Epiduralanästhesie – Epiduralanästhesie in Kombination mit Allgemeinanästhesie

Zusammenfassung

Die Epiduralanalgesie findet eine breite Anwendung in der perioperativen Schmerztherapie. Aber nicht nur aufgrund ihrer hervorragenden Analgesie sondern auch wegen vieler anderer positiven Eigenschaften im Rahmen der Rekonvaleszenz der Patienten wird sie oft zusammen mit der Allgemeinanästhesie angewendet. Nicht zuletzt wird eine reversible Sympathikusblockade mit konsekutiver Abschwächung der perioperativen Stressantwort als pathophysiologsicher Hintergrund für die positiven Effekte auf das kardiovaskuläre und gastrointestinale System sowie die Immunfunktion diskutiert. Ergebnisse aus der Grundlagenforschung lassen ebenso auf einen Behandlungsvorteil bei der Anwendung der Epiduralanalgesie bei tumorchirurgischen Operationen spekulieren. Bei der korrekten Anwendung der Epiduralanalgesie ist ein Benefit auf die Mortalität der Patienten nach großen operativen Eingriffen zu erwarten. Dieser Artikel fasst die angesprochenen Aspekte der Epiduralanalgesie nun zusammen.

Abstract

Epidural anaesthesia is a widely used and accepted technique for perioperative analgesia in different kinds of surgery. Apart from analgetic effect and due to wide positve effects on patients outcome epidural analgesia is often used with general anaesthesia. It represents a reliable and reversible neural deafferentation technique that effectively contributes to a reduction of the surgical stress response with subsequent positive effects on cardiopulmonary, gastrointestinal, and immune function. Animal studies suggest that the use of epidural anaesthesia may be beneficial for cancer surgery because of less tumour recurrence. Further, a benefit is expected in patient's mortality. This article summarizes and critically discusses the current knowledge on the effects of epidural anaesthesia on pain management, cardiopulmonary as well as gastrointestinal functions and patient's outcome.

Kernaussagen

• Die Epiduralanalgesie wirkt sich bei korrekter Anwendung in vielfältiger Weise vorteilhaft auf die Rekonvaleszen operativ versorgter Patienten aus.

• Als Vorteile gelten: eine exzellente Analgesie, eine verbesserte postoperative Erholung und verringerte Morbidität und Letalität bei Patienten, die sich besonders invasiven Operationen unterziehen müssen.

• Hoffnungsvolle Ansätze zeigen sich auch hinsichtlich einer reduzierten Inzidenz chronischer Schmerzen nach Operationen.

Schlüsselwörter:

Epiduralanalgesie - postoperative Analgesie - Organprotektion

Keywords:

epidural analgesia - postoperative analgesia - protective effects

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