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Psoasabszess bei Psoaskompartmentkatheter

Fallbericht einer seltenen Komplikation bei peripherer Katheterregionalanästhesie

Abscess of the psoas muscle caused by a psoas compartment catheter

Case report of a rare complication of peripheral catheter regional anaesthesia

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Zusammenfassung

Ein Psaoasabszess stellt eine seltene Komplikation der Psoaskompartmentblockade dar. Bei einer 27-jährigen Patientin wurde im Rahmen einer Femurverlängerung die Schmerztherapie durch eine kontinuierliche Psoaskompartmentblockade durchgeführt. Punktion und Katheteranlage erfolgten unter streng aseptischen Bedingungen. Nach 5 Tagen kam es bei der Patientin zu einer druckschmerzhaften Rötung an der Kathetereinstichstelle. Der Katheter wurde entfernt; an der Katheterspitze fand sich ein auf die üblichen Antibiotikaklassen sensibler Staphylococcus aureus. In der Folge entwickelte die Patientin Zeichen der systemischen Infektion, wie Fieber und Anstieg des C-reaktiven Proteins (CRP). Im Computertomogramm (CT) wurde ein Psoasbszesses diagnostiziert. Unter antibiotischer Therapie kam es zur Abkapselung und schließlich zur Ausheilung des Abszesses. Die Patientin konnte nach 21 Tagen ohne Folgeschäden entlassen werden. Neben der Falldarstellung wird eine Übersicht über die Literatur zu Infektionen bei Kathetern allgemein sowie eine Risikoabschätzung zur Infektionsrate aus eigenen Daten bei 2304 peripheren Schmerzkathetern gegeben.

Abstract

A 27-year-old female patient was continuously treated with a psoas compartment catheter for pain therapy. The catheter was placed under strictly aseptic conditions. After 5 days a painful swelling and erythema were observed at the catheter introduction site and the catheter was removed. At the tip of the catheter a staphylococcus aureus infection was detected. A few days after removing the catheter, the patient showed signs of a general infection such as fever and an increase of CRP. An abscess of the psoas muscle was diagnosed via computer tomography. After treatment with antibiotics the abscess was healed and the patient was discharged after 21 days. An abscess of the psoas muscle is a rare complication of psoas compartment catheters. Erythema, pain or swelling at the site of introduction can be a sign of infection and the catheter must be removed immediately. In addition to the case report a review of the literature is given with data on risk management and own infection rates by 2304 peripheral pain catheters.

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  1. Abteilung für Anästhesie, BG Unfallklinik, Murnau

    M. Neuburger D.E.A.A., D. Lang & J. Büttner

  2. Abteilung für Anästhesie, BG Unfallklinik, Prof.-Küntscher-Str. 8, 82418, Murnau

    M. Neuburger D.E.A.A.

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  1. M. Neuburger D.E.A.A.
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  2. D. Lang
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  3. J. Büttner
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Correspondence to M. Neuburger D.E.A.A..

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Neuburger, M., Lang, D. & Büttner, J. Psoasabszess bei Psoaskompartmentkatheter. Anaesthesist 54, 341–345 (2005). https://doi.org/10.1007/s00101-005-0818-1

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