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Pädiatrische Schmerztherapie und -prävention bei hospitalisierten Kindern

Pediatric pain treatment and prevention for hospitalized children

  • Pain Clinical Updates
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Zusammenfassung

Einleitung

Schmerzprävention und -therapie sind bei pädiatrischen Patienten im Vergleich zu Erwachsenen häufig nicht nur mangelhaft, sie werden auch umso seltener umgesetzt, je jünger die Kinder sind. Kinder und Jugendliche von 0 bis 17 Jahren sind eine vulnerable Gruppe.

Zielsetzung

Der vorliegende Beitrag befasst sich mit der Prävention und Therapie von akutem und chronischem Schmerz bei Kindern, einschließlich des Schmerzes bei Nadelstichen. In diesem Rahmen werden auch empfohlene analgetische Anfangsdosen angegeben.

Methoden

Dieses klinische Update basiert auf einem Datenblatt zur Schmerztherapie bei Kindern („Factsheet Pain in Children: Management“) der IASP-Kampagne Global Year Against Pain in the Vulnerable von 2019 und fasst die beste Evidenz sowie das beste praktische Vorgehen zusammen.

Ergebnisse

Im Rahmen der multimodalen Schmerztherapie können Arzneimittel (z. B. Basisanalgetika, Opioide und Koanalgetika), Regionalanästhesie, Rehabilitation, psychologische Ansätze, Spiritualität und integrative Verfahren eingesetzt werden, die synergistisch eine wirksamere akute pädiatrische Schmerzkontrolle mit weniger Nebenwirkungen ermöglichen als die einzelnen Analgetika oder Therapieverfahren. Bei chronischem Schmerz hat sich ein interdisziplinärer rehabilitativer Ansatz mit Physiotherapie, Psychotherapie, integrativen Mind-body-Verfahren und Normalisierung der Lebensführung als am wirksamsten erwiesen. In Bezug auf elektive Verfahren, die mit einem Nadelstich verbunden sind, wie Blutentnahmen, venöser Zugang, Injektionen oder Impfungen, führt die Studienlage zu der Forderung, dass jedem Kind in jeder solchen Situation ein Bündel von vier Maßnahmen geboten werden soll, um den Schmerz vollständig oder teilweise zu lindern: (1) topische Anästhesie, z. B. mit Lidocaincreme 4 %, (2) behaglich-beruhigende Positionierung, z. B. Haut-zu-Haut-Kontakt bei Säuglingen, keine Fixierung von Kindern, (3) Saccharose oder Stillen von Säuglingen und (4) altersgerechte Ablenkung. Eine mögliche Ausweichlösung (Plan B) ist die Lachgasanalgesie und -sedierung.

Schlussfolgerung

Die ausbleibende Implementierung einer evidenzbasierten Schmerzprävention und -therapie für Kinder in medizinischen Einrichtungen gilt heute als unzulässig und zeugt von einer schlechten Versorgungsqualität.

Abstract

Introduction

Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population.

Objectives

To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses.

Methods

This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable “Factsheet Pain in Children: Management” and reviews best evidence and practice.

Results

Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind–body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation.

Conclusion

Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.

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Correspondence to Stefan J. Friedrichsdorf.

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Deutsche Fassung von: Friedrichsdorf SJ, Goubert L (2020) Pediatric pain treatment and prevention for hospitalized children. Pain Clinical Updates in Pain Reports. PR9 5 (2020) e804. https://doi.org/10.1097/PR9.0000000000000804. Publikation auf Deutsch mit Genehmigung der International Association for the Study of Pain und der Autoren. Verantwortlich: Frau Prof. Dr. C. Sommer, Würzburg

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Friedrichsdorf, S.J., Goubert, L. Pädiatrische Schmerztherapie und -prävention bei hospitalisierten Kindern. Schmerz 35, 195–210 (2021). https://doi.org/10.1007/s00482-020-00519-0

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