Anästhesie in der Orthopädie /Unfallchirurgie – Regionalanästhesie bei Verletzungen der unteren Extremität

 

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Zusammenfassung

Fast alle operativen Verfahren an der unteren Extremität sind unter Berücksichtigung weniger Kontraindikationen durch Spinalanästhesien oder periphere Blockaden zu gewährleisten. Postoperativ gehen Verletzungen der unteren Extremität größtenteils mit deutlichen Schmerzen und daher oftmals mit einer Immobilisierung einher. Zugleich müssen bei einer systemischen Schmerztherapie häufig auch Opioide einbezogen werden, die Übelkeit, Erbrechen und Vigilanzminderung verursachen können. Regionalanästhesietechniken bieten sich als eine komplikationsärmere Alternative an – sowohl als Single-Shot- als auch als kontinuierliche Katheterverfahren. Hüft- und hüftnahe Frakturen treten besonders häufig bei alten Patienten mit entsprechenden Ko-Morbiditäten auf und sind entsprechend eine anästhesiologische Herausforderung. Auch Verletzungen der Röhrenknochen wie des Femurs und der Tibia gelten als schmerzhaft. Bei diesen Verletzungen ist eine postoperative Schmerztherapie durch Regionalanästhesietechniken zu empfehlen. Bei Verletzungen mit Gelenkbeteiligungen im Bereich des Knies sollten kontinuierliche Verfahren zur postoperativen Schmerztherapie im Vordergrund stehen. Genauso profitieren komplexe Weichteil- und Knochenverletzungen des Sprunggelenks und insbesondere des Kalkaneus von einer effektiven Akutschmerztherapie durch kontinuierliche Kathetertechniken.

Abstract

Almost all surgical procedures following injury can be provided in peripheral regional anaesthesia or spinal anaesthesia – under consideration of specific contraindications. The majority of injuries at the lower limb are associated with severe pain and immobilization during the postoperative phase. Moreover, opioids are often required which are related to nausea, vomiting and impairment of vigilance. For avoidance of those side effects, regional anaesthesia techniques should be considered as a more effective approach with a better profile of side effects. Hip and proximal femur fractures are more frequent in elder patients with a corresponding high morbidity. Therefore anaesthesia is challenging in those patients. Even injuries of the long bones – like the femur and the tibia – are causing severe pain, therefore an appropriate concept for acute pain therapy is required. Moreover, for injuries with affection of bony joint-structures (i. e. knee, ankle, calcaneus) and marked soft-tissue injuries continuous regional anaesthesia techniques could provide advantages during acute pain therapy.

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