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Regionalanästhesie in der Orthopädie

The use of regional anesthesia in orthopedics

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Zusammenfassung

Periphere und rückenmarknahe Anästhesieverfahren sind wichtig in der perioperativen Schmerztherapie orthopädischer Patienten. Der Einfluss der Regionalanästhesie auf die Reduktion postoperativer Komplikationen wie auch der Mortalität ist für verschiedene Operationen erfasst. Einmalig durchgeführte Blockaden sowie Katheterverfahren stehen zur Verfügung. Kathetertechniken erlauben durch kontinuierliche Infusion der Lokalanästhetika die lückenlose postoperative Analgesie. Durch die Kombination von Regional- und Allgemeinanästhesie wird der Verbrauch an systemisch verabreichten Anästhetika gesenkt. Damit sinken auch die Risiken einer systemischen Opiattherapie. Die Blockade der intraoperativen Stressantwort, v. a. bei Periduralanästhesie, führt nicht oder nur abgeschwächt zu den unerwünschten metabolischen Veränderungen des Postagressionsstoffwechsels. Die Patientenzufriedenheit mit der Analgesiequalität ist je nach Verfahren (PDK, PCEA, IVRA, periphere Blockade, i.a.-Injektion) und Medikamenten (LA, Opiate) unterschiedlich.

Abstract

Regional anesthesia has its place in the perioperative pain management of orthopedic patients. A reduction in postoperative mortality and morbidity with regional anesthesia is acknowledged for subsets of patient populations. Single shot and continuous applications are techniques for providing regional analgesia. Continuous infusion of local anesthetics with catheter techniques provides for uninterrupted postoperative analgesia. The combination of regional and general anesthesia reduces the consumption of systemic anesthetics. The side effects of opioid therapy are thereby reduced. The inhibition of intraoperative stress reaction, especially with epidural anesthesia, helps to prevent or lower unwanted metabolic changes. Patient contentment with analgesic quality differs with the technique with which the regional anesthesia is applied (PDA, PCEA, IVRA, peripheral block, i.a. injection), and the medication (LA, opioid) used.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main

    M. Zimmermann & V. Jansen

  2. Orthopädische Universitätsklinik Friedrichsheim, Frankfurt am Main

    M. Rittmeister

  3. Schmerzambulanz der Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60528, Frankfurt am Main

    M. Zimmermann

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Correspondence to M. Zimmermann.

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Zimmermann, M., Jansen, V. & Rittmeister, M. Regionalanästhesie in der Orthopädie. Orthopäde 33, 784–795 (2004). https://doi.org/10.1007/s00132-004-0673-9

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