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Geburtshilfe Frauenheilkd 2021; 81(04): 447-468
DOI: 10.1055/a-1378-4209
GebFra Science
Guideline/Leitlinie

Empfehlungen zur Verhinderung lagerungsbedingter Schäden in der operativen Gynäkologie. Leitlinie der DGGG, OEGGG und SGGG (S2k-Level, AWMF Register Nummer 015/077, Oktober 2020)

Article in several languages: English | deutsch
Markus C. Fleisch
1   Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
,
Werner Bader
2   Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld, Germany
,
Kai Balzer
3   Klinik für Gefäßchirurgie, GFO Kliniken, Bonn, Germany
,
Luisa Bennefeld
1   Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
,
Carsten Boeing
4   Klinik für Gynäkologie und Geburtshilfe, AMEOS Klinikum St. Clemens Oberhausen, Oberhausen, Germany
,
Dorothee Bremerich
5   Klinik für Anästhesiologie, Universitätsklinikum Mainz, Mainz, Germany
,
Paul Gass
6   DGGG Leitliniensekretariat, Germany
,
Verena Geissbuehler
7   Department für Gynäkologie, St. Claraspital Basel, Basel, Switzerland
,
Martin C. Koch
8   Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
,
Monika J. Nothacker
9   AWMF-Institut für Medizinisches Wissensmanagement, Universität Marburg, Marburg, Germany
,
Klaus Pietzner
10   Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
,
Stefan P. Renner
11   Frauenklinik, Klinikum Böblingen, Böblingen, Germany
,
Thomas Römer
12   Frauenklinik, Evangelisches Krankenhaus Weyertal, Köln, Germany
,
Stephan Roth
13   Klinik für Urologie, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
,
Florian Schütz
14   Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
,
Wilhelm Schulte-Mattler
15   Klinik für Neurologie, Universitätsklinikum Regensburg, Regensburg, Germany
,
Jalid Sehouli
10   Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
,
Kristina Lippach
16   Pflegewissenschaften und Praxisentwicklung, LMU München, München, Germany
,
Karl Tamussino
17   Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Graz, Graz, Austria
,
Alexander Teichmann
18   Sichuan Center for Gynaecology and Breast Surgery, Dept. of Perinatal Medicine, Medical University of Southwest China, Luzhou (Sichuan), China
,
Clemens Tempfer
19   Klinik für Frauenheilkunde und Geburtshilfe, Marienhospital Herne, Universitätsklinikum Bochum, Bochum/Herne, Germany
,
Marc Thill
20   Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
,
Hans-Rudolf Tinneberg
21   Frauenklinik, Nordwest Krankenhaus, Frankfurt am Main, Germany
,
Konstantinos Zarras
22   Abteilung für Allgemein-, Viszeral- und Minimalinvasive Chirurgie des VVKD Marienhospitals Düsseldorf, Düsseldorf, Germany
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Zusammenfassung

Ziel Lagerungsschäden sind relativ häufige und forensisch hochrelevante Komplikationen nach gynäkologischen Operationen. Ziel der vorliegenden offiziellen AWMF-S2k-Leitlinie ist es, auf Basis der verfügbaren aktuellen Literatur interdisziplinär und professionell abgestimmte Statements und Empfehlungen zur Vermeidung lagerungsbedingter Schäden zu geben.

Methoden Auf Basis der abgelaufenen S1-Leitlinie aktualisierte systematische Literaturrecherche und Review der relevanten Publikationen zwischen Februar 2014 bis März 2019. Erstellung und Abstimmung von Statements durch Expertengruppe.

Empfehlungen Es werden allgemeine und spezifische Empfehlungen zur Vermeidung, Diagnostik und Therapie lagerungsbedingter Schäden gegeben.

