Intraoperative and postoperative pain assessment and analgesic treatment

K. A. Otto

doi:10.1055/s-0038-1622654

Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere, Table of Contents

Tierarztl Prax Ausg K Kleintiere Heimtiere 2008; 36(01): 12-18
DOI: 10.1055/s-0038-1622654

Allgemeines

Schattauer GmbH

Intraoperative und postoperative Schmerzerkennung und-überwachung

Intraoperative and postoperative pain assessment and analgesic treatment

Authors

K. A. Otto

¹Institut für Versuchstierkunde und Zentrales Tierlabor (Direktor: Prof. Dr. med. vet. H. J. Hedrich) der Medizinischen Hochschule Hannover

Abstract

Zusammenfassung:

Chirurgische Manipulationen führen, in Abhängigkeit von der Narkosetiefe, zu einer Vielzahl von nozizeptiven Reaktionen, die auf spinaler, supraspinaler und zerebrokortikaler Ebene ausgelöst werden. Grundsätzlich kann angenommen werden, dass mit zunehmender Narkosetiefe zuerst die somatosensorischen Reaktionen erlöschen, gefolgt von somatomotorischen und respiratorischen Reaktionen. Höhere Anästhetikakonzentrationen sind für die Unterdrückung hämodynamischer Reaktionen erforderlich, während sich autonome hormonelle Reaktionen mitunter erst durch zusätzliche Nervenblockaden mit einem Lokalanästhetikum unterbinden lassen. Diese Erkenntnis lässt die Schlussfolgerung zu, dass ein Tier, das während der chirurgischen Manipulationen keine motorischen Reaktionen zeigt, bewusstlos ist und demzufolge kein Schmerzempfinden besitzt. Zudem liefert ein stabiles EEG intraoperativ den Hinweis, dass die Impulsfortleitung im Zentralnervensystem durch die Anästhesie unterbrochen ist und damit wesentliche Voraussetzungen für die bewusste Wahrnehmung des Schmerzreizes fehlen. Aufgrund des Fehlens der verbalen Schmerzmitteilung sind für die postoperative Schmerzerkennung und -bewertung primär die Beurteilung der äußeren Erscheinung, des spontanen und des provozierten Verhaltens und der Effekt einer Schmerztherapie von Bedeutung. Die postoperative Schmerzüberwachung kann durch die Verwendung definierter Schmerzbewertungssysteme (numerische Bewertungstabellen [NRS], visuelle Analogskala [VAS]) standardisiert werden.

Summary

Depending on anaesthetic depth surgical stimulation may elicit a number of nociceptive responses at spinal, supraspinal and cerebrocortical levels. These responses are suppressed by general anaesthetics in a dose-dependent manner and in the following order: somatic sensory responses, somatic motor responses, autonomic respiratory responses, autonomic haemodynamic responses and finally autonomic hormonal responses, which may require an additional local anaesthetic nerve block for total suppression. This rank order implies that animals which do not move in response to a noxious stimulus are unconscious and hence unable to perceive pain. In addition, intraoperative recording of a stable EEG pattern not affected by surgical stimulation could be used as an indication that transmission of nerve impulses has been interrupted by anaesthesia, thereby rendering the animal unable to perceive pain. Because of the lack of verbal communication postoperative pain assessment is primarily based on the evaluation of the animal’s appearance, spontaneous behaviour, provoked behaviour, and response to analgesic treatment. The intensity of postoperative pain may be assessed by means of numerical rating scales or a visual analogue scale.

Schlüsselwörter

Schmerzbewertung - intraoperativ - postoperativ - Elektroenzephalographie - numerische Bewertungstabellen - visuelle Analogskala

Key words

Pain assessment - intraoperative - postoperative - electroencephalography - numerical rating scale - visual analogue scale

Full Text

References

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