Zusammenfassung
Eine sichere und effektive kraniale Analgesie ist durch die gezielte Blockade der sensibel versorgenden Nerven möglich. Sie umfassen den N. supraorbitalis, N. supratrochlearis, N. zygomaticotemporalis, N. auriculotemporalis, N. occipitals minor und N. occipitalis major, die an typischer, möglichst proximaler Stelle erreicht werden. Verwendet werden vorrangig lang wirksame Lokalanästhetika wie 0,75%iges Ropivacain mit Zusatz von 5 μg/ml Adrenalin zur Resorptionsverminderung und Wirkungsverlängerung. Der kombinierte Einsatz kranialer Leitungsanästhesien als „Skalpblock“ kann bei Wachkraniotomien die intraoperative neurologische Testung des Patienten wesentlich erleichtern oder bei Kraniotomien in Allgemeinanästhesie deutlich Narkose einsparen. Weitere Anwendungsgebiete sind die minimalinvasive und stereotaktische Neurochirurgie, die schmerzhafte photodynamische Therapie aktinischer Keratosen, kraniale plastische Chirurgie sowie Schmerztherapie.
Abstract
Safe and effective cranial analgesia can be achieved by blocking the sensitive nerves of that region. These include the supraorbital nerve, the supratrochlear nerve, the zygomaticotemporal nerve, the auriculotemporal nerve and the greater and lesser occipital nerves which are accessible at typical and most proximal points. Preferably long acting local anesthetics such as ropivacaine 0.75% or levobupivacaine 0.5% are used supplemented with 5 μg/ml epinephrine to reduce systemic resorption and to elongate the duration. Scalp blocks are useful for intraoperative neurologic testing of the patient during awake craniotomy or for supplementation of general anesthesia for other forms of craniotomy. Other applications are minimally invasive and stereotactic neurosurgery including deep brain stimulation, photodynamic therapy of actinic ceratosis, cranial plastic surgery and pain therapy.
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Kerscher, C., Zimmermann, M., Graf, B. et al. Kraniale Leitungsanästhesien. Anaesthesist 58, 949–960 (2009). https://doi.org/10.1007/s00101-009-1604-2
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DOI: https://doi.org/10.1007/s00101-009-1604-2