Alte und neue Regionalanästhesieverfahren unter Review – Kopf bis Bauch

Die Regionalanästhesie hat mit Einführung der Sonografie eine neue Bedeutung erfahren. Mit ihrer Unterstützung können wichtige Begleitstrukturen umgangen und Komplikationen vermieden werden. Zusätzlich sind komplexe Punktionen möglich, die allein durch Landmarken zu risikoreich wären. Der Artikel beschreibt publizierte und klinisch etablierte Punktionstechniken am Hals, der oberen Extremität und am oberen Rumpf bezüglich Indikationen und Durchführung.

Abstract

By implementation of sonography regional anesthesia became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety during needle placement. Thereby new truncal blocks got enabled. Next to the blocking of specific nerve structures, plane blocks got established which can also be described as interfascial compartment blocks. The present review illustrates published and established blocks in daily practice concerning indications and the procedural issues. Moreover, the authors explain potential risks, complications and dosing of local anesthetics.

Kernaussagen

• Für Rumpfblockaden werden größtenteils Kompartimente bzw. interfasziale Räume anstatt Nervenstrukturen aufgesucht.

• Septen im interfaszialen Raum und eine fehlende kontrollierte Nervenumspülung könnten Ursache einer größeren Wirkungsvarianz sein.

• Eine viszerale Analgesie wird von „interfaszialen“ Blockaden – abgesehen von Paravertebralblockaden – nicht erzeugt, womit die analgetische Potenz im Vergleich zu neuraxialen Verfahren eingeschränkt ist.

• Für Rumpfblockaden werden hohe Volumina an Lokalanästhetika benötigt. Bei Wahl der Konzentration ist auf Höchstdosen zu achten. Bei Mischung verschiedener Lokalanästhetika kann sich die Toxizität addieren.

• Alternativ zur interskalenären Blockade kann eine Nervus-suprascapularis-Blockade kombiniert mit einer Nervus-axillaris-Blockade für die Schulterchirurgie eingesetzt werden.

• Der kostoklavikuläre infraklavikuläre Block ist eine sehr gute Alternative zum lateralen sagittalen infraklavikulären Block, dessen Zielstrukturen deutlich tiefer liegen.

• Der Serratus-anterior-Plane-Block stellt auch als kontinuierliches Verfahren eine Alternative zu epiduralen Blockaden bei Rippenserienfrakturen dar.

• Paravertebralblockaden sind deutlich komplexer in der Durchführung und gehen mit mehr potenziellen Komplikationen einher als Serratus-anterior-Plane- oder Erector-spinae-Plane-Blockaden.

• Die Darstellung der „Conjoint Tendon“ im Rahmen der axillären Plexusblockade und die Umspülung aller beteiligten Nerven stellen eine hohe Erfolgsrate sicher.

Schlüsselwörter

Regionalanästhesie - obere Extremität - Nervenblockaden - Feldblock - Brustwand - Blockade - thoracic block

