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Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50(5): 322-327
DOI: 10.1055/s-0041-102213
Fachwissen
Anästhesiologie
© Georg Thieme Verlag Stuttgart · New York

Adjuvanzien in der modernen Anästhesie – Lidocain

Adjuvants in modern anesthesia – lidocaine
Susanne Picardi
,
Philipp Lirk
,
Romy Boeckh
,
Markus W Hollmann
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Publikationsverlauf

Publikationsdatum:
27. Mai 2015 (online)

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Zusammenfassung

Neben ihren bekannten antinozizeptiven und antiarrhythmischen Eigenschaften, zeigen Lokalanästhetika sogenannte alternative natriumkanalunabhängige Effekte. Hierbei stehen ihre antiinflammatorischen Eigenschaften im Vordergrund, die zumindest teilweise ihre benefiziellen Effekte nach systemischer Gabe im perioperativen Bereich erklären könnten. So reduziert die kontinuierliche intravenöse Gabe von Lidocain postoperative Schmerzen, beschleunigt die Rückkehr der gastrointestinalen Funktion und verkürzt die Krankenhausverweildauer in abdominalchirurgischen Patienten.

Abstract

Local anesthetics (LA) are well known for their antinociceptive and antiarrhythmic properties, but exert alternative effects, i.e. anti-inflammatory activity, as well. These immunomodulatory properties might contribute to the beneficial effects observed in the clinical setting, when intravenous lidocaine is given perioperatively. Systemic LA were shown to attenuate postoperative pain, accelerate the return of bowel function and shorten length of hospital stay in patients undergoing abdominal surgery.

Kernaussagen

  • Lokalanästhetika zeigen benefizielle Effekte, wie z. B. Antiinflammation, in klinisch relevanten Konzentrationen und unabhängig von der Inhibition des Natriumkanals.

  • Ein potenziell zugrundeliegender Wirkmechanismus dieser Effekte scheint neben der Inhibition von Kalium- und Kalziumkanälen eine Modulation der Signalübertragung G-Protein-gekoppelter Rezeptoren sowie ionotroper Rezeptoren zu sein.

  • Viele positive Effekte der klassisch perineural oder epidural applizierten Lokalanästhetika lassen sich im klinischen Alltag durch die systemische Gabe von Lidocain reproduzieren.

  • Bei abdominalchirurgischen Patienten verbessert die perioperative i. v. Gabe von Lidocain die postoperative Qualität der Analgesie, reduziert postoperative Übelkeit und Erbrechen, beschleunigt die Rückkehr der gastrointestinalen Motilität und verkürzt die Krankenhausverweildauer.

  • Der zugrundliegende Wirkmechanismus dieser positiven Effekte nach viszeralchirurgischen Eingriffen scheint u. a. auf einer Reduktion der chirurgisch induzierten Überstimulation der inflammatorischen Antwort zu beruhen.

  • Die Evidenz der positiven Effekte einer systemischen Lidocaingabe in gynäkologischen, urologischen, kardiochirurgischen und orthopädischen Patienten wird kontrovers diskutiert.

  • Im ambulanten Bereich werden positive Effekte einer systemischen Lidocaingabe ebenfalls kontrovers diskutiert.

  • Bei Beachtung von Kontraindikationen, engmaschiger Überwachung und Auswahl des geeigneten Patienten ist die i. v. Gabe von Lidocain eine sichere Therapieoption im perioperativen Bereich.

  • Die systemische Toxizität von Lokalanästhetika beginnt bei Plasmaspiegeln um 5 μg/ml.

  • Die perioperative Gabe von i. v. Lokalanästhetika könnte theoretisch das postoperative Auftreten von Tumorrezidiven reduzieren. Bestätigende klinische Untersuchungen liegen jedoch bisher nicht vor.

Schlüsselwörter:

Lidocain - intravenöse Gabe - perioperativ - antiinflammatorische Effekte

Key words:

lidocaine - intravenous administration - perioperative - anti-inflammatory effects

Ergänzendes Material

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