Alte und neue Regionalanästhesieverfahren unter Review – Bauch bis Fußzehe

Die Ultraschalltechnik hat in den vergangenen Jahren das Spektrum regionalanästhesiologischer Verfahren deutlich erweitert. So sind Bauchwandblockaden und selektive periphere Blockaden der unteren Extremität zunehmend fester Bestandteil multimodaler postoperativer Schmerzkonzepte. Der Beitrag zeigt anhand ausgewählter Blockaden den Wandel im Einsatz regionalanästhesiologischer Verfahren bei Bauchwand- und Blockaden der unteren Extremität auf.

Abstract

Ultrasound (US) technology has significantly expanded the spectrum of regional anesthesiological procedures in recent years. Abdominal wall blocks are becoming an increasingly integral part of a multimodal postoperative pain concept after abdominal surgery, gynecological or urological interventions. Thoracic epidural analgesia remains the gold standard for extensive surgery. The requirement for rapid postoperative mobilization and discharge after lower extremity surgery has led to the abandonment of neuroaxial or plexus blocks in favor of selective, peripheral blocks such as the PENG block or adductor canal block. The following article is intended to show the reader the change in the use of regional anesthesiological procedures for abdominal wall and lower extremity blocks using selected blockages.

Kernaussagen

• Die thorakale Epiduralanalgesie besitzt nach wie vor einen hohen Stellenwert bei ausgedehnten großen abdominalchirurgischen Eingriffen.

• Die Ultraschalltechnologie hat entscheidend zur Verbreitung der Bauchwandblockaden beigetragen.

• Bauchwandblockaden erzeugen primär eine somatische Analgesie und sind daher neuroaxialen Verfahren unterlegen. Als Bestandteil eines multimodalen Schmerzkonzeptes sind Bauchwandblockaden effektiv.

• Als risiko- und nebenwirkungsarme Verfahren erweitern Bauchwandblockaden das Spektrum der Regionalanalgesie auf kleinere und mittlere abdominalchirurgische Operationen, bei denen bisher regionale Techniken nicht in Betracht kamen.

• Die meisten positiven Studien zum klassischen TAP-, QLB- und IL-IH-Block beziehen sich auf Unterbaucheingriffe.

• Werden Regionalanalgesieverfahren für eine Hüft- oder Knieendoprothese eingesetzt, ist die Wahrscheinlichkeit postoperativer Komplikationen geringer als unter einer rein systemischen Analgesie.

• Heutzutage sollten regionale Schmerzverfahren an der unteren Extremität neben einer guten Analgesie auch eine rasche Mobilisierbarkeit ermöglichen.

• Zur postoperativen Schmerztherapie nach Hüftendoprothetik eignen sich der suprainguinale Fascia-iliaca-Kompartment- und der PENG-Block.

• Nach Knieendoprothetik wirkt ein Trigonum-femorale-, nicht so sehr ein Adduktorkanalblock, ähnlich analgetisch wie ein N.-femoralis-Block, bei allerdings erhaltener Kniestreckung.

• Regionaler Goldstandard für Operationen am Sprunggelenk und Fuß ist die distale N.-ischiadicus-Blockade, für Eingriffe am Mittel- und Vorfuß ermöglicht ein sog. Fußblock die sofortige Mobilisation.

Schlüsselwörter

Tranversus-abdominis-Plane-Block - TAP - Quadratus-lumborum-Block - QLB - Adduktor-Kanal-Block - AKB - Trigonum-femorale-Block - TFB - PENG-Block - iPACK-Block

Keywords

tranversus abdominis plane block - quadratus lumborum block - adductor canal block - femoral triangle block - PENG block - iPACK block

Publication History

Article published online:
21 March 2024

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