Keywords

regional anaesthesia - upper limb - nerve block - plane block

Publication History

Article published online:
21 March 2024

• Literatur

• 1 El-Boghdadly K, Wolmarans M, Stengel AD. et al. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. Reg Anesth Pain Med 2021; 46: 571-580
• 2 De Cassai A, Costa F. Editorial: Interfascial Plane Blocks. Front Med (Lausanne) 2022; 9: 962487
• 3 Shao P, Li H, Shi R, Li J. et al. Understanding fascial anatomy and interfascial communication: implications in regional anesthesia. J Anesth 2022; 36: 554-563
• 4 Chin KJ, Versyck B, Elsharkawy H. et al. Anatomical basis of fascial plane blocks. Reg Anesth Pain Med 2021; 46: 581-599
• 5 Elsharkawy H, Pawa A, Mariano ER. et al. Interfascial Plane Blocks: Back to Basics. Reg Anesth Pain Med 2018; 43: 341-346
• 6 Carline L, McLeod GA, Lamb C. et al. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth 2016; 117: 387-394
• 7 Dam M, Moriggl B, Hansen CK. et al. The pathway of injectate spread with the transmuscular quadratus lumborum block: a cadaver study. Anesth Analg 2017; 125: 303-312
• 8 Forero M, Adhikary SD, Lopez H. et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41: 621-627
• 9 Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg 2011; 113: 904-925
• 10 Zink W, Graf BM. Lokalanästhetikatoxizität – Relevanz empfohlener Maximaldosen?. Anasthesiol Intensivmed Notfallmed Schmerzther 2007; 48: 182-205
• 11 Rosenberg P, Veering B, Urmey W. Maximum recommended doses of local anesthetics: A multifactorial concept. Reg Anesth Pain Med 2004; 29: 564-575
• 12 Steinfeldt T, Kessler P, Vicent O. et al. Periphere Rumpfwandblockaden – Übersicht und Bewertung [Peripheral truncal blocks – Overview and assessment]. Anaesthesist 2020; 69: 860-877
• 13 Kitayama M, Wada M, Hashimoto H. et al. Effects of adding epinephrine on the early systemic absorption kinetics of local anesthetics in abdominal truncal blocks. J Anesth 2014; 28: 631-634
• 14 Corvetto MA, Echevarría GC, La Fuente De N. et al. Comparison of plasma concentrations of levobupivacaine with and without epinephrine for transversus abdominis plane block. Reg Anesth Pain Med 2012; 37: 633-637
• 15 Gupta K, Srikanth K, Girdhar KK. et al. Analgesic efficacy of ultrasound-guided paravertebral block versus serratus plane block for modified radical mastectomy: A randomised, controlled trial. Indian J Anaesth 2017; 61: 381-386
• 16 Meier G, Büttner J, Kessler P, Wiesmann T. Allgemeiner Überblick – Anatomie. In: Meier G, Büttner J, Kessler P, Wiesmann T. Atlas der peripheren Regionalanästhesie. 4. Stuttgart: Thieme; 2023
• 17 Schubert AK, Dinges HC, Wulf H. et al. Interscalene versus supraclavicular plexus block for the prevention of postoperative pain after shoulder surgery: A systematic review and meta-analysis. Eur J Anaesthesiol 2019; 36: 427-435
• 18 Kietaibl S, Ferrandis R, Godier A. et al. Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC/ESRA guidelines. Eur J Anaesthesiol 2022; 39: 100-132
• 19 Sivakumar RK, Areeruk P, Karmakar MK. Aberrant vascular anatomy at the costoclavicular space: a word of caution for costoclavicular brachial plexusblock. Reg Anesth Pain Med 2021; 46: 95-96
• 20 Songthamwat B, Karmakar MK, Li JW. et al. Ultrasound-Guided Infraclavicular Brachial Plexus Block: Prospective Randomized Comparison of the Lateral Sagittal and Costoclavicular Approach. Reg Anesth Pain Med 2018; 43: 825-831
• 21 Ranganath A, Srinivasan KK, Iohom G. Ultrasound guided axillary brachial plexus block. Med Ultrason 2014; 16: 246-251
• 22 Armbruster W, Eichholz R, Notheisen T. Ultraschall in der Anästhesiologie. Filderstadt: AEN; 2016
• 23 Tran DQ, Layera S, Bravo D. et al. Diaphragm-sparing nerve blocks should spare the diaphragm. Anesth Pain Med 2020;
• 24 Kim DH, Lin Y, Beathe JC. et al. Superior Trunk Block: A Phrenic-sparing Alternative to the Interscalene Block: A Randomized Controlled Trial. Anesthesiology 2019; 131: 521-533
• 25 Aliste J, Bravo D, Layera S. et al. Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery. Reg Anesth Pain Med 2019;
• 26 Campbell AS, Johnson CD, O’Connor S. Impact of Peripheral Nerve Block Technique on Incidence of Phrenic Nerve Palsy in Shoulder Surgery. Anesthesiol Res Pract 2023; 2023: 9962595
• 27 Sun C, Zhang X, Ji X. et al. Suprascapular nerve block and axillary nerve block versus interscalene nerve block for arthroscopic shoulder surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100: e27661
• 28 Zhao J, Xu N, Li J. et al. Efficacy and safety of suprascapular nerve block combined with axillary nerve block for arthroscopic shoulder surgery: A systematic review and meta-analysis of randomized controlled trials. Int J Surg 2021; 94: 106111
• 29 Lewis SC, Warlow CP, Bodenham AR. GALA Trial Collaborative Group. et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 2008; 372: 2132-2142
• 30 Pandit JJ, Satya-Krishna R, Gration P. Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications. Br J Anaesth 2007; 99: 159-169
• 31 Seidel R. Cervical Plexus Blocks. Anasthesiol Intensivmed Notfallmed Schmerzther 2017; 52: 806-813
