Skip to main content
SpringerLink
Log in

Medikamente zur postoperativen Schmerztherapie: Bewährtes und Neues

Teil 2: Opioide, Ketamin und Gabapentinoide

Drugs for postoperative analgesia: routine and new aspects

Part 2: Opioids, ketamine and gabapentinoids

  • Klinische Pharmakologie
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

In dem Übersichtsartikel (Teil 1) wurden perioperative Aspekte der Anwendung von Nichtopioiden (Paracetamol, Metamizol, traditionelle nichtsteroidale antiphlogistische Rheumatika, Coxibe) diskutiert. Im Teil 2 folgen nun die Opioide (schwach: Tramadol, Tilidin mit Naloxon; stark: Piritramid, Morphin, Oxycodon, Hydromorphon, Fentanyl, Methadon, Buprenorphin) und einige Koanalgetika (Gabapentinoide, Ketamin). Zentraler Punkt der Übersicht ist die Darstellung von Nutzen, Risiken und Kosten einiger Substanzen, um dem Anwender die Differenzialindikation zu erleichtern. Neue Aspekte der Anwendung von Gabapentinoiden und Ketamin werden diskutiert.

Abstract

In part 1 of this review, perioperative aspects of the use of non-opioids (acetaminophene, dipyrone, traditional NSAR, coxibs) were discussed. In part 2 the perioperative aspects of opioids (weak opioids: tramadol, tilidine with naloxone, strong opioids: morphine, piritramide, oxycodone, hydromorphone, fentanyl, methadone, buprenorphine) and coanalgesics (gabapentinoids; ketamine) will now be presented. The main aim of the review is to describe the use, risks and cost of some substances to facilitate the differential indication. New aspects concerning the use of gabapentinoids and ketamine are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Bell RF, Dahl JB, Moore RA, Kalso E (2005) Peri-operative ketamine for acute post-operative pain: a quantitative and qualitative systematic review (Cochrane review). Acta Anaesthesiol Scand 49: 1405–1428

    Article  PubMed  CAS  Google Scholar 

  2. Böger RH, Schmidt G (2007) Analgetika. In: Schwabe U, Paffrath D (Hrsg) Arzneiverordnungsreport 2006. Springer, Berlin Heidelberg New York Tokio, S 273–290

  3. Cali RL, Meade PG, Swanson MS, Freeman C (2000) Effect of morphine and incision length on bowel function after colectomy. Dis Colon Rectum 43: 163–168

    Article  PubMed  CAS  Google Scholar 

  4. Chou R, Clark E, Helfland M (2003) Comparative efficacy and safety of long-lasting oral opioids for chronic non-cancer pain: a systematic review. J Pain Sympt Manage 26: 1026–1048

    Article  CAS  Google Scholar 

  5. Cicero TJ, Inciardi JA, Munoz A (2005) Trends in abuse of Oxycontin and other opioid analgesics in the United States: 2002–2004. J Pain 6: 662–672

    Article  PubMed  Google Scholar 

  6. Elia N, Tramèr MR (2005) Ketamine and postoperative pain – a quantitative systematic review of randomized trials. Pain 113: 61–70

    Article  PubMed  CAS  Google Scholar 

  7. Ensrud KE, Blackwell T, Mangione CM et al. (2003) Central nervous system active medications and risk for fractures in older women. Arch Intern Med 163: 949–957

    Article  PubMed  Google Scholar 

  8. Grond S, Hall J, Spacek A et al. (2007) Iontophoretic transdermal system using fentanyl compared with patient-controlled intravenous analgesia using morphine for postoperative pain management. Br J Anaesth 98: 806–815

    Article  PubMed  CAS  Google Scholar 

  9. Jage J (2004) Essentials der postoperativen Schmerztherapie. Thieme, Stuttgart New York

  10. Jage J, Heid F (2006) Anästhesie und Analgesie bei Suchtpatienten. Anaesthesist 55: 611–628

    Article  PubMed  CAS  Google Scholar 

  11. Jage J, Portenoy RK, Foley KM (1990) Die Bestimmung des i.m.-Morphin-Äquivalents zur Therapie des Krebsschmerzes mit verschiedenen Opioiden oder beim Wechsel des Verabreichungsweges. Schmerz 4: 110–117

    Article  PubMed  CAS  Google Scholar 

  12. Kaiko RF, Foley KM, Grabinski PY et al. (1983) Central nervous excitatory effects of meperidine in cancer patients. Ann Neurol 13: 180–185

    Article  PubMed  CAS  Google Scholar 

  13. Kalso E, Edwards JE, Moore RA, McQuay HJ (2004) Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 112: 372–380

    Article  PubMed  CAS  Google Scholar 

  14. Kietzmann D, Bouillon T, Hamm C et al. (1997) Pharmacodynamic modelling of the analgesic effects of piritramide in postoperative patients. Br J Anaesth 41: 888–894

