Neuroaxiale Gabe von Morphin nach Sectio caesarea: ein Update

Zusammenfassung

Für die Behandlung von Schmerzen nach Sectio caesarea (Wundschmerz, Nachwehen) stellt die neuroaxiale Morphingabe in Kombination mit peripher wirkenden Analgetika im angloamerikanischen Raum den Goldstandard dar. Damit kann eine langanhaltende Analgesie (bis zu 24 h) erreicht werden. Dieser Beitrag stellt den aktuellen Wissensstand zu diesem Thema dar und beschreibt die gegenwärtigen Empfehlungen.

Abstract

The use of neuraxial morphine, in combination with nonopioid analgesic regimens for postoperative analgesia after Caesarean deliveries is common practice, especially in the Anglo-American world. Neuraxial morphine offers a longer-lasting superior analgesia than intravenous opioids or patient-controlled analgesia. If neuraxial anaesthesia is being used for a caesarean delivery, it may be recommended to concomitantly administer neuraxial morphine for the postoperative analgesia.

A low dose of neuraxial morphine in a healthy parturient bears a low morbidity and mortality risk. The optimal frequency, duration and modality of respiratory monitoring for patients at low risk for respiratory depression is dependent on the dose of morphine administered and the patient-specific and obstetric risk profile.

Kernaussagen

• Neuroaxiales Morphin bietet eine hochwertige langanhaltende Analgesie verglichen mit einer äquivalenten Dosis intravenösen Opioids oder patientenkontrollierter Analgesie.

• Bei Anwendung von neuroaxialen Anästhesieverfahren zur SC empfiehlt sich die neuroaxiale Gabe von Morphin für die postoperative Analgesie. Es ermöglicht eine gute Schmerzkontrolle über die ersten postoperativen 24 h und reduziert signifikant den Schmerzmittelbedarf.

• Das Mortalitäts- und Morbiditätsrisiko nach Gabe einer niedrigen Dosis neuroaxialen Morphins bei gesunden Gebärenden ist gering.

• Beim Säugling ist nach einer einmaligen niedrigdosierten neuroaxialen Gabe von Morphin an die Mutter mit keinen signifikanten Auswirkungen auf Vitalität und Trinkverhalten zu rechnen.

• Die Häufigkeit, Dauer und Methode des respiratorischen Monitorings hängen von der Dosis und dem Risikoprofil ab.

• Patientinnenspezifische Risikofaktoren für eine Atemdepression nach neuroaxialer Gabe von Morphin sind Adipositas, bekannte oder vermutete Schlafapnoe, chronische Opioideinnahme, zusätzliche Einnahme sedierender Medikation (Benzodiazepine, Antihistaminika), relevante kardiopulmonale Erkrankungen und perioperative negative respiratorische Ereignisse.

• Geburtshilfliche Risikofaktoren für eine Atemdepression sind die Präeklampsie und die Einnahme von Magnesiumsulfat.

• Pruritus, Übelkeit und Erbrechen sind nach neuroaxialer Applikation von Morphin häufig zu beobachten.

Schlüsselwörter

Schmerztherapie - Analgesie - Opioid - Atemdepression - respiratorisches Monitoring - Risikoeinschätzung

Key words

obstetrics - pain management - analgesia - opioid - respiratory monitoring - risk management

Publication History

Article published online:
29 June 2021

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