Rückenmarknahe Regionalanästhesie: Epiduralanästhesie

  • Dietmar Craß
  • Florian GerheuserEmail author
  • Ulrich Schwemmer
Living reference work entry
Part of the Springer Reference Medizin book series (SRM)


Die Stärke der Epiduralanästhesie liegt in der segmentalen Anästhesieausbreitung. Diese kommt besonders bei abdominellen oder thorakalen Eingriffen zur Geltung. Hier ermöglicht die Epiduralanästhesie, intraoperativ supplementiert durch eine Allgemeinanästhesie, eine Blockade der Nozizeption und damit Dämpfung der Postaggressionsreaktion sowie eine überragende postoperative Analgesie (Kap. Regionalanästhesie: Indikationen, Vorbereitung, Evaluation, Nachsorge, Dokumentation).

Supplementary material

Video 1

Anlage eines Epiduralkatheters (WMV 9292 kb)


  1. 1.
    Wulf H (1998) Epidurale Analgesie in der Behandlung postoperativer Schmerzen. Eine Übersicht. Anästhesist 47:501–510CrossRefGoogle Scholar
  2. 2.
    Lirk P et al (2005) Incidence of lower thoracic ligamentum flavum midline gaps. Br J Anaesth 94:852–855CrossRefPubMedGoogle Scholar
  3. 3.
    Cousins MJ, Bridenbaugh PO (1998) Neural blockade in clinical anesthesia and management of pain, 3. Aufl. Lippincott-Raven, PhiladelphiaGoogle Scholar
  4. 4.
    Tran D et al (2015) Confirmation of loss-of-resistance for epidural analgesia. Reg Anesth Pain Med 40:166–173CrossRefPubMedGoogle Scholar
  5. 5.
    Evron S et al (2007) Predistention of the epidural space before catheter insertion reduces the incidence of intravascular epidural catheter insertion. Anesth Analg 105:460–464CrossRefPubMedGoogle Scholar
  6. 6.
    Igarashi T et al (1999) The epidural structure changes during deep breathing. Can J Anaesth 46:850–855CrossRefPubMedGoogle Scholar
  7. 7.
    Faheem M, Sarwar N (2002) Sliding of the skin over subkutaneous tissue is an important factor in epidural catheter migration. Can J Anesth 49:634CrossRefPubMedGoogle Scholar
  8. 8.
    Hirabayashi Y et al (1997) Magnetic resonance imaging of the extradural space of the thoracic spine. Br J Anaesth 79:563–566CrossRefPubMedGoogle Scholar
  9. 9.
    Hogan Q (1998) Epidural anatomy: new observations. Can J Anaesth 45:R40–R44CrossRefPubMedGoogle Scholar
  10. 10.
    Camorcia M (2009) Testing the epidural catheter. Curr Opin Anaesthesiol 22:336–340CrossRefPubMedGoogle Scholar
  11. 11.
    Tamai H et al (2005) The electrical properties of epidural catheters: what are the requirements for nerve stimulation guidance? Anesth Analg 100:1704–1707CrossRefPubMedGoogle Scholar
  12. 12.
    Tsui B et al (1999) Detection of subarachnoid and intravascular epidural catheter placement. Can J Anaesth 46:675–678CrossRefPubMedGoogle Scholar
  13. 13.
    Lena P, Martin R (2005) Subdural placement of an epidural catheter detected by nerve stimulation. Can J Anesth 52:618–621CrossRefPubMedGoogle Scholar
  14. 14.
    Brown D et al (1990) Comparison of 0,5 % ropivacaine and 0,5 % bupivacaine for epidural anesthesia in patients undergoing lower-extremity surgery. Anesthesiology 72:633–636CrossRefPubMedGoogle Scholar
  15. 15.
    Morrison L et al (1994) Efficiacy and kinetics of extradural ropivacaine: comparison with bupivacaine. Br J Anaesth 72:164–169CrossRefPubMedGoogle Scholar
  16. 16.
    Irestedt L et al (1997) Ropivacaine 7,5 mg/ml for elective Caesarean section. A clinical and pharmacokinetic comparison of 150 mg and 187,5 mg. Acta Anaesthesiol Scand 41:1149–1156CrossRefPubMedGoogle Scholar
  17. 17.
    Datta S et al (1995) Clinical effects and maternal and fetal plasma concentrations of epidural ropivacaine vs. bupivacaine for cesarean section. Anesthesiology 82:1346–1352CrossRefPubMedGoogle Scholar
  18. 18.
    Vranken JH, Troost D, de Haan P et al (2006) Severe toxic damage to the rabbit spinal cord after intrathecal administration of preservative-free S(+)-Ketamine. Anesthesiology 105:813–818CrossRefPubMedGoogle Scholar
