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Kinder- und Jugendmedizin 2004; 4(05): 156-160
DOI: 10.1055/s-0037-1617829
Schmerz
Schattauer GmbH

Paracetamol rektal – das postoperative Analgetikum der Wahl?[*]

Paracetamol rectal – the procedure of choice for postoperative analgesia?
Paul Reinhold
1   Klinik für Anaesthesiologie, operative Intensivmedizin, Schmerztherapie, Klinikum Herford (Chefarzt: Prof. Dr. med. Paul Reinhold)
,
Egbert Schlüter
1   Klinik für Anaesthesiologie, operative Intensivmedizin, Schmerztherapie, Klinikum Herford (Chefarzt: Prof. Dr. med. Paul Reinhold)
› Author Affiliations
Further Information

Publication History

Publication Date:
10 January 2018 (online)

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Zusammenfassung

Paracetamol rektal ist das derzeit meist genutzte postoperative Analgetikum im Kindesalter in Deutschland. Wie in verschiedenen Studien gezeigt werden konnte, weist es jedoch nur eine geringe analgetische Potenz auf und erreicht auf Grund niedriger Bioverfügbarkeit in den zugelassenen Dosierungen (10-15 mg/kg KG) bei rektaler Anwendung keine effektiven Plasmaspiegel. Als Monoanalgetikum ist es daher in aller Regel in dieser Applikationsform in der postoperativen Phase unzureichend. Da die langsame rektale Resorption das Erreichen der maximalen Plasmakonzentration auf 2-3 Stunden hinauszögert, wird eine wirksame Therapie erschwert; Opioide können zudem nicht optimal titriert werden. Darüber hinaus wirkt Paracetamol kaum antiphlogistisch und überhaupt nicht spasmolytisch.

Bei zu hoher Dosierung verursacht Paracetamol potenziell letale hepatotoxische Nebenwirkungen, weshalb die Tageshöchstdosierungen in Abhängigkeit vom Lebensalter auf 50-90 mg/kg KG begrenzt sind. Wenn man sich trotz fehlender antiinflammatorischer und spasmolytischer Aktivität für Paracetamol entscheidet, sollte die Wahl auf die effektivere und zuverlässigere perorale oder noch besser auf die intravenöse Applikationsform fallen.

Ansonsten bieten sich in der postoperativen Phase als effektive und hervorragend steuerbare Schmerzmittel vom Nonopioidtyp das Analgetikum Metamizol oder auch die nonsteroidalen Analgetika an.

Summary

Rectal paracetamol (engl. Acetaminophen) is the most favoured procedure for postoperative analgesia in pediatrics in Germany. But is it also the best choice? Several studies demonstrated an insufficient analgesic effect using the licensed dose of 10-15 mg/kg BW. Due to the low bioavailability of paracetamol by the rectal route, adequate plasmaconcentrations are not achieved by that dose.

The slow rectal reabsorption delays the attainment of the peak plasma concentration for 2-3 or even more hours. Another hour is needed for reaching maximal levels in the cerebrospinal fluid for an maximal optimal analgesic effect.

Since time course and strength of the analgesia are rather unpredictiable, an optimal titration with opioids simultaneously to the Paracetamol application is hardly practicable. Although it could be demonstrated that the success rate increased with increased doses of rectally applied paracetamol, higher doses of paracetamol caused potentially lethal hepatotoxic effects. Therefore the maximum licensed dose is limited to 50-90 mg/kg BW per day. A more effective and realiable analgetic method is the oral, or even better, intravenous application of paracetamol, or the application of NSAIDs and metamizol because of their antiinflamatory and spasmolytic properties.

Schlüsselwörter

Paracetamol - postoperative Schmerztherapie - rektale Applikation - Paracetamoldosierung

Keywords

Acetaminophen - postoperative analgesia - rectal route - dosages

* in Anlehnung an einen Vortrag (DGSS – Jahrestagung in Aachen, 27.09.2002)


 

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