Der Anaesthesist

, Volume 62, Issue 3, pp 175–182 | Cite as

Regionalanästhesie bei Patienten mit Infektionen oder Immunsuppression

Leitthema

Zusammenfassung

Regionalanästhesiologische Verfahren gehören zu den effektivsten Maßnahmen der Akutschmerztherapie. Inwieweit rückenmarknahe bzw. periphere Verfahren bei Patienten mit infektiösen Vorerkrankungen, Immunsuppression oder anderen Risikofaktoren durchführbar sind, ist bisher nur unzureichend untersucht. Literaturübersichten und Kasuistiken zeigen eine insgesamt seltene Inzidenz von schweren entzündlichen Komplikationen nach Regionalanästhesie. Wenn sie jedoch auftreten, sind vermehrt Patienten mit Risikofaktoren wie beispielsweise Diabetes mellitus, Steroidtherapie oder Tumorerkrankungen betroffen. Insgesamt erscheint die strikte Ablehnung regionalanästhesiologischer Verfahren bei vorbestehender Infektion oder Immunsuppression nicht gerechtfertigt, notwendig ist jedoch eine individuelle Nutzen-Risiko-Abwägung.

Schlüsselwörter

Rückenmarknahe Anästhesie Nervenblockade Katheter Abszess Literaturübersicht 

Regional anesthesia in patients with pre-existing infections or immunosuppression

Abstract

Regional anesthesia is the most effective procedure for acute pain therapy. Whether neuraxial and peripheral blocks in patients with pre-existing infectious conditions, immune deficits or other risk factors increase the risk of additional infections is unclear. Analyzing the available literature currently seems to indicate that the incidence of severe infectious complications is generally low. Diabetes, steroid therapy or malignant diseases are apparently present in many cases in which infections associated with regional anesthesia and analgesia have been described. A strict contraindication in patients with pre-existing systemic or local infections seems unjustifiable. A clear and documented risk-benefit ratio in these patients is mandatory.

