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Der Anaesthesist

, Volume 60, Issue 9, pp 850–853 | Cite as

Epidurale Fehllage eines interskalenären Plexuskatheters

  • P. GausEmail author
  • B. Heß
  • Z. Tanyay
  • H. Müller-Breitenlohner
Kasuistiken

Zusammenfassung

Ein Patient erhält vor der Schulteroperation einen interskalenären Plexuskatheter. Die Anlage erfolgt nach Narkoseeinleitung in der Technik nach Winnie. Durch den Katheter werden 5 ml Ropivacain injiziert. Im Aufwachraum fällt leichte Dyspnoe ohne Stridor auf, die sich spontan bessert. Nach einem erneuten Ropivacainbolus entwickeln sich Dyspnoe und eine einseitige Parese des kontralateralen Arms; der Patient wird hypoton. Die Computertomographie zeigt eine epidurale Katheterlage. Rückenmarknahe Komplikationen der interskalenären Regionalanästhesie sind besonderes bei medialer Stichrichtung möglich und in der Literatur mehrfach beschrieben. Symptomatik und Empfehlungen zur Vermeidung werden diskutiert.

Schlüsselwörter

Regionalanästhesie Schulter/Chirurgie Plexus brachialis Perioperative Komplikationen Prävention und Kontrolle 

Epidural malpositioning of an interscalene plexus catheter

Abstract

A patient received an interscalene plexus catheter before shoulder surgery. After induction of general anesthesia catheter placement was performed with Winnie’s technique and 5 ml of ropivacaine was injected via the catheter. In the recovery room slight dyspnea without wheezing was observed which improved spontaneously. Following another bolus of ropivacaine, dyspnea and paralysis of the contralateral arm developed and the patient became hypotensive. The tomography scan showed epidural malpositioning of the catheter. Neuraxial complications of interscalene regional anesthesia are especially possible with medially directed insertion of the needle and have been described many times in the literature. The symptoms and recommendations for prevention are discussed.

Keywords

Anesthesia, regional Shoulder/surgery Brachial plexus Complications, perioperative Prevention and control 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • P. Gaus
    • 1
    Email author
  • B. Heß
    • 1
  • Z. Tanyay
    • 1
  • H. Müller-Breitenlohner
    • 1
  1. 1.Abteilung für Anästhesie und IntensivmedizinKliniken Dr. Erler gGmbHNürnbergDeutschland

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