Periphere Regionalanästhesie ohne Komplikationen – Ein Traum wird wahr?!

Zusammenfassung

Periphere Regionalanästhesieverfahren sind relativ sichere Verfahren der klinischen Anästhesie – dennoch können typische, meist transiente und selten sogar persistierende Komplikationen auftreten. Neben allgemeinen Komplikationen und Strategien zur Risikoreduktion widmet sich dieser Artikel akzidentellen Mitblockaden anderer nervaler Strukturen am Beispiel des Plexus brachialis. Ein Ausblick in die Zukunft informiert über selektivere Blockaden.

Abstract

Peripheral regional anesthesia procedures, such as femoral nerve block, are relatively safe procedures in clinical anesthesia. Nevertheless, it may lead to typical, usually transient and rarely even persistent complications. This article aims to highlight key aspects of complications in peripheral regional anesthesia and, in particular, strategies to reduce risk. Moreover, beside general complications, which might potentially occur in any peripheral nerve blockade (“bleeding/infection/nerve damage”), accidental co-blockades of other nerval structures are discussed using the example of the brachial plexus. In addition to the presentation of the possible complications, this article discusses improvements in the techniques during the last two decades. Due to the use of ultrasound, some side effects nowadays are supposed to occur less likely. An outlook into the future will inform the reader about improved or more selective blockages.

Kernaussagen

• Schwere Komplikationen sind in der peripheren Regionalanästhesie glücklicherweise selten, häufig transienter Natur und extrem selten persistierend.

• Infektiöse Komplikationen sind bei einzeitigen Verfahren eine absolute Rarität.

• Kontinuierliche Techniken („Schmerzkatheter“) zeigen häufig eine bakterielle Kolonisation, bei sorgfältiger klinischer Verlaufsbeurteilung aber nur selten eine relevante infektiöse Komplikation.

• Die Anwendung von Ultraschall reduziert die Raten an akzidentellen Gefäßpunktionen, Hämatomen und „Versagern“.

• Ultraschalleinsatz führt bei vielen Lokalisationen zu einer vollständigeren Blockade als die alleinige Anwendung des Nervenstimulators. Vermutlich hat die Anwendung des Ultraschalls die peripheren RA-Verfahren zugleich deutlich sicherer gemacht. Nervenschäden treten allerdings auch bei ultraschallunterstützten Verfahren auf.

• Perioperative Nervenschäden werden häufig durch Lagerung, Tourniquet oder chirurgisches Trauma, aber eben auch durch die Regionalanästhesie verursacht.

• Nervenschäden sind vermutlich oft bedingt durch eine Kombination aus mechanischem Trauma (direktes oder indirektes Nadeltrauma), Minderperfusion des Nervs und neurotoxischen Nebenwirkungen (Lokalanästhetika) – insbesondere bei Patienten mit neuropathischen Vorerkrankungen.

Schlüsselwörter

periphere Nervenblockade - Regionalanästhesie - Komplikationen - Nervenschaden

Key words

peripheral nerve blocks - regional anesthesia - complications - nerve injury

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