Indikationen. Probleme. Benefits. mit Lehrstuhl für Orthopädie der Friedrich Schiller Universität Jena.

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1 28.Workshop Regional-Anästhesie Dietrich Bonhoeffer Klinikum Neubrandenburg Kontinuierliche Periphere Nervenanästhesie Notwendig oder Spielerei? Indikationen Schmerz, Sympathikolyse Probleme Zeit-und versorgungsintensiv, g Kosten? Benefits Kontinuierliche Katheterverfahren Sinn und Unsinn in der Orthopädie Rehabilitation, Thromboseprophylaxe, Nebenwirkungen und Komplikationen m.lange@krankenhaus-eisenberg.de 2 Vergleich von Patienten-kontrolliertem transdermalem Fentanyl-Hydrochlorid mit einer Intravenösen Morphinpumpe bei postoperativen Schmerzen (E.U. Viscusi et.al.jama; March 17,2004) Brodner et.al. A&A 2001; 92: Cont Fem Nerve Bl Provides Sup Analgesia Compared with Cont Intra-art and Wound Infusion after Ant Cruciate Lig Re- Construction Dauri M RAPM Vol34 Nu 2 M/A 2009 Effects of Perioperative Analgesic Technique on the Surgical Outcome and Duration of Rehabilitation after Major Knee Surgery(1) Capdevila X, Anesthesiology 1999,91:8-15 Weniger Schmerzen in Ruhe /bei passiver Bewegung durch Kont. Femoralisblock Frühzeitigere Rehabilitation Weniger Nebenwirkungen Femoraliskatheter ist der Wundinfiltration überlegen, aber : motorische Einschränkung (PCA mit MO, vs PDK Lido-Suf, vs CPNB Lido) 5 6 1

2 Effects of Perioperative Analgesic Technique on the Surgical Outcome and Duration of Rehabilitation after Major Knee Surgery(2) Capdevila X, Anesthesiology 1999,91:8-15 Continuous Peripheral Nerve Blocks in Hospital Wards after Orthopedic Surgery(1) Capdevila, X Anesthesiology 2005;103: Continuous Peripheral Nerve Blocks in Hospital Wards after Orthopedic Surgery(2) Capdevila, X Anesthesiology 2005;103:

3 Can Anesthetic Technique for Primary Breast Cancer Surgery Affect Recurrence or Metastasis? A.Exadaktylos et.al. Anesthesiology V 105 No 4, Oct 2006; A survey of perioperative therapy for elective colon resection In Germany Hasenberg T ; Chirurg.2007 Sep;78(9): Fast-track rehabilitation for elective colonic surgery in Germany Prospective observational data from a multi-centre quality assurance Programme. wolfgang.schwenk@charite.de Int J Colorectal Dis Jan; 23(1):93-9 Effects of epidural anaesthesia on surgical stress-induced immunosuppression during upper abdominal surgery Kawasaki T Br J Anaesth Jun;98(6): Effect of Patient-controlled Perineural Analgesia on Rehabilitation and Pain after Ambulatory Orthopedic Surgery Auswertung von ISK/Acromiopaltik n= 43 und PoplitealKath./Hallux valgus n=40 PCA mit MO vs Ropivacain 0,2 % Basal-Bolusmodus Basal Bolus Modus PNB mit den besten Ergebnissen für Rehabilitation und bzgl.nw iv. PCA mit MO : höherer MO Verbrauch, mehr NW Abteilungsname Capdevilla X et.al. Anesthesiology, V 105,No3, Sep Capdevila X Gründe für Aktivitätseinschränkung Capdevila X, Pain Scores

4 Risiken peripherer Nervenblockaden für ambulante Operationen 1. Sturzgefahr bei Blockadetechniken der unteren Extremität (Williams BA, A&A 2005) 233 Pat mit ACL und FK 4 Stürze ( ein Patient aus der Vergleichsgruppe ) 2. Infektion ( Compere V, A&A 2009 in 6,2 % Colonisation d. Kath.) ( Capdevilla X, A&A 2009 Abszess nach ISK ) Kathetermigration, Störungen von Pumpen, Dislokation, Hämatom Continuous popliteal sciatic nerve block for postoperative pain control at home Kernaussage 0,2 % Ropivacain or 0,9% Saline infusion for 3 days VAS 0 vs. 4 ; Improved overall satisfaction Ilfeld et.al. Anesthesiology (4) Ambulatory Perineural Infusion: The Patients Perspective BM Ilfeld RAPM S/O 2003 Ambulatory Perineural Infusion : The Patients Perspective lfeld BM et.al. RAPM S/O2003 Table 3. Survey Results by Anatomic Catheter Location Copyright 2009 Wolters Kluwer. Published by Lippincott Williams & Wilkins Copyright 2009 Wolters Kluwer. Published by Lippincott Williams & Wilkins

5 The Effects of Varying Local Anesthetic Concentration and Volume on Continuous Popliteal Sciatic Nerve Blocks: A Dual- Center, Randomized, Controlled Study Kleine Volumina mit höherer Konzentration 4ml/h 0,4 % Ropivacain, Bolus 2ml) Vs. 8 ml /h 0,2 % R. Bolus 4 ml BM Ilfeld AnesthAnalg Vol.107,No2,August Copyright 2009 Wolters Kluwer. Published by Lippincott Williams & Wilkins Copyright 2009 Wolters Kluwer. Published by Lippincott Williams & Wilkins Copyright 2009 Wolters Kluwer. Published by Lippincott Williams & Wilkins

6 Ultrasound Imaging for Regional Anaesthesia Effect of Pat-Contr Perineural Analgesia on Reha and Pain After Ambulatory Orthopedic Surgery Capdevila X Anesthesiology 2006;105: Abteilungsname Effect of Patient-controlled Perineural Analgesia on Rehabilitation and Pain afterambulatory Orthopedic Surgery Effect of Patient-controlled Perineural Analgesia on Rehabilitation and Pain after Ambulatory Orthopedic Surgery Capdevilla X et.al. Anesthesiology, V 105,No3, Sep Capdevilla X et.al. Anesthesiology, V 105,No3, Sep Copyright 2009 Wolters Kluwer. Published by Lippincott Williams & Wilkins