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Therapie akuter Schmerzen bei Kindern und Jugendlichen

Treatment of acute pain in children and adolescents

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Zusammenfassung

Schmerzen gehören zu den häufigsten Ursachen für eine Konsultation des Kinderarztes. Die Stärke akuter Schmerzen kann anhand von Selbstbewertungs- oder Beobachtungsskalen erhoben werden. Akute Schmerzen jeder Genese müssen schnellstmöglich behandelt werden. Nach Ursachenerforschung und kausal ausgerichteter Therapie sind Ibuprofen und Paracetamol die am häufigsten eingesetzten Analgetika. Bei Letzterem sind das niedrige analgetische Potenzial sowie die geringe therapeutische Breite zu beachten. Bei starken bis sehr starken akuten Schmerzen sollten auch bei Kindern Opioide Mittel der ersten Wahl sein. Im Rahmen der postoperativen Schmerzbehandlung kommen Analgetikaregimes mit Basis- und Bedarfsanalgesie zum Einsatz. Starke Schmerzerfahrungen im Kindesalter können zur psychischen Traumatisierung führen und über die Ausbildung eines Schmerzgedächtnisses langfristig das Schmerzempfinden beeinflussen. Schmerzen müssen deshalb konsequent zu vermeiden versucht bzw. behandelt werden.

Abstract

Pain is one of the most common causes for consultation of a paediatrician and represents a major problem in paediatrics. Simple self-reporting and behavioural pain scales are suitable for assessment of intensity of acute pain. Acute pain of whatever origin should be treated immediately. The most commonly used analgesics are ibuprofen and paracetamol (acetaminophen). In the case of paracetamol the narrow therapeutic range should be kept in mind. Opioids should be first choice in therapy of severe pain, also for children. Perioperative pain should be treated with a combination of non-pharmacological and pharmacological strategies with basis medication and medication on demand. Experience of severe pain can result in the generation of a chronic pain memory with emotional trauma which can have a long-term influence on the sensitivity to pain. Therefore, every effort should be made to prevent pain and to treat it effectively.

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Authors and Affiliations

  1. Kinderchirurgische Klinik, Dr. von Haunersches Kinderspital, Ludwig-Maximilian-Universität München, Lindwurmstraße 4, 80337, München, Deutschland

    M. Heinrich

  2. Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital, Ludwig-Maximilian-Universität München, München, Deutschland

    F. Hoffmann

  3. Vodafone-Stiftungsinstitut und Lehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Datteln, Deutschland

    B. Zernikow

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  1. M. Heinrich
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Correspondence to M. Heinrich.

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Heinrich, M., Hoffmann, F. & Zernikow, B. Therapie akuter Schmerzen bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 158, 789–806 (2010). https://doi.org/10.1007/s00112-010-2254-9

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