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Anästhesiol Intensivmed Notfallmed Schmerzther 2024; 59(03): 180-189
DOI: 10.1055/a-2065-7696
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Periphere Regionalanästhesieverfahren – Standards im Wandel?!

Peripheral Regional Anesthesia Techniques – Standards in Flux?!
Thomas Wiesmann
,
Thorsten Steinfeldt
,
Ann-Kristin Schubert
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In der peripheren Regionalanästhesie gibt es einige aktuelle Entwicklungen – basierend auf Diskussionen bei Fachveranstaltungen und Anfragen an den Arbeitskreis Regionalanästhesie der DGAI stellt dieser Beitrag sie dar. Relevante Themen sind u. a. die Handhabung antithrombotischer Medikation bei peripheren Blockaden, der Entlasszeitpunkt nach Plexusanästhesien sowie periphere Nervenblockaden unter Allgemeinanästhesie und in der Notfallmedizin.

Abstract

This review article provides an overview of current developments in peripheral regional anaesthesia (RA). The authors present a subjective compilation based on discussions at professional events and inquiries to the Working Group on Regional Anaesthesia of the German Society for Anaesthesiology and Intensive Care Medicine (DGAI). The article addresses several relevant topics, including the handling of antithrombotic medication in peripheral blockades with reference to European guidelines, the debate on the discharge timing after plexus anaesthesia, and the consideration of rebound pain as an independent pain entity following RA.

Furthermore, the contentious discussion regarding the administration of peripheral nerve blockades under general anaesthesia is illuminated. The authors express no fundamental concerns in this regard but emphasize the importance of preoperative evaluation and individual patient needs. The question of mixing local anaesthetics is also addressed, with the authors critically questioning this tradition and recommending the use of individual, long-acting substances.

Another focal point is the application of peripheral nerve blockades in emergency medicine, both in preclinical and emergency room settings. The authors highlight the necessity for high-quality studies and discuss the complex organizational issues associated with the preclinical application of RA techniques.

Kernaussagen

  • Für oberflächliche periphere Nervenblockaden gibt es keine Einschränkungen unter antithrombotischer Medikation.

  • Rebound Pain ist eine mittlerweile besser verstandene Schmerzmodalität nach abklingender Nervenblockade. Dexamethason scheint eine protektive Wirkung zu haben.

  • Das Mischen von kurz- und langwirksamen Lokalanästhetika für periphere Blockaden verbessert nicht die Anschlagzeit und bewirkt eine intermediäre Wirkdauer.

  • Präklinische Nervenblockaden sind bisher noch schlecht untersucht, eine Durchführung außerhalb von Studien wird nicht empfohlen.

  • Nervenblockaden zur Schmerzreduktion oder vor Gelenkreposition in der Notaufnahme sind effektiv und risikoarm.

Schlüsselwörter

periphere Regionalanästhesie - Standards - Analgosedierung - präklinische Analgesie - Lokalanästhetika

Keywords

peripheral regional anesthesia - standards - analgosedation - prehospital analgesia - local anesthetics


Publication History

Article published online:
21 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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