Keywords

Anesthesia, spinal Nerve block Catheters Abscess Literature review 

Notes

Interessenkonflikt

Die korrespondierende Autorin gibt für sich und ihre Koautoren an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Deutsche Interdisziplinäre Vereinigung für Schmerztherapie (2007) S3-Leitlinie, Behandlung akuter perioperativer und posttraumatischer Schmerzen. AWMF-Register Nr. 041/001. http://www.awmf.orgGoogle Scholar
  2. 2.
    Baer E (2006) Post-dural puncture bacterial meningitis. Anesthesiology 105:381–393PubMedCrossRefGoogle Scholar
  3. 3.
    Morin A, Kerwat K, Büttner J (2006) Hygieneempfehlungen für die Anlage und weiterführende Versorgung von Regionalanästhesie-Verfahren. Anaesth Intensivmed 47:372–379Google Scholar
  4. 4.
    Schulz-Stübner S, Pottinger JM, Coffin SA et al (2008) Nosocomial infections and infection control in regional anesthesia. Acta Anaesthesiol Scand 52:1144–1157PubMedCrossRefGoogle Scholar
  5. 5.
    Morin A, Kerwat K, Klotz M (2005) Risk factors for bacterial catheter colonization in regional anaesthesia. BMC Anesthesiol 5:1–9PubMedCrossRefGoogle Scholar
  6. 6.
    Capdevila X, Pirat P, Bringuier S (2005) Continuous peripheral nerve blocks in hospital wards after orthopedic surgery. Anesthesiology 103:1035–1045PubMedCrossRefGoogle Scholar
  7. 7.
    Cuvillon P, Ripart J, Lalourcey L (2001) The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 93:1045–1049PubMedCrossRefGoogle Scholar
  8. 8.
    Capdevila X, Bringuier S, Borgeat A (2009) Infectious risk of continuous peripheral nerve blocks. Anesthesiology 110:182–188PubMedCrossRefGoogle Scholar
  9. 9.
    Volk T, Engelhardt L, Spies C (2009) Infektionsinzidenz von Katheterverfahren zur Regionalanästhesie. Anaesthesist 58:1107–1112PubMedCrossRefGoogle Scholar
  10. 10.
    Wang L, Hauerberg J, Schmidt J (1999) Incidence of spinal epidural abscess after epidural analgesia. Anesthesiology 91:1928–1936PubMedCrossRefGoogle Scholar
  11. 11.
    Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 101:950–959PubMedCrossRefGoogle Scholar
  12. 12.
    Pöpping D, Zahn PK, Van Aken HK (2008) Effectiveness and safety of postoperative pain management: a survey of 18,925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 101:832–840PubMedCrossRefGoogle Scholar
  13. 13.
    Cook T, Counsell D, Wildsmith JAW (2009) Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth 102:179–190PubMedCrossRefGoogle Scholar
  14. 14.
    McDonough A, Curtis JR, Saag KG (2008) The epidemiology of glucocorticoid-associated adverse events. Curr Opin Rheumatol 20:131–137PubMedCrossRefGoogle Scholar
  15. 15.
    Fishman J (2007) Infection in solid-organ transplant recipients. N Engl J Med 357:2601–2614PubMedCrossRefGoogle Scholar
  16. 16.
    Hamouda O (2011) Schätzung der Prävalenz und Inzidenz von HIV-Infektionen in Deutschland. RKI Epidemiol Bull 46:417–422Google Scholar
  17. 17.
    Akgün K, Pisani M, Crothers K (2011) The changing epidemiology of HIV-infected patients in the intensive care unit. J Intensive Care Med 26:151–164PubMedCrossRefGoogle Scholar
  18. 18.
    Kork F, Neumann T, Spies C (2010) Perioperative management of patients with alcohol, tobacco and drug dependency. Curr Opin Anaesthesiol 23:384–390PubMedCrossRefGoogle Scholar
  19. 19.
    Lecube A, Pachón G, Petriz J (2011) Phagocytic activity is impaired in type 2 diabetes mellitus and increases after metabolic improvement. PLoS One 6:8CrossRefGoogle Scholar
  20. 20.
    Balkwill F (2012) The chemokine system and cancer. J Pathol 226:148–157PubMedCrossRefGoogle Scholar
  21. 21.
    Stone MB, Muresanu M (2010) Ultrasound-guided ulnar nerve block in the management of digital abscess and hand cellulitis. Acad Emerg Med 17:3–4CrossRefGoogle Scholar
  22. 22.
    Stone MB, Price D, Wang R (2007) Ultrasound-guided supraclavicular block for the treatment of upper extremity fractures, dislocations, and abscesses in the ED. Am J Emerg Med 25:472–475PubMedCrossRefGoogle Scholar
  23. 23.
    Shteif M, Lesmes D, Hartmann G (2008) The use of the superficial cervical plexus block in the drainage of submandibular and submental abscesses – an alternative for general anesthesia. J Oral Maxillofac Surg 66:2642–2645PubMedCrossRefGoogle Scholar
  24. 24.
    Ling KU, Shahnaz Hasan M, Ha KO (2009) Superficial cervical plexus block combined with auriculotemporal nerve block for drainage of dental abscess in adults with difficult airways. Anaesth Intensive Care 37:124–126PubMedGoogle Scholar
