Zusammenfassung
Rückenmarknahe Blockaden mit Lokalanästhetika werden schon sehr lange zur Behandlung postoperativer Schmerzen eingesetzt. Die kontinuierlichen Verfahren gehen auf Tuohy zurück, der 1944 durch eine dicke Spinalnadel einen Ureterenkatheter in den Liquorraum legte und dadurch mit intermittierenden Procaingaben zeitlich beliebig ausgedehnte Spinalanästhesien durchführte [75]. Curbelo wandte kurz danach dasselbe Vorgehen für die kontinuierliche Epiduralanästhesie an [18], und auch Cleland beschrieb bereits 1949 repetitive Kaudal-und Extraduralblockaden [15]. Ab 1953 wurden die respiratorischen Vorteile solcher Segmentalanalgesien erkannt. Dawkins wandte 1956 erstmalig Lokalanästhetikainfusionen an [20], und Simpson et al. erreichten 1961 mit überwiegend thorakalen Epiduralanalgesien nach Oberbaucheingriffen bemerkenswerte Erfolge hinsichtlich Schmerzfreiheit und Ventilation [64]. Wegen der Bedenken gegen eine kontinuierliche intrathekale Medikation angesichts der theoretischen Infektionsgefahr spielte in den folgenden Jahrzehnten die epidurale Route zur postoperativen Analgesie die wichtigere Rolle als „Langzeitmethode“ [1]. Demgegenüber haben sich die kontinuierliche Spinalanästhesie bzw. die Kombination mit einer epiduralen Technik erst in den letzten Jahren weit verbreitet [4], so daß diese Verfahren seit 1989 als Alternative zur kontinuierlichen Epiduralanästhesie zu erwägen sind [24, 28, 77].
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Hempel, V., Lehmann, K.A. (1994). Rückenmarknahe Blockaden: Lokalanästhetika. In: Lehmann, K.A. (eds) Der postoperative Schmerz. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-21762-7_22
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