    CAS  Google Scholar 

  15. Koppert W (2004) Opioid-induzierte Hyperalgesie. Anaesthesist 53: 455–466

    Article  PubMed  CAS  Google Scholar 

  16. Koppert W, Sittl R, Scheuber K et al. (2003) Differential modulation of remifentanil-induced analgesia and postinfusion hyperalgesia by S-ketamine and clonidine in humans. Anesthesiology 99: 152–159

    Article  PubMed  CAS  Google Scholar 

  17. Lehmann KA (1994) Patientenkontrollierte Analgesie. In: Lehmann KA (Hrsg) Der postoperative Schmerz, 2. Aufl. Springer, Berlin Heidelberg New York Tokio, S 317–355

  18. Liu M, Wittbrodt E (2002) Low-dose oral naloxone reverses opioid-induced constipation and analgesia. J Pain Sympt Manage 23: 48–53

    Article  Google Scholar 

  19. Michelet P, Guervilly C, Hélaine A et al. (2007) Adding ketamine to morphine for patient-controlled analgesia after thoracic surgery: influence on morphine consumption, respiratory function, and nocturnal desaturation. Br J Anaesth 99: 396–403

    Article  PubMed  CAS  Google Scholar 

  20. Montes A, Warner W, Puig MM (2000) Use of intravenous patient-controlled analgesia for the documentation of synergy between tramadol and metamizol. Br J Anaesth 85: 217–223

    Article  PubMed  CAS  Google Scholar 

  21. Morlion B, Ebner E, Weber A et al. (1999) Influence of bolus size on efficacy of postoperative patient-controlled analgesia with piritramide. Br J Anaesth 82: 52–55

    PubMed  CAS  Google Scholar 

  22. Ong CK, Lirk P, Seymour RA, Jenkins BJ (2005) The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 100: 757–773

    Article  PubMed  Google Scholar 

  23. Pogatzki-Zahn EM, Zahn P (2007) Postoperative Akutschmerztherapie. Neue Möglichkeiten der systemischen Analgesie. Anasthesiol Intensivmed Notfallmed Schmerzther 42: 22–31

    Article  PubMed  Google Scholar 

  24. Reid CM, Martin RM, Sterne JA et al. (2006) Oxycodone for cancer-related pain: meta-analysis of randomized controlled trials. Arch Intern Med 166: 837–843

    Article  PubMed  CAS  Google Scholar 

  25. Spacek A, Goraj E, Neiger FX et al. (2003) Superior postoperative analgesic efficacy of a continuous infusion of tramadol and dipyrone (metamizol). Acute Pain 5: 3–9

    Article  CAS  Google Scholar 

  26. Stamer U, Lehnen K, Höthker F et al. (2003) Impact of CYP2D6 genotype on postoperative tramadol analgesia. Pain 105: 231–238

    Article  PubMed  CAS  Google Scholar 

  27. Sykes NP (1996) An investigation of the ability of oral naloxone to correct opioid-related constipation in patients with advanced cancer. Palliat Med 10: 135–144

    Article  PubMed  CAS  Google Scholar 

  28. Thummel KE, Shen DD, Isoherranen N, Smith HE (2006) Design and optimization of dosage regimens: pharmacokinetic data. In: Brunton LL, Lazo JS, Parker KL (eds) Goodman & Gilman’s The pharmacological basis of therapeutics, 11th edn. McGraw-Hill, New York Chicago San Francisco, pp 1787–1888

  29. Tiippana EM, Hamunen K, Kontinen VK, Kalso E (2007) Do surgical patients benefit from postoperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg 104: 1545–1556

    Article  PubMed  CAS  Google Scholar 

  30. Tofil NM, Benner KW, Faro SJ (2006) The use of enteral naloxone to treat opioid-induced constipation in a pediatric intensive care unit. Pediatr Crit Care Med 7: 252–254

    Article  PubMed  Google Scholar 

  31. Webb AR, Leong S, Myles PS, Burn SJ (2002) The addition of a tramadol infusion to morphine-controlled analgesia after abdominal surgery: a double-blinded, placebo-controlled randomized trial. Anesth Analg 95: 1713–1718

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der korrespondierende Autor hat Vorträge auf Honorarbasis für die Firmen Aventis, Bristol Myers-Squibb, Grünenthal, Janssen-Cilag, MSD und Mundipharma gehalten.

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland

    J. Jage, R. Laufenberg-Feldmann & F. Heid

Authors
  1. J. Jage
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Laufenberg-Feldmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Heid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Jage.

Additional information

Der erste Teil dieses Beitrags zum Thema „Nichtopioide“ ist in Ausgabe 4/2008 dieser Zeitschrift erschienen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jage, J., Laufenberg-Feldmann, R. & Heid, F. Medikamente zur postoperativen Schmerztherapie: Bewährtes und Neues. Anaesthesist 57, 491–498 (2008). https://doi.org/10.1007/s00101-008-1327-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-008-1327-9

Schlüsselwörter

Keywords

Search

Navigation