Schlüsselwörter

gynäkologische Operationen - Lagerungsschäden - Verhinderung


Publication History

Received: 26 January 2021
Received: 02 December 2020

Accepted: 29 January 2021

Article published online:
14 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Bommert M, Wagner JK, Sehouli J. et al. Perioperative management of positioning in gynecological cancersurgery: a national NOGGO-AGO intergroup survey. Int J Gynecol Cancer 2020; 30: 1589-1594
    CrossrefPubMedGoogle Scholar
  • 2 Warner MA. Perioperative neuropathies. Mayo Clin Proc 1998; 73: 567-574
    CrossrefPubMedGoogle Scholar
  • 3 Loorham-Battersby C. Heel Damage And Epidural Analgesia. Are the two linked?. Saarbrücken: LAP LAMBERT Academic Publishing; 2012
    Google Scholar
  • 4 Peterson T, Wissing H. Lagerungsschäden beim Patienten mit unbekanntem „thoracic outlet syndrome“. Anästhesiol Intensivmed Notfallmed Schmerzther 1995; 30: 516-518
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Stevens J, Nichelson E, Linehan WM. et al. Risk factors for skin breakdown after renal and adrenal surgery. Urology 2004; 64: 246-249
    CrossrefPubMedGoogle Scholar
  • 6 Bauer ECA, Koch N, Janni W. et al. Compartment syndrome after gynecologic operations: evidence from case reports and reviews. Eur J Obstet Gynecol Reprod Biol 2014; 173: 7-12
    CrossrefPubMedGoogle Scholar
  • 7 Warner MA, Warner DO, Harper CM. et al. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000; 93: 938-942
    CrossrefPubMedGoogle Scholar
  • 8 Vereinbarung über die Zusammenarbeit in der operativen Gynäkologie und in der Geburtshilfe der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin und des Berufsverbands Deutscher Anästhesisten mit der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe und dem Berufsverband der Frauenärzte. 1996 Accessed March 30, 2020 at: https://www.bda.de/docman/alle-dokumente-fuer-suchindex/oeffentlich/empfehlungen/536-eev-2011-s-19-24/file.html
    PubMedGoogle Scholar
  • 9 Weissauer W. Abgrenzung der Verantwortung für die operative Lagerung des Patienten und Haftung für Lagerungsschäden. Unfallchirurg 2002; 105: 404-412
    CrossrefPubMedGoogle Scholar
  • 10 Association of Perioperative Registered Nurses. Recommended practices for positioning the patient in the perioperative practice setting. AORN J 2001; 73: 231-235 237–238. Erratum in: AORN J 2001; 74: 201 Erratum in: AORN J 2001; 74: 201
    CrossrefPubMedGoogle Scholar
  • 11 Practice advisory for the prevention of perioperative peripheral neuropathies: a report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies. Anesthesiology 2000; 92: 1168-1182
    CrossrefPubMedGoogle Scholar
  • 12 (AST) Association of surgical technologists (AST). AST recommended Standards of Practice for Surgical Positioning, 2011. Accessed March 27, 2020 at: https://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/Standard Surgical Positioning.pdf
    PubMedGoogle Scholar
  • 13 Cluver C, Novikova N, Hofmeyr GJ. et al. Maternal position during caesarean section for preventing maternal and neonatal complications. Cochrane Database Syst Rev 2013; (03) CD007623
    PubMedGoogle Scholar
  • 14 Cohen MM, Duncan PG, Pope WD. et al. A survey of 112,000 anaesthetics at one teaching hospital (1975–83). Can Anaesth Soc J 1986; 33: 22-31
    CrossrefPubMedGoogle Scholar
  • 15 Winfree CJ, Kline DG. Intraoperative positioning nerve injuries. Surg Neurol 2005; 63: 5-18 discussion 18
    CrossrefPubMedGoogle Scholar
  • 16 Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol 2010; 17: 414-420
    CrossrefPubMedGoogle Scholar
  • 17 Reich H. Laparoscopic treatment of extensive pelvic adhesions, including hydrosalpinx. J Reprod Med 1987; 32: 736-742