• 32 Seidel R, Schulze M, Zukowski K. et al. Ultrasound-guided intermediate cervical plexus block. Anatomical study. Anaesthesist 2015; 64: 446-450
• 33 Rössel T, Kersting S, Heller AR. et al. Combination of high-resolution ultrasound-guided perivascular regional anesthesia of the internal carotid artery and intermediate cervical plexus block for carotid surgery. Ultrasound Med Biol 2013; 39: 981-986
• 34 Seidel R, Zukowski K, Wree A. et al. Ultrasound-guided intermediate cervical plexus block and perivascular local anesthetic infiltration for carotid endarterectomy: A randomized controlled trial. Anaesthesist 2016; 65: 917-924
• 35 Koköfer A, Nawratil J, Felder TK. et al. Ropivacaine 0.375% vs. 0.75% with prilocaine for intermediate cervical plexus block for carotid endarterectomy: A randomised trial. Eur J Anaesthesiol 2015; 32: 781-789
• 36 Reisig F, Büttner J. Ultrasound-guided thoracic paravertebral block for acute thoracic trauma: continuous analgesia after high speed injury. Anaesthesist 2013; 62: 460-463
• 37 Krediet AC, Moayeri N, van Geffen GJ. et al. Different Approaches to Ultrasound-guided Thoracic Paravertebral Block: An Illustrated Review. Anesthesiology 2015; 123: 459-474
• 38 Blanco R. The “pecs block”: a novel technique for providing analgesia after breast surgery. Anaesthesia 2011; 66: 847-848
• 39 Byhahn C, Meininger D. Thoracic paravertebral block. Anasthesiol Intensivmed Notfallmed Schmerzther 2009; 44: 530-542
• 40 Bashandy GMN, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med 2015; 40: 68-74
• 41 Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim 2012; 59: 470-475
• 42 Purcell N, Wu D. Novel use of the PECS II block for upper limb fistula surgery. Anaesthesia 2014; 69: 1294
• 43 Durant E, Dixon B, Luftig J. et al. Ultrasound-guided serratus plane block for ED rib fracture pain control. Am J Emerg Med 2017; 35: 197.e3-197.e6
• 44 Piracha MM, Thorp SL, Puttanniah V. et al. “A Tale of Two Planes”: Deep Versus Superficial Serratus Plane Block for Postmastectomy Pain Syndrome. Reg Anesth Pain Med 2017; 42: 259-262
• 45 Mayes J, Davison E, Panahi P. et al. An anatomical evaluation of the serratus anterior plane block. Anaesthesia 2016; 71: 1064-1069
• 46 Blanco R, Parras T, McDonnell JG. et al. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 2013; 68: 1107-1113
• 47 Forero M, Adhikary SD, Lopez H. et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med 2016; 41: 621-627
• 48 Ueshima H, Otake H. Erector spinae plane block provides effective pain management during pneumothorax surgery. J Clin Anesth 2017; 40: 74
• 49 Forero M, Rajarathinam M, Adhikary S. et al. Continuous Erector Spinae Plane Block for Rescue Analgesia in Thoracotomy After Epidural Failure: A Case Report. Case Rep 2017; 8: 254-256
• 50 Scimia P, Basso Ricci E. et al. The Ultrasound-Guided Continuous Erector Spinae Plane Block for Postoperative Analgesia in Video-Assisted Thoracoscopic Lobectomy. Reg Anesth Pain Med 2017; 42: 537
• 51 Forero M, Rajarathinam M, Adhikary S. et al. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series. Scand J Pain 2017; 17: 325-329
• 52 Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. Br J Anaesth 2017; 118: 474-475
• 53 Ohgoshi Y, Ikeda T, Kurahashi K. Continuous erector spinae plane block provides effective perioperative analgesia for breast reconstruction using tissue expanders: A report of two cases. J Clin Anesth 2018; 44: 1-2
• 54 Chin KJ, Adhikary S, Sarwani N. et al. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia 2017; 72: 452-460
• 55 Chin KJ, Malhas L, Perlas A. The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery: A Report of 3 Cases. Reg Anesth Pain Med 2017; 42: 372-376
• 56 Restrepo-Garces CE, Chin KJ, Suarez P. et al. Bilateral Continuous Erector Spinae Plane Block Contributes to Effective Postoperative Analgesia After Major Open Abdominal Surgery: A Case Report. A A Case Rep 2017; 9: 319-321
• 57 Aksu C, Gürkan Y. Ultrasound guided erector spinae block for postoperative analgesia in pediatric nephrectomy surgeries. J Clin Anesth 2018; 45: 35-36
• 58 Tulgar S, Selvi O, Senturk O. et al. Clinical experiences of ultrasound-guided lumbar erector spinae plane block for hip joint and proximal femur surgeries. J Clin Anesth 2018; 47: 5-6
• 59 Tulgar S, Senturk O. Ultrasound guided Erector Spinae Plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty. J Clin Anesth 2018; 44: 68
• 60 Darling CE, Pun SY, Caruso TJ. et al. Successful directional thoracic erector spinae plane block after failed lumbar plexus block in hip joint and proximal femur surgery. J Clin Anesth 2018; 49: 1-2
• 61 Adhikary SD, Bernard S, Lopez H. et al. Erector Spinae Plane Block Versus Retrolaminar Block: A Magnetic Resonance Imaging and Anatomical Study. Reg Anesth Pain Med 2018; 43: 756-762
• 62 Chin KJ, Adhikary SD, Forero M. Understanding ESP and Fascial Plane Blocks: A Challenge to Omniscience. Reg Anesth Pain Med 2018; 43: 807-808
• 63 El-Boghdadly K, Pawa A. The erector spinae plane block: plane and simple. Anaesthesia 2017; 72: 434-438