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.

Kernaussagen

• Verletzungen der oberen Extremität können mit starken postoperativen Schmerzen einhergehen.

• Die Schmerztherapie über regionalanästhesiologische Katheterverfahren ist die effektivste Form der postoperativen Analgesie.

• Für Eingriffe der Schulter und des proximalen Oberarms ist die interskalenäre Plexus-brachialisAnästhesie das Mittel der Wahl.

• Die Blockade des Plexus brachialis über einen supraklavikulären Zugang deckt den weitesten Bereich der oberen Extremität sensibel ab.

• Der axilläre Zugang zum Plexus brachialis ist mit den wenigsten schwerwiegenden Komplikationen verbunden.

• Die Einführung des Ultraschalls hat Regionalverfahren der oberen Extremität sicherer (supraklavikulärer Zugang) und besser (axillärer Zugang) gemacht sowie die Ausbildung verbessert.

Schlüsselwörter:

Plexus-brachialis-Blockade - obere Extremität - Regionalanästhesie

Key words:

brachial plexus block - upper extremity - regional anaesthesia

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