Regionalanästhesien bei urologischen Eingriffen im Kindesalter

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

Literatur

• 1 Adewale L, Dearlove O, Wilson B, Hindle K, Robinson D N. The caudal canal in children: a study using magnetic resonance imaging.  Paediatr Anaesth. 2000;  10 (2) 137-141
• 2 Ala-Kokko T I, Karinen J, Raiha E, Kiviluoma K, Alahuhta S. Pharmacokinetics of 0.75 % ropivacaine and 0.5 % bupivacaine after ilioinguinal-iliohypogastric nerve block in children.  Br J Anaesth. 2002;  89 (3) 438-441
• 3 Ala-Kokko T I, Partanen A, Karinen J, Kiviluoma K, Alahuhta S. Pharmacokinetics of 0.2 % ropivacaine and 0.2 % bupivacaine following caudal blocks in children.  Acta Anaesthesiol Scand. 2000;  44 (9) 1099-1102
• 4 Amory C, Mariscal A, Guyot E, Chauvet P, Leon A, Poli-Merol M L. Is ilioinguinal/iliohypogastric nerve block always totally safe in children?.  Paediatr Anaesth. 2003;  13 (2) 164-166
• 5 Anatol T I, Pitt-Miller P, Holder Y. Trial of three methods of intraoperative bupivacaine analgesia for pain after paediatric groin surgery.  Can J Anaesth. 1997;  44 (10) 1053-1059
• 6 Berde C. Regional anesthesia in children: what have we learned?.  Anesth Analg. 1996;  83 (5) 897-900
• 7 Bichel T, Rouge J C, Schlegel S, Spahr-Schopfer I, Kalangos A. Epidural sufentanil during paediatric cardiac surgery: effects on metabolic response and postoperative outcome.  Paediatr Anaesth. 2000;  10 (6) 609-617
• 8 Constant I, Gall O, Gouyet L, Chauvin M, Murat I. Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children.  Br J Anaesth. 1998;  80 (3) 294-298
• 9 Da Conceicao M J, Coelho L. Caudal anaesthesia with 0.375 % ropivacaine or 0.375 % bupivacaine in paediatric patients.  Br J Anaesth. 1998;  80 (4) 507-508
• 10 Da Conceicao M J, Coelho L, Khalil M. Ropivacaine 0.25 % compared with bupivacaine 0.25 % by the caudal route.  Paediatr Anaesth. 1999;  9 (3) 229-233
• 11 Dalens B, Vanneuville G, Dechelotte P. Penile block via the subpubic space in 100 children.  Anesth Analg. 1989;  69 (1) 41-45
• 12 De Saint Blanquat L, Simon L, Laplace C, Egu J F, Hamza J. Preoperative coagulation tests in former preterm infants undergoing spinal anaesthesia.  Paediatr Anaesth. 2002;  12 (4) 304-307
• 13 Ecoffey C, Dubousset A M, Samii K. Lumbar and thoracic epidural anesthesia for urologic and upper abdominal surgery in infants and children.  Anesthesiology. 1986;  65 (1) 87-90
• 14 Flandin-Blety C, Barrier G. Accidents following extradural analgesia in children. The results of a retrospective study.  Paediatr Anaesth. 1995;  5 (1) 41-46
• 15 Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists.  Anesth Analg. 1996;  83 (5) 904-912
• 16 Haberkern C M, Lynn A M, Geiduschek J M, Nespeca M K, Jacobson L E, Bratton S L, Pomietto M. Epidural and intravenous bolus morphine for postoperative analgesia in infants.  Can J Anaesth. 1996;  43 (12) 1203-1210
• 17 Hager H, Marhofer P, Sitzwohl C, Adler L, Kettner S, Semsroth M. Caudal clonidine prolongs analgesia from caudal S(+)-ketamine in children.  Anesth Analg. 2002;  94 (5) 1169-1172, table of contents
• 18 Holder K J, Peutrell J M, Weir P M. Regional anaesthesia for circumcision. Subcutaneous ring block of the penis and subpubic penile block compared.  Eur J Anaesthesiol. 1997;  14 (5) 495-498
• 19 Irwin M G, Cheng W. Comparison of subcutaneous ring block of the penis with caudal epidural block for post-circumcision analgesia in children.  Anaesth Intensive Care. 1996;  24 (3) 365-367
• 20 Ishigooka M, Yaguchi H, Hashimoto T, Hayami S, Sasagawa I, Nakada T, Mitobe K. Penile block via subpubic space for children who underwent superficial operation of the penis.  Urol Int. 1994;  53 (3) 147-149
• 21 Ivani G, Lampugnani E, de Negri P, Lonnqvist P A, Broadman L. Ropivacaine vs bupivacaine in major surgery in infants.  Can J Anaesth. 1999;  46 (5 Pt 1) 467-469
