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Regionalanästhesiologische Verfahren im Kindesalter

Österreichische interdisziplinäre Handlungsempfehlungen zum perioperativen Schmerzmanagement bei Kindern

Regional anesthesia procedures in childhood

Austrian interdisciplinary recommendations on pediatric perioperative pain management

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Zusammenfassung

Eine Regionalanästhesie sollte bei Kindern wann immer möglich zum Einsatz kommen. Sie ist als wesentliches Element eines multimodalen Schmerzmanagements anzusehen. Voraussetzung für die sichere und effektive Anwendung sind die genaue Kenntnis der anatomischen, physiologischen und pharmakologischen Unterschiede im Kindesalter, der Einsatz eines altersgerechten Equipments und das rasche Erkennen und Behandeln möglicher Komplikationen. Essenziell ist eine ausreichende Erfahrung sowohl in der Kinder- als auch in der Regionalanästhesie. Bei der Auswahl des für den jeweiligen Patienten idealen Regionalanästhesieverfahrens gilt der Leitsatz: „So zentral wie nötig, so peripher wie möglich.“ Eine Nutzen-Risiko-Abschätzung hat immer zu erfolgen. Sehr spezielle Techniken wie die thorakale und lumbale Epiduralanästhesie im Kindesalter müssen kinderanästhesiologischen Zentren vorbehalten bleiben, da Erfahrung erforderlich ist, die nur mit einer großen Fallzahl erworben und erhalten werden kann. Sehr wirkungsvoll sind aber bereits technisch einfache Verfahren wie die Kaudalanästhesie, der Peniswurzelblock und die Wundinfiltration. Auch wenn die Evidenz nach wie vor fehlt, stellt die ultraschallgesteuerte Anlage der Regionalanästhesie beim Kind heute die Methode der Wahl dar. Der Einsatz wird zu einer erhöhten Akzeptanz und Anwenderfreundlichkeit der Verfahren im Kindesalter führen. Mit der vorliegenden Handlungsempfehlung soll aufgezeigt werden, was bei der Durchführung einer Regionalanästhesie im Kindesalter allgemein beachtet werden muss. Es wird auch ein Überblick über die Verfahren der Regionalanästhesie bei Kindern gegeben.

Abstract

Regional anesthesia should be used for children whenever possible and is an essential element of a multimodal pain management. The prerequisites for a safe and effective procedure are detailed knowledge of the anatomical, physiological and pharmacological differences in childhood, the use of age-appropriate equipment and rapid recognition and treatment of possible complications. Extensive experience in pediatric as well as regional anesthesia is essential. The rule for selection of the ideal regional anesthesia procedure for each individual patient is: as central as necessary and as peripheral as possible. A risk-benefit assessment must always be carried out. Very specialized techniques, such as thoracic and lumbar epidural anesthesia in childhood must be reserved for specialist pediatric anesthesia centers because experience is necessary which can only be acquired and maintained from a large number of cases. Technically simple procedures, such as caudal anesthesia, penis root block and wound infiltration are, however, also very effective. Even if the evidence is still lacking, ultrasound-guided placement of regional anesthesia is nowadays the method of choice for children. The use will lead to an increased level of acceptance and user-friendliness of the procedure in childhood. This article presents recommendations which demonstrate those points that must be generally observed when carrying out regional anesthesia in children. An overview of the regional anesthesia procedure in children is given.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. B. Messerer, M. Platzer, C. Justin und M. Vittinghoff geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Universitätsklinik für Anästhesiologie und Intensivmedizin, LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich

    B. Messerer, C. Justin & M. Vittinghoff

  2. Abteilung für Anästhesiologie und Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich

    M. Platzer

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  1. B. Messerer
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  2. M. Platzer
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  3. C. Justin
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  4. M. Vittinghoff
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Correspondence to B. Messerer.

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Messerer, B., Platzer, M., Justin, C. et al. Regionalanästhesiologische Verfahren im Kindesalter. Schmerz 28, 67–81 (2014). https://doi.org/10.1007/s00482-013-1386-y

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