Zusammenfassung
Die ultraschallgesteuerte Regionalanästhesie verbreitet sich zunehmend. Von grundlegender Bedeutung für eine erfolgreiche Blockade ist jedoch nicht nur der direkte Vorgang. Viele Entscheidungen, die bereits im Vorfeld getroffen werden, haben enormen Einfluss auf die Qualität der Durchführung. Ziel dieses Artikels ist es, auf aktuellem Stand des Wissens Durchführungshinweise bezüglich der Risikostratifizierung, der Hygiene, Wahl der Nadel, der Ausbildung sowie des Ablaufs der ultraschallgesteuerten Regionalanästhesie zu geben. Es werden Stolperfallen und wesentliche Voraussetzungen für eine erfolgreiche Arbeit mit dieser Methode dargestellt.
Abstract
The ultrasound in regional anesthesia is gaining currency. Of fundamental importance for a successful blockade is not only the direct process. Many decisions taken in advance, have enormous impact on the quality of implementation. The aim of this article is about the current state of knowledge on implementing instructions of the risk stratification, hygiene, choice of the needle, the training and the sequence concerning ultrasound regional anesthesia. There are pitfalls and presented important conditions for successful work with this method.
Schlüsselwörter:
Ultraschall - ultraschallgesteuerte Regionalanästhesie - Anästhesie - Gerinnung - Nadel - Ausbildung
Key words:
Ultrasound - needle - nerve block - regional anaesthesia - coagulation - education
Kernaussagen
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Die Kenntnisse der Ultraschallgrundlagen tragen zu einer Verbesserung der Bildqualität bei.
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Die Sterilität des Regionalanästhesieverfahrens beinhaltet auch die Sterilität des Ultraschall-kopfes.
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Ultraschall und Nervenstimulator können sich sinnvoll ergänzen.
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Die Wahl der Punktionsnadel beeinflusst die Sichtbarkeit und das potentielle Risiko der Punktion.
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Es gibt verschiedene Möglichkeiten (Nadel, Ultraschallgerät, Stichtechnik), welche die Sichtbarkeit der Nadel unter Punktion verbessern können.
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Ausbildung ist ein zentraler Faktor, um die Qualität einer neuen Methode sicherzustellen.
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Im Rahmen einer individuellen Risiko-Nutzen-Abwägung können Regionalanästhesien auch am tief sedierten Patienten durchgeführt werden.
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Dr. med. Thomas Ermert
Dr. med. Alexander Schnabel
Email: ermert@uni-muenster.de
Email: alexander_schnabel@gmx.de
