Analgesie und Anästhesie bei opiatabhängigen Patienten unter Substitution mit Buprenorphin

Zusammenfassung

Hintergrund: Die Inzidenz von akuten und chronischen Schmerzen ist bei substituierten Patienten erhöht, inadäquate Schmerztherapie ist ein häufiger Grund die Substitution abzubrechen. Substitution ist eine etablierte Therapie der Opiatabhängigkeit und reduziert die Mortalität deutlich. Buprenorphin ist ein Substitutionsmittel und Analgetikum mit gutem Sicherheits-/Wirkprofil. Das besondere Wirkprofil von Buprenorphin führt zur Verunsicherung bezüglich der optimalen medikamentösen Schmerztherapie.

Methode: Wir führten eine systematische Literaturrecherche in Pubmed mit qualitativer Synthese der Ergebnisse durch. Übereinstimmende Empfehlungen wurden übernommen, dort wo sich die Empfehlungen widersprachen wurde eine kritische Würdigung der vorhandenen Evidenz durchgeführt.

Ergebnisse: Es wurden 23 relevante Artikel identifiziert, in der Hauptsache Literaturarbeiten und Expertenmeinung.

Schlussfolgerung: Die Ergebnisse legen nahe, dass eine ausreichende Analgesie und Anästhesie unter Buprenorphinsubstitution möglich ist.

Abstract

Background: The incidence of acute and chronic pain is increased in patients in opioid-maintenance-programmes, inadequate pain therapy is a frequent reason for dropping out of therapy. Buprenorphine is a maintenance drug, but also an analgesic with a good safety profile. Due to its specific Pharmacodynamics and –kinetics doubt has been raised whether effective analgesia and anaesthesia is possible in Patients on Buprenorphine maintenance therapy (BMT).

Method: We conducted a systematic literature research in Pubmed with a qualitative synthesis of the results. All English and German language articles published after the year 2000 were included. Concurrent recommendations were adopted; in case of conflicting recommendations a critical appraisal of the available evidence was conducted.

Results: We identified 23 relevant articles, mainly based on experience and literature research.

Conclusion: According to our results, adequate analgesia and anaesthesia under BMT is feasible.

Schlüsselworter

Buprenorphin - Substitution - Schmerz - Analgesie - Anästhesie

Key words

buprenorphine - maintenance-therapy - pain - analgesia - anaesthesia

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