    PubMedGoogle Scholar
  • 18 Romanowski L, Reich H, McGlynn F. et al. Brachial plexus neuropathies after advanced laparoscopic surgery. Fertil Steril 1993; 60: 729-732
    CrossrefPubMedGoogle Scholar
  • 19 Cheney FW, Domino KB, Caplan RA. et al. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology 1999; 90: 1062-1069
    CrossrefPubMedGoogle Scholar
  • 20 Kretschmer T, Heinen CW, Antoniadis G. et al. Iatrogenic nerve injuries. Neurosurg Clin N Am 2009; 20: 73-90 vii
    CrossrefPubMedGoogle Scholar
  • 21 Bradshaw AD, Advincula AP. Optimizing patient positioning and understanding radiofrequency energy in gynecologic surgery. Clin Obstet Gynecol 2010; 53: 511-520
    CrossrefPubMedGoogle Scholar
  • 22 Zhang J, Moore AE, Stringer MD. Iatrogenic upper limb nerve injuries: a systematic review. ANZ J Surg 2011; 81: 227-236
    CrossrefPubMedGoogle Scholar
  • 23 Eteuati J, Hiscock R, Hastie I. et al. Brachial plexopathy in laparoscopic-assisted rectal surgery: a case series. Tech Coloproctol 2013; 17: 293-297
    CrossrefPubMedGoogle Scholar
  • 24 Advincula AP, Song A. The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol 2007; 19: 331-336
    CrossrefPubMedGoogle Scholar
  • 25 JACKSON L, KEATS AS. MECHANISM OF BRACHIAL PLEXUS PALSY FOLLOWING ANESTHESIA. Anesthesiology 1965; 26: 190-194
    CrossrefPubMedGoogle Scholar
  • 26 Britt BA, Gordon RA. PERIPHERAL NERVE INJURIES ASSOCIATED WITH ANAESTHESIA. Can Anaesth Soc J 1964; 11: 514-536
    CrossrefPubMedGoogle Scholar
  • 27 Cooper DE, Jenkins RS, Bready L. et al. The prevention of injuries of the brachial plexus secondary to malposition of the patient during surgery. Clin Orthop Relat Res 1988; (228) 33-41
    PubMedGoogle Scholar
  • 28 Ben-David B, Stahl S. Prognosis of intraoperative brachial plexus injury: a review of 22 cases. Br J Anaesth 1997; 79: 440-445
    CrossrefPubMedGoogle Scholar
  • 29 Suozzi BA, Brazell HD, OʼSullivan DM. et al. A comparison of shoulder pressure among different patient stabilization techniques. Am J Obstet Gynecol 2013; 209: 478.e1-478.e5
    CrossrefPubMedGoogle Scholar
  • 30 Coppieters MW. Shoulder restraints as a potential cause for stretch neuropathies: biomechanical support for the impact of shoulder girdle depression and arm abduction on nerve strain. Anesthesiology 2006; 104: 1351-1352
    CrossrefPubMedGoogle Scholar
  • 31 Klauschie J, Wechter ME, Jacob K. et al. Use of anti-skid material and patient-positioning to prevent patient shifting during robotic-assisted gynecologic procedures. J Minim Invasive Gynecol 2010; 17: 504-507
    CrossrefPubMedGoogle Scholar
  • 32 Haupt WF. Intraoperative Lagerungsschäden des Nervus ulnaris bei anatomischen Varianten. Dtsch Med Wochenschr 1989; 114: 1789-1792
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Warner MA, Warner DO, Matsumoto JY. et al. Ulnar neuropathy in surgical patients. Anesthesiology 1999; 90: 54-59
    CrossrefPubMedGoogle Scholar
  • 34 Padua L, Aprile I, Caliandro P. et al. Natural history of ulnar entrapment at elbow. Clin Neurophysiol 2002; 113: 1980-1984
    CrossrefPubMedGoogle Scholar
  • 35 Stoelting RK. Postoperative ulnar nerve palsy–is it a preventable complication?. Anesth Analg 1993; 76: 7-9
    CrossrefPubMedGoogle Scholar
  • 36 Burkhart FL, Daly JW. Sciatic and peroneal nerve injury: a complication of vaginal operations. Obstet Gynecol 1966; 28: 99-102
    PubMedGoogle Scholar
  • 37 Aschemann D. Hrsg. OP-Lagerungen für Fachpersonal. Heidelberg: Springer; 2009
    CrossrefGoogle Scholar
  • 38 Roy S, Levine AB, Herbison GJ. et al. Intraoperative positioning during cesarean as a cause of sciatic neuropathy. Obstet Gynecol 2002; 99: 652-653