  25. 25.
    Jakobsen KB, Christensen MK, Carlsson PS (1995) Extradural anaesthesia for repeated surgical treatment in the presence of infection. Br J Anaesth 75:536–540PubMedCrossRefGoogle Scholar
  26. 26.
    Gritsenko K, Marcello D, Liguori GA (2012) Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses. Br J Anaesth 108:485–490PubMedCrossRefGoogle Scholar
  27. 27.
    Kotzé A, Hinton W, Crabbe DCG (2007) Audit of epidural analgesia in children undergoing thoracotomy for decortication of empyema. Br J Anaesth 98:662–666PubMedCrossRefGoogle Scholar
  28. 28.
    Goodman E, De Horta E, Taguiam JM (1996) Safety of spinal and epidural anesthesia in parturients with chorioamnionitis. Reg Anesth 21:436–441PubMedGoogle Scholar
  29. 29.
    Bader A, Gilbertson L, Kirz L et al (1992) Regional anesthesia in women with chorioamnionitis. Reg Anesth 17:84–86PubMedGoogle Scholar
  30. 30.
    Buttenschoen K, Buttenschoen DC, Berger D et al (2001) Endotoxemia and acute-phase proteins in major abdominal surgery. Am J Surg 181:36–43PubMedCrossRefGoogle Scholar
  31. 31.
    Carp H, Bailey S (1992) The association between meningitis and dural puncture in bacteremic rats. Anesthesiology 76:739–742PubMedCrossRefGoogle Scholar
  32. 32.
    Teele DW, Dashefsky B, Rakusan T et al (1981) Meningitis after lumbar puncture in children with bacteremia. N Engl J Med 305:1079–1081PubMedCrossRefGoogle Scholar
  33. 33.
    Wedel DJ, Horlocker TT (2006) Regional anesthesia in the febrile or infected patient. Reg Anesth Pain Med 31:324–333PubMedGoogle Scholar
  34. 34.
    Fusi L, Sterr PJ, Maresh MJA (1989) Maternal pyrexia and epidural anaesthesia. Lancet 334:1250–1252CrossRefGoogle Scholar
  35. 35.
    Riley L, Celi AC, Onderdonk AB et al (2011) Association of epidural-related fever and noninfectious inflammation in term labor. Obstet Gynecol 117:588–595PubMedCrossRefGoogle Scholar
  36. 36.
    DeOrange FA, Passini R Jr, Amorim MMR et al (2011) Combined spinal and epidural anaesthesia and maternal intrapartum temperature during vaginal delivery: a randomized clinical trial. Br J Anaesth 107:762–768CrossRefGoogle Scholar
  37. 37.
    Horlocker T, Wedel DJ (2006) Regional anesthesia in the immunocompromised patient. Reg Anesth Pain Med 31:334–345PubMedGoogle Scholar
  38. 38.
    Groß U (2006) Medizinische Mikrobiologie und Infektiologie. Thieme, Stuttgart, S 289–292Google Scholar
  39. 39.
    Marmer M (1965) Acute herpes zoster: successful treatment by continuous epidural analgesia. Calif Med 103:277–279PubMedGoogle Scholar
  40. 40.
    Bader A, Camann WR, Datta S (1990) Anesthesia for caesarean delivery in patients with herpes simplex virus type-2 infections. Reg Anesth 15:261–263PubMedGoogle Scholar
  41. 41.
    Crosby E, Halpern SH, Rolbin SH (1989) Epidural anaesthesia for Caesarean section in patients with active recurrent genital herpes simplex infections: a retrospective review. Can J Anaesth 36:701–704PubMedCrossRefGoogle Scholar
  42. 42.
    Chen YH, Rau RH, Keller JJ et al (2012) Possible effects of anaesthetic management on the 1 yr followed-up risk of herpes zoster after Caesarean deliveries. Br J Anaesth 108:278–282PubMedCrossRefGoogle Scholar
  43. 43.
    Bauchat J (2010) Neuraxial morphine and oral herpes reactivation in the obstetric population. Anesth Analg 111:1238–1241PubMedCrossRefGoogle Scholar
  44. 44.
    Nseir S, Pronnier P, Soubrier S et al (2004) Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block. Br J Anaesth 92:427–429PubMedCrossRefGoogle Scholar
  45. 45.
    Adam F, Jaziri S, Chauvin M (2003) Psoas abscess complicating femoral nerve block catheter. Anesthesiology 99:230–231PubMedCrossRefGoogle Scholar
  46. 46.
    Clendenen SR, Robards CB, Wang RD et al (2010) Continous interscalene block associated with neck hematoma and postoperative sepsis. Anesth Analg 110:1236–1238PubMedGoogle Scholar
  47. 47.
    Compére V, Cornet C, Fourdrinier V (2005) Thigh abscess as a complication of continuous popliteal sciatic nerve block. Br J Anaesth 95:255–256PubMedCrossRefGoogle Scholar
  48. 48.
    Hooten WM, Kinney MO, Huntoon MA (2004) Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc 79:682–686PubMedCrossRefGoogle Scholar
  49. 49.
    Götz F, Lanfermann H, Becker H (2009) Zervikaler Abszess nach lumbaler epiduraler Schmerztherapie. Clin Neuroradiol 19:220–226CrossRefGoogle Scholar