• 22 Ivani G, Lampugnani E, Torre M, Calevo Maria G, DeNegri P, Borrometi F, Messeri A, Calamandrei M, Lonnqvist P A, Morton N S. Comparison of ropivacaine with bupivacaine for paediatric caudal block.  Br J Anaesth. 1998;  81 (2) 247-248
• 23 Johr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child.  Anesth Analg. 1999;  88(5) 1051-1052
• 24 Koinig H, Krenn C G, Glaser C, Marhofer P, Wildling E, Brunner M, Wallner T, Grabner C, Klimscha W, Semsroth M. The dose-response of caudal ropivacaine in children.  Anesthesiology. 1999;  90 (5) 1339-1344
• 25 Lee H M, Sanders G M. Caudal ropivacaine and ketamine for postoperative analgesia in children.  Anaesthesia. 2000;  55 (8) 806-810
• 26 Lim S L, Ng Sb A, Tan G M. Ilioinguinal and iliohypogastric nerve block revisited: single shot versus double shot technique for hernia repair in children.  Paediatr Anaesth. 2002;  12 (3) 255-260
• 27 Machotta A, Risse A, Bercker S, Streich R, Pappert D. Comparison between instillation of bupivacaine versus caudal analgesia for postoperative analgesia following inguinal herniotomy in children.  Paediatr Anaesth. 2003;  13 (5) 397-402
• 28 Macpherson D S. Preoperative laboratory testing: should any tests be “routine” before surgery?.  Med Clin North Am. 1993;  77 (2) 289-308
• 29 Motsch J, Bottiger B W, Bach A, Bohrer H, Skoberne T, Martin E. Caudal clonidine and bupivacaine for combined epidural and general anaesthesia in children.  Acta Anaesthesiol Scand. 1997;  41 (7) 877-883
• 30 Murthy B V, Pandya K S, Booker P D, Murray A, Lintz W, Terlinden R. Pharmacokinetics of tramadol in children after i. v. or caudal epidural administration.  Br J Anaesth. 2000;  84 (3) 346-349
• 31 O'Connor M E, Drasner K. Preoperative laboratory testing of children undergoing elective surgery.  Anesth Analg. 1990;  70 (2) 176-180
• 32 Ozbek H, Bilen A, Ozcengiz D, Gunes Y, Ozalevli M, Akman H. The comparison of caudal ketamine, alfentanil and ketamine plus alfentanil administration for postoperative analgesia in children.  Paediatr Anaesth. 2002;  12 (7) 610-616
• 33 Roux C L, Lejus C, Surbleb M, Renaudin M, Guillaud C, Windt A, Lasnier B, Pinaud M. Is haemostasis biological screening always useful before performing a neuraxial blockade in children?.  Paediatr Anaesth. 2002;  12 (2) 118-123
• 34 Samuel M, Hampson-Evans D, Cunnington P. Prospective to a randomized double-blind controlled trial to assess efficacy of double caudal analgesia in hypospadias repair.  J Pediatr Surg. 2002;  37 (2) 168-174
• 35 Semple D, Findlow D, Aldridge L M, Doyle E. The optimal dose of ketamine for caudal epidural blockade in children.  Anaesthesia. 1996;  51 (12) 1170-1172
• 36 Sengebusch U. Gerinnungswerte vor Kaudalanästhesie?.  Anaesthesist. 2000;  49 (5) 476-477
• 37 Smith T, Moratin P, Wulf H. Smaller children have greater bupivacaine plasma concentrations after ilioinguinal block.  Br J Anaesth. 1996;  76 (3) 452-455
• 38 Somri M, Gaitini L A, Vaida S J, Yanovski B, Sabo E, Levy N, Greenberg A, Liscinsky S, Zinder O. Effect of ilioinguinal nerve block on the catecholamine plasma levels in orchidopexy: comparison with caudal epidural block.  Paediatr Anaesth. 2002;  12 (9) 791-797
• 39 Suraseranivongse S, Chowvanayotin S, Pirayavaraporn S, Kongsayreepong S, Gunnaleka P, Kraiprasit K, Petcharatana S, Montapaneewat T. Effect of bupivacaine with epinephrine wound instillation for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy.  Reg Anesth Pain Med. 2003;  28 (1) 24-28
• 40 Verghese S T, Hannallah R S, Rice L J, Belman A B, Patel K M. Caudal anesthesia in children: effect of volume versus concentration of bupivacaine on blocking spermatic cord traction response during orchidopexy.  Anesth Analg. 2002;  95 (5) 1219-1223, table of contents
• 41 Wulf H, Peters C, Behnke H. The pharmacokinetics of caudal ropivacaine 0.2 % in children. A study of infants aged less than 1 year and toddlers aged 1 - 5 years undergoing inguinal hernia repair.  Anaesthesia. 2000;  55 (8) 757-760