    PubMedGoogle Scholar
  • 39 Umo-Etuk J, Yentis SM. Sciatic nerve injury and caesarean section. Anaesthesia 1997; 52: 605-606
    PubMedGoogle Scholar
  • 40 Batres F, Barclay DL. Sciatic nerve injury during gynecologic procedures using the lithotomy position. Obstet Gynecol 1983; 62 (3 Suppl.): 92s-94s
    PubMedGoogle Scholar
  • 41 McQuarrie HG, Harris JW, Ellsworth HS. et al. Sciatic neuropathy complicating vaginal hysterectomy. Am J Obstet Gynecol 1972; 113: 223-232
    CrossrefPubMedGoogle Scholar
  • 42 Cherian RP, Li Y. Clinical and Electrodiagnostic Features Of Nontraumatic Sciatic Neuropathy. Muscle Nerve 2019; 59: 309-314
    CrossrefPubMedGoogle Scholar
  • 43 Chan JK, Manetta A. Prevention of femoral nerve injuries in gynecologic surgery. Am J Obstet Gynecol 2002; 186: 1-7
    CrossrefPubMedGoogle Scholar
  • 44 Hopper CL, Baker JB. Bilateral femoral neuropathy complicating vaginal hysterectomy. Analysis of contributing factors in 3 patients. Obstet Gynecol 1968; 32: 543-547
    PubMedGoogle Scholar
  • 45 Räber G, Schneider HP. Femoralisparese nach vaginaler Hysterektomie und ihre forensische Bedeutung. Zentralbl Gynakol 1993; 115: 273-278
    PubMedGoogle Scholar
  • 46 al Hakim M, Katirji B. Femoral mononeuropathy induced by the lithotomy position: a report of 5 cases with a review of literature. Muscle Nerve 1993; 16: 891-895
    CrossrefPubMedGoogle Scholar
  • 47 Roblee MA. Femoral neuropathy from the lithotomy position: case report and new leg holder for prevention. Am J Obstet Gynecol 1967; 97: 871-872
    CrossrefPubMedGoogle Scholar
  • 48 Sinclair RH, Pratt JH. Femoral neuropathy after pelvic operation. Am J Obstet Gynecol 1972; 112: 404-407
    CrossrefPubMedGoogle Scholar
  • 49 Koç G, Tazeh NN, Joudi FN. et al. Lower extremity neuropathies after robot-assisted laparoscopic prostatectomy on a split-leg table. J Endourol 2012; 26: 1026-1029
    CrossrefPubMedGoogle Scholar
  • 50 Goldman JA, Feldberg D, Dicker D. et al. Femoral neuropathy subsequent to abdominal hysterectomy. A comparative study. Eur J Obstet Gynecol Reprod Biol 1985; 20: 385-392
    CrossrefPubMedGoogle Scholar
  • 51 Litwiller JP, Wells RE, Halliwill JR. et al. Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves. Clin Anat 2004; 17: 45-49
    CrossrefPubMedGoogle Scholar
  • 52 Lindner A, Schulte-Mattler W, Zierz S. Postpartales Nervus obturatorius-Syndrom: Fallbericht und Ubersicht über die Nervenkompressionssyndrome während Schwangerschaft und Geburt. Zentralbl Gynakol 1997; 119: 93-99
    PubMedGoogle Scholar
  • 53 Fleisch MC. Risiken der Anwendung von Koagulationsgeräten im kleinen Becken. Gynäkologe 2016; 49: 888-890 doi:10.1007/s00129-016-3953-7
    CrossrefPubMedGoogle Scholar
  • 54 Liu P, He W, Chen H-L. Diabetes mellitus as a risk factor for surgery-related pressure ulcers: a meta-analysis. J Wound Ostomy Continence Nurs 2012; 39: 495-499
    CrossrefPubMedGoogle Scholar
  • 55 Connor T, Sledge JA, Bryant-Wiersema L. et al. Identification of pre-operative and intra-operative variables predictive of pressure ulcer development in patients undergoing urologic surgical procedures. Urol Nurs 2010; 30: 289-295 305
    CrossrefPubMedGoogle Scholar
  • 56 Lindholm C, Sterner E, Romanelli M. et al. Hip fracture and pressure ulcers – the Pan-European Pressure Ulcer Study – intrinsic and extrinsic risk factors. Int Wound J 2008; 5: 315-328
    CrossrefPubMedGoogle Scholar
  • 57 Edwards JL, Pandit H, Popat MT. Perioperative analgesia: a factor in the development of heel pressure ulcers?. Br J Nurs 2006; 15: S20-S25
    CrossrefPubMedGoogle Scholar
  • 58 Scott EM, Leaper DJ, Clark M. et al. Effects of warming therapy on pressure ulcers–a randomized trial. AORN J 2001; 73: 921-927 929–933, 936–938