  50. 50.
    Kaul S, Meena AK, Sundaram C et al (2000) Spinal extradural abscess following local steroid injection. Neurol India 48:181–183PubMedGoogle Scholar
  51. 51.
    Koka VK, Potti A (2002) Spinal epidural abscess after corticosteroid injections. South Med J 95:772–774PubMedGoogle Scholar
  52. 52.
    Cummings KC, Dolak JA (2006) Case report: epidural abscess in a parturient with pruritic urticarial papules and plaques of pregnancy (PUPPP). Can J Anaesth 53:1010–1014PubMedCrossRefGoogle Scholar
  53. 53.
    Coupe N, O’Brien M, Gibson P et al (2005) Anesthesia for pediatric renal transplantation with and without epidural analgesia – a review of 7 years experience. Pediatr Anesth 15:220–228CrossRefGoogle Scholar
  54. 54.
    Trzebicki J, Nicinska B, Blaszczyk B et al (2010) Thoracic epidural analgesia in anaesthesia for liver transplantation: the 10-year experience of a single centre. Ann Transplant 15:35–39PubMedGoogle Scholar
  55. 55.
    Hughes S, Dailey PA, Landers D (1995) Parturients infected with human immunodeficiency virus and regional anesthesia. Anesthesiology 82:32–37PubMedCrossRefGoogle Scholar
  56. 56.
    Avidan M, Groves P, Blott M et al (2002) Low complication rate associated with cesarean section under spinal anesthesia for HIV-1-infected women on antiretroviral therapy. Anesthesiology 97:320–324PubMedCrossRefGoogle Scholar
  57. 57.
    Bremerich DH, Ahr A, Büchner S et al (2002) Anästhesiologische Versorgung von HIV-positiven Schwangeren zur elektiven Sectio caesarea. Anaesthesist 52:1124–1131CrossRefGoogle Scholar
  58. 58.
    Tom DJ, Gulevich SJ, Shapiro HM et al (1992) Epidural blood patch in the HIV-positive patient. Anesthesiology 76:943–947PubMedCrossRefGoogle Scholar
  59. 59.
    Gosavi C, Bland D, Poddar R et al (2004) Correspondence: epidural abscess complicating insertion of epidural catheters. Br J Anaesth 92:294–298PubMedCrossRefGoogle Scholar
  60. 60.
    Cameron CM, Scott DA, McDonald WM et al (2007) A review of neuraxial epidural morbidity. Anesthesiology 106:997–1002PubMedCrossRefGoogle Scholar
  61. 61.
    Llewellyn N, Moriarty A (2007) The national pediatric epidural audit. Pediatric Anesth 17:520–533CrossRefGoogle Scholar
  62. 62.
    Christie IW, McCabe S (2007) Major complications of epidural analgesia after surgery: results of a six-year survey. Anaesthesia 62:335–341PubMedCrossRefGoogle Scholar
  63. 63.
    Green LK, Paech MJ (2010) Obstetric epidural catheter-related infections at a major teaching hospital: a retrospective case series. Int J Obstet Anesth 19:38–43PubMedCrossRefGoogle Scholar
  64. 64.
    Sethna NF, Clendenin D, Athiraman U et al (2010) Incidence of epidural catheter-associated infections after continuous epidural analgesia in children. Anesthesiology 113:224–232PubMedCrossRefGoogle Scholar
  65. 65.
    Kindler CH, Seeberger MD, Staender SE (1998) Epidural abscess complicating epidural anesthesia and analgesia. Acta Anaesthesiol Scand 42:614–620PubMedCrossRefGoogle Scholar
  66. 66.
    Du Pen S, Peterson DG, Williams A et al (1990) Infection during chronic epidural catheterization: diagnosis and treatment. Anesthesiology 73:905–909CrossRefGoogle Scholar
  67. 67.
    DeJong P, Kansen PJ (1994) A comparison of epidural catheters with or without subcutaneous injection ports for treatment of cancer pain. Anesth Analg 78:94–100Google Scholar
  68. 68.
    Smitt P, Tsafka A, VanDeZande F et al (1998) Outcome and complications of epidural analgesia in patients with chronic cancer pain. Cancer 83:2015–2022PubMedCrossRefGoogle Scholar
  69. 69.
    Stojadinovic A, Auton A, Peoples GE et al (2006) Responding to challenges in modern combat casualty care: innovative use of advanced regional anesthesia. Pain Med 7:330–338PubMedCrossRefGoogle Scholar
  70. 70.
    Borgeat A, Dullenkopf A, Ekatodramis G, Nagy L (2003) Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery. Anesthesiology 99:436–442PubMedCrossRefGoogle Scholar
  71. 71.
    Neuburger M, Büttner J, Blumenthal S et al (2007) Inflammation and infection complications of 2285 perineural catheters: a prospective study. Acta Anaesthesiol Scand 51:108–114PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Klinik für Anästhesiologie, Intensivmedizin und SchmerztherapieUniversitätsklinikum des SaarlandesHomburgDeutschland

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