  19. 19.
    Axelsson K, Gupta A (2009) Local anaesthetic adjuvants: neuraxial versus peripheral nerve block. Curr Opin Anaesthesiol 22:649–654CrossRefPubMedGoogle Scholar
  20. 20.
    Schug SA, Saunders D, Kurowski I, Paech MJ (2006) Neuraxial drug administration. A review of the treatment options for anaesthesia and analgesia. CNS Drugs 20:917–933CrossRefPubMedGoogle Scholar
  21. 21.
    Carvalho B (2008) Respiratory depression after neuraxial opioids in the obstetric setting. Anesth Analg 107:956–961CrossRefPubMedGoogle Scholar
  22. 22.
    Youssef N et al (2014) What epidural opioid results in the best analgesia outcomes and fewest side effects after surgery? A meta-analysis of randomized controlled trials. Anesth Analg 119:965–977CrossRefPubMedGoogle Scholar
  23. 23.
    Curatolo M et al (1998) Epidural fentanyl, adrenaline and clonidine as adjuvants to local anaesthetics for surgical analgesia: meta-analyses of analgesia and side-effects. Acta Anaesthesiol Scand 42:910–920CrossRefPubMedGoogle Scholar
  24. 24.
    Brodner G et al (2000) What concentration of sufentanil should be combined with ropivacaine 0,2 % for postoperative patient-controlled epidural analgesia? Anesth Analg 90:649–657CrossRefPubMedGoogle Scholar
  25. 25.
    Capogna GC, Camorcia M (2004) Epidural analgesia for childbirth. Pediatr Drugs 6:375–386CrossRefGoogle Scholar
  26. 26.
    Choi J et al (2000) Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. Can J Anesth 47:33–37CrossRefPubMedGoogle Scholar
  27. 27.
    Farmery AD, Wilson-MacDonald J (2009) The analgesic effect of epidural clonidine after spinal surgery: a randomized placebo-controlled trial. Anesth Analg 108:631–634CrossRefPubMedGoogle Scholar
  28. 28.
    Eisenach J et al (1996) α2-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984–1995). Anesthesiology 85:655–674CrossRefPubMedGoogle Scholar
  29. 29.
    De Kock M et al (1999) Epidural clonidine or bupivacaine as the sole analgesic agent during and after abdominal surgery. Anesthesiology 90:1354–1362CrossRefPubMedGoogle Scholar
  30. 30.
    Paech M et al (2000) Patient-controlled epidural analgesia in labor: the addition of clonidine to bupivacaine-fentanyl. Reg Anesth Pain Med 25:34–40PubMedGoogle Scholar
  31. 31.
    Hermanides J et al (2012) Failed epidural: causes and management. Br J Anaesth 109:144–154CrossRefPubMedGoogle Scholar
  32. 32.
    Neruda B (2005) Entwicklung und gegenwärtiger Stand der kombinierten Spinal − Epiduralanästhesie. Anasthesiol Intensivmed Notfallmed Schmerzther 40:459–468CrossRefPubMedGoogle Scholar
  33. 33.
    Simmons SW et al (2012) Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev (10):CD003401Google Scholar
  34. 34.
    Casati A et al (1998) A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia. Reg Anesth Pain Med 23:390–394CrossRefPubMedGoogle Scholar
  35. 35.
    Holmström B et al (1995) Risk of catheter migration during combined spinal epidural block: percutaneous epiduroscopiy study. Anesth Analg 80:747–753PubMedGoogle Scholar
  36. 36.
    Felsby S, Juelsgaard P (1995) Combined spinal and epidural anesthesia. Anesth Analg 80:821–826PubMedGoogle Scholar
  37. 37.
    Monsel A et al (2007) The transesophageal doppler and hemodynamic effects of epidural anesthesia in infants anesthetized with Sevoflurane and Sufentanil. Anesth Analg 105:46–50CrossRefPubMedGoogle Scholar
  38. 38.
    Hoelzle M et al (2010) Comparison of awake spinal with awake caudal anesthesia in preterm and ex-preterm infants for herniotomy. Pediatr Anesth 20:620–624CrossRefGoogle Scholar
  39. 39.
    Schorer C (2006) Leistenhernien-Operation in Kaudalanästhesie beim Frühgeborenen. Anasthesiol Intensivmed Notfallmed Schmerzther 41:165–167CrossRefPubMedGoogle Scholar
  40. 40.
