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Intensivmedizin up2date 2014; 10(04): 289-300
DOI: 10.1055/s-0034-1390738
Allgemeine Prinzipien der Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Schmerztherapie auf der Intensivstation

Jörg Freyhoff
,
Irmela Gnass
,
Hans-Georg Bone
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Publikationsverlauf

Publikationsdatum:
23. Oktober 2014 (online)

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Kernaussagen

  • Viele Patienten auf der Intensivstation klagen über starke bis stärkste Schmerzen.

  • Eine gute Schmerztherapie kann postoperative Komplikationen reduzieren.

  • Die Schmerztherapie auf der Intensivstation sollte in ein kombiniertes Analgosedierungs- und Delirkonzept integriert sein.

  • Kontaktfähige Patienten sollte man mit der NRS-Skala untersuchen. Für analgosedierte und beatmete Patienten eignet sich die BPH-Skala, für bewusstseinsgetrübte, nicht intubierte Patienten die BPS-NI-Skala.

  • Eine basale Schmerztherapie mit Bedarfsmedikation und eine tägliche Unterbrechung der Analgosedierung ist die Grundlage der medikamentösen Schmerztherapie.

  • Besonders geeignet sind gut steuerbare Analgetika (Sufentanil, Remifentanil) oder die intermittierende Bolusgabe von Piritramid, ggf. sind adjuvante Medikamente sinnvoll. Man sollte möglichst auch eine Regionalanästhesie einsetzen. Zusätzlich sollte man nichtmedikamentöse Verfahren verwenden.

  • Die Schmerztherapie sollte klinikinternen Standards folgen. Außerdem ist ein Qualitätssicherungsverfahren empfehlenswert (Peer Review, Zertifizierung).

 

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