Kraniale Leitungsanästhesien

Kerscher, C.; Zimmermann, M.; Graf, Bernhard M.; Hansen, Ernil

doi:10.1007/s00101-009-1604-2

Cited by 23 publications

(7 citation statements)

References 25 publications

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“…Excellent anatomical reviews have been published before describing in detail the location of the nerves in relation to the surface anatomy. 36 – 39 When applying a direct nerve block, several considerations need to be taken into account. While the landmarks where these nerves leave the skull are quite well defined, the area they cover shows an enormous variability.…”

Section: Innervation Of the Scalp And Direct Nerve Blockmentioning

confidence: 99%

Local anesthetics for brain tumor resection: current perspectives

Potters¹,

Klimek²

2018

LRA

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This review summarizes the added value of local anesthetics in patients undergoing craniotomy for brain tumor resection, which is a procedure that is carried out frequently in neurosurgical practice. The procedure can be carried out under general anesthesia, sedation with local anesthesia or under local anesthesia only. Literature shows a large variation in the postoperative pain intensity ranging from no postoperative analgesia requirement in two-thirds of the patients up to a rate of 96% of the patients suffering from severe postoperative pain. The only identified causative factor predicting higher postoperative pain scores is infratentorial surgery. Postoperative analgesia can be achieved with multimodal pain management where local anesthesia is associated with lower postoperative pain intensity, reduction in opioid requirement and prevention of development of chronic pain. In awake craniotomy patients, sufficient local anesthesia is a cornerstone of the procedure. An awake craniotomy and brain tumor resection can be carried out completely under local anesthesia only. However, the use of sedative drugs is common to improve patient comfort during craniotomy and closure. Local anesthesia for craniotomy can be performed by directly blocking the six different nerves that provide the sensory innervation of the scalp, or by local infiltration of the surgical site and the placement of the pins of the Mayfield clamp. Direct nerve block has potential complications and pitfalls and is technically more challenging, but mostly requires lower total doses of the local anesthetics than the doses required in surgical-site infiltration. Due to a lack of comparative studies, there is no evidence showing superiority of one technique versus the other. Besides the use of other local anesthetics for analgesia, intravenous lidocaine administration has proven to be a safe and effective method in the prevention of coughing during emergence from general anesthesia and extubation, which is especially appreciated after brain tumor resection.

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Section: Innervation Of the Scalp And Direct Nerve Blockmentioning

confidence: 99%

Local anesthetics for brain tumor resection: current perspectives

Potters¹,

Klimek²

2018

LRA

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“…Long-acting local anaesthetics are helpful if available, such as bupivacaine (0.5%), levobupivacaine (0.5%), and ropivacaine (0.75%), which all should be supplemented with epinephrine to reduce systemic absorption and to elongate duration [23]. Furthermore, adequate scalp blocks are known to improve recovery profiles and postoperative pain [24].…”

Section: Anaesthetic Management and Implicationsmentioning

confidence: 99%

Anaesthesia for deep brain stimulation

Grant¹,

Gruenbaum

Gerrard³

2015

Current Opinion in Anaesthesiology

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Purpose of review Deep brain stimulation (DBS) is a well tolerated and efficacious surgical treatment for movement disorders, chronic pain, psychiatric disorder, and a growing number of neurological disorders. Given that the brain targets are deep and small, accurate electrode placement is commonly accomplished by utilizing frame-based systems. DBS electrode placement is confirmed by microlectrode recordings and macrostimulation to optimize and verify target placement. With a reliance on electrophysiology, proper anaesthetic management is paramount to balance patient comfort without interfering with neurophysiology. Recent findings To achieve optimal pain control, generous amounts of local anaesthesia are instilled into the planned incision. During the opening and closing states, conscious sedation is the prevailing method of anaesthesia. The preferred agents are dexmedetomidine, propofol, and remifentanil, as they affect neurocognitive testing the least, and shorter acting. All the agents are turned off 15–30 min prior to microelectrode recording. Dexmedetomidine has gained popularity in DBS procedures, but has some considerations at higher doses. The addition of ketamine is helpful for pediatric cases. Summary DBS is a robust surgical treatment for a variety of neurological disorders. Appropriate anaesthetic agents that achieve patient comfort without interfering with electrophysiology are paramount.

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“…Kraniale Leitungsblockaden (KLB) stellen eine effektive und sichere Methode dar, um Schmerzfreiheit im Operationsgebiet zu gewährleisten [13,19]. Erfahrungen bei Kraniotomien in Allgemeinanästhesie zeigen, dass dadurch effektiv Anästhetika eingespart werden kön-nen, die Stressreaktion reduziert ist, ein höherer Komfort erreicht wird und zusätzlich eine ausgezeichnete postoperative Schmerztherapie besteht.…”

Section: Kraniale Leitungsanästhesieunclassified

“…Das Auffinden der Punktionsstellen für die KLB gelingt leicht anhand von anatomischen Landmarken [13]. Eine Über-sicht über die zu betäubenden Nerven mit dem jeweiligen Innervationsgebiet, Injektionsort und Besonderheiten geben .…”

Section: Kraniale Leitungsanästhesieunclassified

Anästhesiologisches Management zur Wachkraniotomie

et al. 2014

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Awake craniotomy is indicated in deep brain stimulation (DBS) for treatment of certain movement disorders, such as in Parkinson disease patients or in the surgery of brain tumors in close vicinity to the language area. The standard procedure is the asleep-awake-asleep technique where general anesthesia or analgosedation is intermittently interrupted for neurological testing. In DBS the intraoperative improvement of symptoms, stereotactic navigation and microelectrode reading guide to the optimal position. In brain tumor resection, reversible functional impairments during electrical stimulation on the brain surface (brain mapping) show the exact individual position of eloquent or motoric areas that should be protected.The anesthesiology procedures used are very variable. It is a balancing act between overdosing of anesthetics with impairment of respiration and alertness and underdosing with pain, strain and stress for the patient. For the asleep-awake-asleep technique high acceptance but also frequent and partly severe complications have been reported. The psychological stress for the patient can be immense. Obviously, a feeling of being left alone and being at someone's mercy is not adequately treated by drugs and performance of the neurological tests is undoubtedly better and more reliable with less pharmacological impairment. Cranial nerve blocks can reduce the amount of anesthetics as they provide analgesia of the scalp more efficiently than local infiltration. With these nerve blocks, a strong therapeutic relationship and a specific communication, sedatives can be avoided and the need for opioids markedly reduced or abolished. The suggestive communication promotes for instance dissociation to an inner safe refuge, as well as reframing of disturbing noises and sensations. Each of the methods applied for awake craniotomy can profit from the principles of this awake-awake-awake technique.

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Kraniale Leitungsanästhesien

Cited by 23 publications

References 25 publications

Local anesthetics for brain tumor resection: current perspectives

Local anesthetics for brain tumor resection: current perspectives

Anaesthesia for deep brain stimulation

Anästhesiologisches Management zur Wachkraniotomie

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