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Vergleich der Analgesiequalität und Komplikationen von ultraschall- und nervenstimulatorgesteuerten peripheren Nervenkathetern

Datenbankanalyse zu patientenrelevanten Zielparametern

Differences of analgesic efficacy and complication rates between ultrasound and nervestimulator guided peripheral nerve catheters

Database analysis on patient-relevant target parameters

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Zusammenfassung

Hintergrund

Obwohl Ultraschall(US)-gesteuerte periphere Nervenkatheter(PNK)-Anlagen zunehmend häufiger angewendet werden, sind die meisten Untersuchungen, in denen US bzw. Nervenstimulator(NS)-gesteuerte PNK verglichen werden, darauf ausgelegt, anästhesierelevante Unterschiede zu detektieren. Es gibt dagegen nur wenige Untersuchungen, in denen patientenrelevante Zielparameter in der postoperativen Phase miteinander verglichen wurden.

Ziel der Arbeit

Diese Analyse verglich die analgetische Effektivität und die Komplikationsrate von US- vs. NS-gesteuerten PNK zur postoperativen Schmerztherapie.

Material und Methoden

Daten von erwachsenen Patienten (Juni 2006 bis Dezember 2010), die mithilfe von US (nus = 368, 06/2008–12/2010) oder NS (nns = 574, 06/2006–5/2008) gelegten PNK therapiert wurden, wurden retrospektiv analysiert. Neben den demografischen Merkmalen wurden die postoperativen Schmerzintensitäten [“numeric rating scale“ (NRS): 0–10], die Anzahl der Patienten mit zusätzlichem postoperativem Opioidbedarf, der kumulative Lokalanästhetikaverbrauch und die katheterassoziierten Komplikationen erfasst.

Ergebnisse

Patienten, die einen mit einem US gesteuerten PNK erhielten, gaben am Operationstag geringere Schmerzintensitäten in Ruhe (p = 0,034) und bei Belastung (p < 0,001) an. Außerdem war die Anzahl der Patienten, die postoperativ zusätzlich Opioide benötigten, am Operationstag signifikant niedriger (p < 0,001). Auch die Zahl von Mehrfachpunktionen (p < 0,001) und absoluten Fehlanlagen (p = 0,06) war in der US-Gruppe geringer.

Schlussfolgerung

Diese retrospektive Datenbankanalyse zeigte, dass PNK, die mithilfe des US gelegt wurden, am Operationstag eine bessere Analgesie erzielten als PNK, die mithilfe der NS gelegt wurden. Weiterhin konnten die Zahlen an benötigten Mehrfachpunktionen und absoluten Fehlanlagen in der US Gruppe reduziert werden; dies kann als ein besseres Risikoprofil der US-Technik angesehen werden.

Abstract

Background

Peripheral nerve catheters (PNC) play an important role in postoperative pain treatment following major extremity surgery. There are several trials reported in the literature which investigated the efficacy and safety of ultrasound (US) and nerve stimulator (NS) guided PNC placement; however, most of these trials were only small and focused mainly on anesthesiologist-related indicators of block success (e.g. block onset time and procedure time) but not primarily on patient-related outcome data including postoperative pain during movement.

Aim

This retrospective analysis compared the analgesic efficacy and safety of US versus NS guided peripheral nerve catheters (PNC) for postoperative pain therapy in a large cohort of patients.

Material and methods

Data of patients (June 2006–December 2010) treated with US (nus = 368 June 2008–December 2010) and NS (nns = 574, June 2006–May 2008) guided PNC were systematically analyzed. Apart from demographic data, postoperative pain scores [numeric rating scale (NRS): 0–10] on each treatment day, the number of patients with need for additional opioids, cumulative local anesthetic consumption and catheter-related complications were compared.

Results

On the day of surgery patients treated with US-guided PNC reported lower NRS at rest (p = 0.034) and during movement (p < 0.001). Additionally, the number of patients requiring additional opioids on the day of surgery was lower in the US group (absolute difference 12.4 %, p = 0.001). Furthermore, the number of multiple puncture attempts (absolute difference 5.6 %, p < 0.001) and failed catheter placements (absolute difference 3.4 %, p = 0.06) were lower in the US group. There were no patients in both groups with long-lasting neurological impairment.

Conclusion

This database analysis demonstrated that patients treated with US-guided PNC reported significantly lower postoperative pain scores and the number of patients requiring additional opioids was significantly lower on the day of surgery. The numbers of multiple punctures and failed catheter placements were reduced in the US group, which might be seen as an advantage of US-guided regional anaesthesia.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Schnabel, B. Middendorf, M.G. Boschin, A. Gottschalk, H. Van Aken, P.K. Zahn und E.M. Pogatzki-Zahn geben an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethikkommission (die Ethikkommission der Universitätsklinik Münster erteilte am 23.11.2011 ihr Einverständnis für die vorliegende retrospektive Datenbankanalyse), im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt.

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Correspondence to E.M. Pogatzki-Zahn.

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Schnabel, A., Middendorf, B., Boschin, M. et al. Vergleich der Analgesiequalität und Komplikationen von ultraschall- und nervenstimulatorgesteuerten peripheren Nervenkathetern. Anaesthesist 63, 825–831 (2014). https://doi.org/10.1007/s00101-014-2379-7

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  • DOI: https://doi.org/10.1007/s00101-014-2379-7

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