesics are summarized. First, the pharmacology of diclofenac, acetyl salicylic acid, dipyrone, acetaminophen and the COX-2 inhibitors is described. Second, the analgesic efficacy of non-opioid analgesics is analyzed for moderate pain (e.g. ambulatory surgery) and for moderate to severe pain (e.g. abdominal surgery—in combination with opioids). There is limited evidence for an additive analgesic effect of two non-opioid analgesics. Third, the major side-effects of non-opioid analgesics are discussed in relation to the pathophysiology, the frequency and the clinical relevance of these effects. In particular, side-effects on the gastrointestinal tract (ulcus formation), on coagulation (bleeding and thrombosis), on the renal (renal insufficiency), the pulmonary (bronchospasm) and the hematopoetic systems (agranulocytosis) are described. Recommendations for the clinical use of non-opioid analgesics for perioperative pain therapy are given.

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  1. Klinik für Anaesthesiologie und operative Intensivmedizin, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin

    A. Brack, H. L. Rittner & M. Schäfer

  2. Klinik für Anaesthesiologie und operative Intensivmedizin, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin

    A. Brack

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Brack, A., Rittner, H.L. & Schäfer, M. Nichtopioidanalgetika zur perioperativen Schmerztherapie. Anaesthesist 53, 263–280 (2004). https://doi.org/10.1007/s00101-003-0641-5

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