Evidenz in der infiltrativen Schmerztherapie des Bewegungsapparates

Zusammenfassung

Durch ultraschallgezielte therapeutische Infiltrationen können Wirkstoffe in kleinen Mengen exakt an den anatomischen Ort des Schmerzgeschehens gebracht werden. Einen Überblick über die wissenschaftliche Evidenz unterschiedlicher Infiltrationsverfahren soll dieser Artikel geben.

Abstract

Musculoskeletal pain symptoms frequently generate limitations in daily work and life in many patients. Usually, symptomatic treatment is possible before clarifying the in depth diagnosis. A symptom-based infiltration therapy will never replace a thoroughly done physical examination and thoughtful collection of patient history, however, it can be of great benefit for the patient when done focused on the point of pain and executed with profound anatomical knowledge. Furthermore, the knowledge of the level of evidence of therapeutic infiltrations improves their outcomes and shapes realistic patientsʼ expectations. Ultrasound-guided therapeutic infiltrations improve the outcome despite the use of lower amounts of active agents by pinpointed applications. This article provides an overview of the scientific evidence of effectiveness of (ultrasound-guided) infiltration techniques in diverse musculoskeletal regions.

Kernaussagen

• Beschwerden des Bewegungs- und Stützapparates können oft durch eine symptombasierte Infiltrationstherapie behandelt werden.

• Durch ultraschallgesteuerte therapeutische Infiltrationen können analgetisch wirksame Substanzen in kleinen Mengen exakt an den anatomischen Ort des Schmerzgeschehens gebracht werden.

• Zum Einsatz kommen u. a. Lokalanästhetika, Steroide, autologes Blut und Blutprodukte und Salzlösung.

• Zwei klassische Strategien der Nadelvisualisierung durch Ultraschall sind in der Literatur beschrieben:

  • Beim In-Plane-Ansatz verläuft die Nadel parallel zur Schallsondenausrichtung und wird dementsprechend als Linie im Bild angezeigt.

  • Beim Out-of-Plane-Ansatz liegt die Schallsonde im rechten Winkel zum Nadelverlauf, die Nadel wird als Einzelpunkt im Bild angezeigt.

• Schmerzen an der Wirbelsäule können durch die Infiltrationstherapie ebenso behandelt werden wie Sakroiliakalgelenkschmerzen, Schmerzen an der oberen (Schultergürtel, Ellenbogengelenk, Handgelenk/Hand) wie auch der unteren Extremität (Hüfte, Kniegelenk, Sprunggelenk, Fuß).

• Es bestehen unterschiedliche Evidenzlevel in den verschiedenen Lokalisationen und auch in Abhängigkeit von den eingesetzten Substanzen.

• Bei Einhaltung der Hygieneschutzmaßnahmen handelt es sich um ein sehr sicheres Verfahren.

• Bei der Indikationsstellung zu diagnostischen Infiltrationen sollten sich Konsequenzen für die weitere Behandlung ergeben.

Schlüsselwörter

Lokalanästhetikum - Schmerztherapie - Analgesie - evidenzbasierte Medizin

Key words

Local anesthetic - pain therapy - analgesia - evidence-based medicine

Publication History

Article published online:
10 February 2021

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