Alte und neue Regionalanästhesieverfahren unter Review – Kopf bis Bauch

Die Regionalanästhesie hat mit Einführung der Sonografie eine neue Bedeutung erfahren. Mit ihrer Unterstützung können wichtige Begleitstrukturen umgangen und Komplikationen vermieden werden. Zusätzlich sind komplexe Punktionen möglich, die allein durch Landmarken zu risikoreich wären. Der Artikel beschreibt publizierte und klinisch etablierte Punktionstechniken am Hals, der oberen Extremität und am oberen Rumpf bezüglich Indikationen und Durchführung.

Abstract

By implementation of sonography regional anesthesia became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety during needle placement. Thereby new truncal blocks got enabled. Next to the blocking of specific nerve structures, plane blocks got established which can also be described as interfascial compartment blocks. The present review illustrates published and established blocks in daily practice concerning indications and the procedural issues. Moreover, the authors explain potential risks, complications and dosing of local anesthetics.

Kernaussagen

• Für Rumpfblockaden werden größtenteils Kompartimente bzw. interfasziale Räume anstatt Nervenstrukturen aufgesucht.

• Septen im interfaszialen Raum und eine fehlende kontrollierte Nervenumspülung könnten Ursache einer größeren Wirkungsvarianz sein.

• Eine viszerale Analgesie wird von „interfaszialen“ Blockaden – abgesehen von Paravertebralblockaden – nicht erzeugt, womit die analgetische Potenz im Vergleich zu neuraxialen Verfahren eingeschränkt ist.

• Für Rumpfblockaden werden hohe Volumina an Lokalanästhetika benötigt. Bei Wahl der Konzentration ist auf Höchstdosen zu achten. Bei Mischung verschiedener Lokalanästhetika kann sich die Toxizität addieren.

• Alternativ zur interskalenären Blockade kann eine Nervus-suprascapularis-Blockade kombiniert mit einer Nervus-axillaris-Blockade für die Schulterchirurgie eingesetzt werden.

• Der kostoklavikuläre infraklavikuläre Block ist eine sehr gute Alternative zum lateralen sagittalen infraklavikulären Block, dessen Zielstrukturen deutlich tiefer liegen.

• Der Serratus-anterior-Plane-Block stellt auch als kontinuierliches Verfahren eine Alternative zu epiduralen Blockaden bei Rippenserienfrakturen dar.

• Paravertebralblockaden sind deutlich komplexer in der Durchführung und gehen mit mehr potenziellen Komplikationen einher als Serratus-anterior-Plane- oder Erector-spinae-Plane-Blockaden.

• Die Darstellung der „Conjoint Tendon“ im Rahmen der axillären Plexusblockade und die Umspülung aller beteiligten Nerven stellen eine hohe Erfolgsrate sicher.

Schlüsselwörter

Regionalanästhesie - obere Extremität - Nervenblockaden - Feldblock - Brustwand - Blockade - thoracic block

Keywords

regional anaesthesia - upper limb - nerve block - plane block

Publication History

Article published online:
21 March 2024

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