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Interpleurale Katheteranalgesie

Eine aktuelle Übersicht

Interpleural analgesia

A topical review

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Abstract

Interpleural analgesia is a method of postoperative analgesia that was developed by Kvalheim and Reiestad in 1984. The main indication is postoperative pain after unilateral thoracic and upper abdominal surgery. Many authors report good analgesic effects and better postoperative lung function following cholecystectomy. There is some controversy on the effectiveness of this method after thoracic surgery. Further indications are post-traumatic pain after multiple rib fractures and chronic pain in the upper abdomen (carcinoma of the pancreas, chronic pancreatitis). The local anaesthetic of choice is bupivacaine (in concentrations of 0.25–0.75%, injection volumes of 10–40 ml, with or without epinephrine, applied as bolus or infusion), but others, such as lidocaine or morphine, are also being tested. Risks involved in this method are pneumothorax when the catheter is placed blind and the systemic toxicity of the local anaesthetic. This review provides information on the mechanism of action, the technique, the clinical use to date and possible risks.

Zusammenfassung

Die Interpleuralanalgesie ist ein 1984 von Kvalheim und Reistad entwickeltes Verfahren zur postoperativen Analgesie. Hauptanwendungsgebiet ist die Behandlung des postoperativen Schmerzes nach unilateralen Thorax- und Oberbaucheingriffen. Nach Cholezystektomien wurden vornehmlich gute analgetische Effekte sowie eine Verbesserung der postoperativen Lungenfunktion verzeichnet. Die Effektivität des Verfahrens nach Thorakotomien wurde widersprüchlich beurteilt. Weitere Anwendungsgebiete sind posttraumatische Schmerzzustände nach Rippenserienfrakturen sowie chronische Oberbauchschmerzen (Pankreaskarzinom, chronische Pankreatitis). Das Lokalanästhetikum der Wahl ist Bupivacain (in Konzentrationen von 0,25% bis 0,75%, Injektionsvolumina von 10 bis 40 ml, mit oder ohne Vasokonstriktorenzusatz, appliert als Bolus oder Infusion), aber auch andere Substanzen wie Lidocain und Morphin wurden getestet. Risiken des Verfahrens sind der Pneumothorax bei blinder Katheterplazierung sowie die Systemtoxizität des Lokalanästhetikums. Die folgende Übersicht soll Informationen über den Wirkungsmechanismus, die Technik und bisherige klinische Anwendung des Verfahrens liefern, praktische Hinweise für die Anwendung geben sowie auf mögliche Risiken hinweisen.

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  1. Klinik für Anästhesiologie der Johannes Gutenberg-Universität, Langenbeckstraße, D-55131, Mainz

    U. Mantzke, D. Duda & W. Dick

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  2. D. Duda
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  3. W. Dick
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Mantzke, U., Duda, D. & Dick, W. Interpleurale Katheteranalgesie. Schmerz 8, 12–18 (1994). https://doi.org/10.1007/BF02527505

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