    Brenner L et al (2010) Caudal anaesthesia under sedation: a prospective analysis of 512 infants and children. Br J Anaesth 104:751–755CrossRefPubMedGoogle Scholar
  41. 41.
    Gerber AC, Weiss M (2002) Das ehemalige Frühgeborene mit Leistenhernien – welches Anästhesieverfahren? Anaesthesist 51:448–456CrossRefPubMedGoogle Scholar
  42. 42.
    Craven PD, Badawi N, Henderson-Smart DJ, O’Brien M (2003) Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev (3):CD003669Google Scholar
  43. 43.
    Abouleish AE, Chung DH, Cohen M (2005) Caudal anesthesia for vascular access procedures in two extremely small premature neonates. Pediatr Surg Int 21:749–751CrossRefPubMedGoogle Scholar
  44. 44.
    Veyckemans F, Van Obbergh L, Gouverneur J (1992) Lessons from 1100 pediatric caudal blocks in a teaching hospital. Reg Anesth 17:119–125PubMedGoogle Scholar
  45. 45.
    Dalens B, Hasnaoui A (1989) Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg 68:83–89CrossRefPubMedGoogle Scholar
  46. 46.
    Baris S, Guldogus F, Baris Y, Karakaya D, Kelsaka E (2004) Is tissue coring a real problem after caudal injection in children? Pediatr Anesth 14:755–758CrossRefGoogle Scholar
  47. 47.
    Shin SK et al (2009) Ultrasound evaluation of the sacral area and comparison of sacral interspinous and hiatal approach for caudal block in children. Anesthesiology 111:1135–1140CrossRefPubMedGoogle Scholar
  48. 48.
    Tobias JD (2001) Caudal epidural block: a review of test dosing and recognition of systemic injection in children. Anesth Analg 93:1156–1161CrossRefPubMedGoogle Scholar
  49. 49.
    Sethna NF, McGowan FX (2005) Do results from studies of a simulated epidural test dose improve our ability to detect unintentional epidural vascular puncture in children? Pediatr Anesth 15:711–715CrossRefGoogle Scholar
  50. 50.
    Bouchut J, Dubois R, Godard J (2001) Clonidine in preterm-infant caudal anesthesia may be responsible for postoperative apnea. Reg Anesth Pain Med 26:83–85CrossRefPubMedGoogle Scholar
  51. 51.
    Fellmann C, Gerber A, Weiss M (2002) Apnoea in a former preterm infant after caudal bupivacaine with clonidine for inguinal herniorrhaphy. Pediatr Anesth 12:637–640CrossRefGoogle Scholar
  52. 52.
    Galante D (2005) Preoperative apnea in a preterm infant after caudal block with ropivacaine and clonidine. Pediatr Anesth 15:708–709CrossRefGoogle Scholar
  53. 53.
    Dalens B (2006) Some current controversies in paediatric regional anaesthesia. Curr Opin Anaesthesiol 19:301–308CrossRefPubMedGoogle Scholar
  54. 54.
    Reich A (2006) Rückenmarknahe Regionalanästhesieverfahren bei Kindern – Kaudalblock und Spinalanästhesie. Anasthesiol Intensivmed Notfallmed Schmerzther 9:542–547CrossRefGoogle Scholar
  55. 55.
    Roth W, Kühbacher-Luz G, Keller C (2006) Neuroaxiale Regionalanästhesie bei Kindern – Das Innsbrucker Konzept. Anasthesiol Intensivmed Notfallmed Schmerzther 41:167–170CrossRefPubMedGoogle Scholar
  56. 56.
    Walker SM, Yaksh TL (2012) Neuraxial analgesia in neonates and infants: a review of clinical and preclinical strategies for the development of safety and efficacy data. Anesth Analg 115:638–662CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© © Springer-Verlag GmbH Deutschland 2016

Authors and Affiliations

  • Dietmar Craß
    • 1
  • Florian Gerheuser
    • 2
    Email author
  • Ulrich Schwemmer
    • 3
  1. 1.AlphacarePrivatklinik LindbergWinterthurSchweiz
  2. 2.Zentralklinikum Augsburg, Klinik für Anästhesiologie und Operative IntensivmedizinAugsburgDeutschland
  3. 3.Kliniken des Landkreises Neumarkt i.d.Opf., Klinik für Anästhesiologie und IntensivmedizinNeumarkt i.d.OPf.Deutschland

Section editors and affiliations

  • Christian Werner
    • 1
  1. 1.Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für AnästhesiologieMainzDeutschland

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