Einsatz von Ultraschall zur Durchführung peripherer Nervenblockaden

U. Schwemmer; C. K. Markus; J. Brederlau; F. Schuster; A. Redel; N. Roewer

doi:10.1055/s-0028-1109117

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2009; 30(1): 6-24
DOI: 10.1055/s-0028-1109117

CME-Fortbildung/Continuing Education

Einsatz von Ultraschall zur Durchführung peripherer Nervenblockaden

Use of Ultrasound in Peripheral Nerve BlocksU. Schwemmer¹ , C. K. Markus¹ , J. Brederlau¹ , F. Schuster¹ , A. Redel¹ , N. Roewer¹

¹Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg

Abstract

Key words

anatomy - anesthesia - ultrasound 2D - nervous-peripheral - interventional procedures

Kernaussagen zum Artikel

Zur Identifikation von Nerven bei peripheren Nervenblockaden eignen sich besonders Ultraschallsysteme mit Hochfrequenzschallköpfen.
Kenntnisse über die Besonderheiten der Sonografie und der Gerätetechnik sind für die Interpretation der Ultraschallbilder unerlässlich.
Fundierte Kenntnisse der Anatomie sind die Voraussetzung, um die mit der Sonografie dargestellten Strukturen sicher identifizieren zu können.
Nerven können ihre Erscheinung im Ultraschallbild durch die Veränderung des Einschallwinkels verändern.
Nerven haben ein typisches Schallmuster, das ihrem histologischen Aufbau entspricht.
Mit der Sonografie gelingt neben der Identifikation der Nerven auch die Darstellung potenziell durch die Punktion gefährdeter Begleitstrukturen.
Bei der Punktion ohne Führungshilfen quer zur Schallebene ist darauf zu achten, dass der Eintritt der Kanülenspitze in die Schallebene sicher identifiziert wird.
Mit der ultraschallgeführten Nervenblockade gelingt es, die Ausbreitung des Lokalanästhetikums während der Injektion zu kontrollieren.
Ultraschallgeführte periphere Nervenblockaden zeichnen sich durch kurze Anschlagszeiten und sehr hohe Erfolgsraten aus.

Main statements of the article

Ultrasound systems with high-frequency probes are particularly suitable for identifying nerves for peripheral nerve blocks.
Knowledge of the special features of sonography and the equipment technology is essential for interpreting ultrasound images.
In-depth knowledge of anatomy is required for reliably identifying structures visualized with sonography.
The appearance of nerves on an ultrasound image can change due to a change in application angle.
Nerves have a typical sound pattern corresponding to their histological structure.
With sonography nerves can be identified and accompanying structures possibly at risk due to puncture can be visualized.
During puncture without a guide transverse to the sound plane, it must be ensured that the entrance of the cannula tip on the sound plane is reliably identified.
Ultrasound-guided nerve blocks make it possible to control the spread of a local anesthetic during injection.
Ultrasound-guided peripheral nerve blocks are characterized by a short time to take effect and very high success rates.

Full Text

References

Literatur/References

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PD Dr. Ulrich Schwemmer

Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Zentrum Operative Medizin

97080 Würzburg

Phone: ++ 49/9 31/20 13 00 40

Fax: ++ 49/9 31/20 13 00 49

Email: Schwemmer_U@klinik.uni-wuerzburg.de