Zusammenfassung
Regionalanästhesietechniken sind in der Kinderanästhesie weit verbreitet und stellen ein hervorragendes Instrument der perioperativen Schmerztherapie dar. In den vergangenen Jahrzehnten hat ihre Anwendung stetig zugenommen und heutzutage können sie bei angemessenem Gebrauch bei fast jedem chirurgischen Eingriff eingesetzt werden. Obwohl sie lange Zeit als unzuverlässig und gefährlich angesehen wurden, sind sie mit dem heutigen Wissen der Physiologie und Pharmakologie sicher anwendbar. Gerade ambulant behandelte Kinder können von einer derartigen Schmerztherapie profitieren. Entweder wird der Eingriff ausschließlich in einer Regionalanästhesie durchgeführt oder was in der überwiegenden Anzahl der Kinder notwendig ist, in Kombination mit einer flachen Allgemeinanästhesie. Sowohl zentrale Blockaden, wie die Kaudalanästhesie, als auch periphere Nervenblockaden, wie der Peniswurzelblock, werden von kleinen Kindern und auch von Adoleszenten hervorragend toleriert. Sie sind technisch einfach und leicht durchführbar. Abgesehen von der genauen Anamneseerhebung sind bei sonst gesunden Kindern keine weiteren invasiven Test zur Bestimmung der Gerinnungsparameter erforderlich. Nach Abklingen der Wirkung einer Regionalanästhesie ist eine Fortführung der Akutschmerztherapie mit Nichtopioidanalgetika wie Paracetamol oder Ibuprofen sinnvoll.
Abstract
Regional anesthetic techniques are widely used in pediatric anesthesia since they represent excellent tools to prevent and treat postoperative pain. Their range of application has considerably expanded during the last decades, and virtually all aspects of surgical pain management can benefit from their appropriate use. Previously considered unreliable and potentially hazardous, regional anesthetic techniques have now been proven safe. Most children undergoing outpatient surgery can benefit from regional anesthetic techniques, either as the sole anesthetic regimen or, as usual in pediatric practice, in combination with light anesthesia. Central blocks as well as peripheral nerve blocks are well tolerated by infants and young children. They are easy to perform and show a high level of efficacy. Only the patient's history has to be available. No tests, such as invasive blood coagulation screening, are required. Subsequent to a regional anesthesia, non-opioid analgetics, e. g., paracetamol or ibuprofen, have to be used for further pain management.
Schlüsselwörter
Operation: Kinder - Anästhesie: regional, lokal - Analgesie: postoperative - Kinder: Nervenblock
Key words
Surgery: pediatrics - anesthesia: regional, local - analgesia: postoperative - child: nerve block
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Dr. med. Alexander Reich
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin · Universitätsklinikum Münster
Albert-Schweitzer-Straße 33
48129 Münster
Deutschland
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Email: reich@anit.uni-muenster.de