    CrossrefPubMedGoogle Scholar
  • 59 EPUAP/NPUAP. Prävention und Behandlung von Dekubitus: Kurzfassung der Leitlinie, 2014. Accessed March 27, 2020 at: https://www.epuap.org/wp-content/uploads/2016/10/german_quick-reference-guide.pdf
    PubMedGoogle Scholar
  • 60 Moore ZE, Patton D. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev 2019; (01) CD006471
    PubMedGoogle Scholar
  • 61 McInnes E. The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. J Tissue Viability 2004; 14: 4-6 8, 10 passim
    CrossrefPubMedGoogle Scholar
  • 62 Deutsches Netzwerk für Qualitätsentwicklung in der Pflege (DNQP). Expertenstandard Dekubitusprophylaxe in der Pflege. 2. Aktualisierung, 2017. Accessed March 22, 2021 at: https://www.dnqp.de/fileadmin/HSOS/Homepages/DNQP/Dateien/Expertenstandards/Dekubitusprophylaxe_in_der_Pflege/Dekubitus_2Akt_Auszug.pdf
    PubMedGoogle Scholar
  • 63 Nicosia G, Gliatta AE, Woodbury MG. et al. The effect of pressure-relieving surfaces on the prevention of heel ulcers in a variety of settings: a meta-analysis. Int Wound J 2007; 4: 197-207
    CrossrefPubMedGoogle Scholar
  • 64 Cullum N, Nelson EA, Flemming K. et al. Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess 2001; 5: 1-221
    CrossrefPubMedGoogle Scholar
  • 65 Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA 2006; 296: 974-984
    CrossrefPubMedGoogle Scholar
  • 66 Adler LM, Loughlin JS, Morin CJ. et al. Bilateral compartment syndrome after a long gynecologic operation in the lithotomy position. Am J Obstet Gynecol 1990; 162: 1271-1272
    CrossrefPubMedGoogle Scholar
  • 67 Lawrenz B, Kraemer B, Wallwiener D. et al. Lower extremity compartment syndrome after laparoscopic radical hysterectomy: brief report of an unusual complication of laparoscopic positioning requirements. J Minim Invasive Gynecol 2011; 18: 531-533
    CrossrefPubMedGoogle Scholar
  • 68 Schofield PF, Grace RH. Acute compartment syndrome of the legs after colorectal surgery. Colorectal Dis 2004; 6: 285-287
    CrossrefPubMedGoogle Scholar
  • 69 Halliwill JR, Hewitt SA, Joyner MJ. et al. Effect of various lithotomy positions on lower-extremity blood pressure. Anesthesiology 1998; 89: 1373-1376
    CrossrefPubMedGoogle Scholar
  • 70 Bauer ECA, Koch N, Erichsen CJ. et al. Survey of compartment syndrome of the lower extremity after gynecological operations. Langenbecks Arch Surg 2014; 399: 343-348
    CrossrefPubMedGoogle Scholar
  • 71 Martin JT. Compartment syndromes: concepts and perspectives for the anesthesiologist. Anesth Analg 1992; 75: 275-283
    CrossrefPubMedGoogle Scholar
  • 72 Svendsen LB, Flink P, Wøjdemann M. et al. Muscle oxygen saturation during surgery in the lithotomy position. Clin Physiol 1997; 17: 433-438
    CrossrefPubMedGoogle Scholar
  • 73 Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth 2009; 102: 3-11
    CrossrefPubMedGoogle Scholar
  • 74 Pfeffer SD, Halliwill JR, Warner MA. Effects of lithotomy position and external compression on lower leg muscle compartment pressure. Anesthesiology 2001; 95: 632-636
    CrossrefPubMedGoogle Scholar
  • 75 Mars M, Hadley GP. Failure of pulse oximetry in the assessment of raised limb intracompartmental pressure. Injury 1994; 25: 379-381
    CrossrefPubMedGoogle Scholar
  • 76 Wey JM, Guinn GA. Ulnar nerve injury with open-heart surgery. Ann Thorac Surg 1985; 39: 358-360
    CrossrefPubMedGoogle Scholar
  • 77 AWMF. S3 Leitlinie „Vermeidung perioperativer Hypothermie“. Aktualisierung 2019. Accessed March 30, 2020 at: https://www.awmf.org/uploads/tx_szleitlinien/001-018l_S3_Vermeidung_perioperativer_Hypothermie_2019-08.pdf
    PubMedGoogle Scholar