Anästhesie in der Orthopädie /Unfallchirurgie – Regionalanästhesie bei Verletzungen der oberen Extremität

Zusammenfassung

Bei Verletzungen der oberen Extremität hat die Regionalanästhesie deutliche Vorteile gegenüber der reinen Narkose mit einer opioidgestützten postoperativen Analgesie. Starke Schmerzen können als Risikofaktor für die Entwicklung chronischer postoperativer Schmerzsyndrome bei Erwachsenen und Kindern angesehen werden. In Abhängigkeit von dem zu erwartenden postoperativen Schmerzniveau und der Schmerzdauer sollten Katheterverfahren angewendet werden. Frakturen der oberen Extremität sind häufig und können auch bei vermeintlich kleinen Verletzungen mit starken postoperativen Schmerzen einhergehen. Nervenschäden können sowohl primär traumatisch bei Frakturen oder iatrogen bei der operativen Versorgung entstehen. Die exzellente Schmerzausschaltung durch die Regionalanästhesieverfahren sollte durch eine mögliche verminderte neurologische Beurteilbarkeit nicht verhindert werden. Da bis auf wenige Ausnahmen der Plexus brachialis für die sensible Versorgung der gesamten oberen Extremität zuständig ist, kommen als regionalanästhesiologische Verfahren prinzipiell alle bekannten Blockadetechniken in Frage. Durch die Verwendung des Ultraschalls bei der Anlage der Regionalanästhesie (USGRA) wurden ältere Verfahren, die durch hohe Komplikationsraten in Vergessenheit geraten waren, wieder entdeckt. Andere Verfahren konnten durch die Visualisierung der Blockade deutlich effektiver gemacht werden.

Abstract

Regional anaesthesia has significant advantages compared to general anaesthesia with an opiate-based postoperative analgesia in injuries of the upper extremity. Severe pain may be considered a risk factor for the development of chronic postoperative pain syndromes in adults and children. Depending on the anticipated postoperative pain level, a catheter procedure should be used. Fractures of the upper extremity are common and may also be associated with seemingly minor injuries with a high postoperative pain level. Nerve damage can be caused mainly by traumatic fractures, or iatrogenically during surgical procedures. Reduced possible neurological evaluability should not prevent the excellent pain control which regional anesthesia can provide. Since the brachial plexus is predominantly responsible for the sensory innervation of the entire upper extremity, therefore all known block techniques in regional anaesthesia apply. Since the introduction of ultrasound in regional anaesthesia (USGRA), older methods like the supraclavicular approach, which were previously banned due to high complication rates, are now being rediscovered. Both new and old blockade methods are much more effective and safe with ultrasound support because of the rapid visualization of the anatomy and needle.

Schlüsselwörter:

Plexus-brachialis-Blockade - obere Extremität - Regionalanästhesie

Key words:

brachial plexus block - upper extremity - regional anaesthesia

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