Die perioperative Analgesie ist nicht nur für die Patientenzufriedenheit wichtig –
in der Thoraxchirurgie ist sie auch zur Vermeidung postoperativer Komplikationen ein
zentrales Thema.
Ultraschallgestützte Rumpfwandblockaden füllen hierbei eine Lücke zwischen opiatbasierten
Therapieregimen und neuroaxialen Verfahren. Dieser Beitrag bietet einen Überblick
über die
verschiedenen thorakalen Rumpfwandblockaden und ihre Einsatzmöglichkeiten.
Abstract
Perioperative analgesia plays an important role in thoracic surgery, regarding not
only patient satisfaction, but also in preventing postoperative complications such
as pneumonia.
Ultrasound-guided thoracic wall blocks close the gap between opiate based and neuraxial
pain management concepts.
The following article explores the different ultrasound-guided approaches to anesthetize
the thoracic wall, ranging from the ventral blocks such as parasternal or PECS I/II,
followed by the
lateral blocks (i.e. serratus anterior), up to the dorsal approaches including the
paravertebral, erector spinae plane, and retrolaminar block.
In summary, the anterolateral blocks are supplementary blocks in an opiate sparing,
multimodal anaesthesia concept, whereas the dorsal procedures, as they include visceral
anaesthesia, are
an alternative to neuraxial anaesthesia, as they have a comparable analgetic potency.
For minimally invasive thoracic surgery, where due to risk-benefit considerations
epidural anaesthesia
is omitted, thoracic wall blocks can be utilized in a single shot or a continuous,
catheter-based approach.
Schlüsselwörter
Anästhesie - perioperative Schmerztherapie - Thoraxchirurgie - interventioneller Ultraschall
Keywords
anaesthesia - pain management - thoracic surgery - interventional ultrasonography
