Prophylaktische Plexuskatheterbehandlung bei operativen Eingriffen nach Komplexem Regionalen Schmerzsyndrom (CRPS)

Zusammenfassung

Hintergrund Die vorliegende Arbeit soll die Wirkung der perioperativen Plexuskatheterbehandlung bei ehemaligen CRPS-Patienten untersuchen und diskutieren.

Patienten und Methoden Durchgeführt wurde eine retrospektive Analyse gepaarter Gruppen von je 10 CRPS-Patienten mit vergleichbaren Ausgangsverletzungen, welche nach Diagnosestellung eine Folgeoperation im erkrankungsfreien Intervall erfuhren – in 10 Fällen unter Plexuskatheterschutz (Interventionsgruppe), in 10 Fällen ohne Plexuskatheterschutz (Kontrollgruppe).

Ergebnisse In der Interventionsgruppe betrug das durchschnittliche Schmerzniveau 105 (20–184) Tage nach der letzten Operation 6,4 (4–8) auf der visuellen Analogskala (VAS; 0 bis 10), der durchschnittliche Fingerkuppenhohlhandabstand 3,2 (0–7,6) cm, der Bewegungsumfang des Handgelenkes 47,5 (0–95) ° und die Griffkraft 9,2 (2,1–16,6) kg. In der Kontrollgruppe betrug das durchschnittliche Schmerzniveau 129 (19–410) Tage nach der letzten Operation 6 (3–10) auf der visuellen Analogskala, der durchschnittliche Fingerkuppenhohlhandabstand 2,7 (0–4,5) cm, der Bewegungsumfang des Handgelenkes 64 (0–125) °, die Griffkraft 12,4 (0,8–23,8) kg. Ein signifikanter Unterschied zwischen den Gruppen zeigte sich nicht. Ein Rezidiv des CRPS nach der Operation wurde in beiden Gruppen nicht beobachtet.

Schlussfolgerung Eine perioperative Plexuskatheterbehandlung nach stattgehabter CRPS-Erkrankung zur Prophylaxe eines CRPS-Rezidives kann durch die aktuelle Datenlage derzeit nicht begründet werden.

Abstract

Background This paper investigates and discusses the effect of perioperative plexus catheter treatment in former CRPS patients.

Patients and Methods A retrospective matched-pair analysis was conducted on 10 CRPS patients with comparable injuries, who underwent surgery in the disease-free interval. In 10 cases, the procedure was performed with perioperative plexus catheter treatment (intervention group), whereas 10 patients did not receive perioperative plexus catheter treatment (control group).

Results In the intervention group, after a follow-up time of 105 (20–184) days after the last surgical procedure, pain intensity on the visual analogue scale (VAS; 0 to 10) was 6.4 (4–8), fingertip-to-palm distance averaged 3.2 (0–7.6) cm, active range of wrist motion was 47.5 (0–95), and grip strength was 9.2 (2.1–16.6) kg. In the control group, after a follow-up time of 129 (19–410) days since the last surgical procedure, pain intensity on the visual analogue scale was 6 (3–10), fingertip-to-palm distance averaged 2.7 (0–4.5) cm, active range of wrist-motion was 64 (0–125), and grip strength was 12.4 (0.8–23.8) kg. There was no significant difference between the groups. There was no recurrence of CRPS disease in either group after surgery.

Conclusion There is no evidence so far for perioperative plexus catheter treatment to prevent recurrence in former CRPS patients.

Schlüsselwörter

komplexes regionales Schmerzsyndrom - Anästhesie - Plexus-Anästhesie

Key words

complex regional pain syndrome - anaesthesia - plexus catheter treatment - CRPS

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