Periduralanästhesie

Gerheuser, Florian; Roth, Andrew G.

doi:10.1007/s00101-007-1181-1

Cited by 25 publications

(22 citation statements)

References 71 publications

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“…At this point interventional pain therapy, such as epidural analgesia can be introduced with much greater efficacy [12]. Tissue toxicity to LA has been documented in animal studies particularly at higher concentrations [2,3,4,6,7,8,11,13,14,15,16,17,18,19,20,25,29,31,32,33,34,37,38] but seldom observed using the recommended clinical concentrations in humans [1,15,22,23,24,26,28,31].…”

Section: Abstract · Zusammenfassung Discussionmentioning

confidence: 99%

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Bupivacaine crystal deposits after long-term epidural infusion

et al. 2013

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Section: Abstract · Zusammenfassung Discussionmentioning

confidence: 99%

“…Analgesia provided by LA agents administered neuraxially can often be augmented by the addition of adjuvants, such as opioids (morphine) and alpha agonists (clonidine; [12]). Different LA mixtures or …”

Section: Abstract · Zusammenfassung Discussionmentioning

confidence: 99%

Bupivacaine crystal deposits after long-term epidural infusion

et al. 2013

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“…Begleitmedikation eine Beeinträchtigung der Thrombozytenfunktion und/oder der plasmatischen Gerinnung anzunehmen ist, und damit auch das potenzielle Risiko eines epiduralen Hämatoms nehmen zu [15]. Die Inzidenz dieser schwerwiegenden Komplikation (bei nichtgeburtshilflichen Verfahren) wird mit bis zu 1:3800 angegeben [24].…”

Section: Gerinnungsstörungenunclassified

“…Sollte die erhobene Anamnese hinsichtlich der Blutungsneigung unauffäl-lig sein, erscheint auch eine zusätzliche routinemäßige Bestimmung der Gerinnungsparameter oder der Thrombozytenzahl nicht notwendig [15,20]. Dagegen zwingt eine auffällige Anamnese oder eine schon bekannte Gerinnungsstörung zu einer sorgfältigen Risiko-Nutzen-Ab- wägung bezüglich einer rückenmarkna-hen Anästhesie.…”

Section: Gerinnungsdiagnostikunclassified

Rückenmarknahe Regionalanästhesie bei Patienten mit hämorrhagischen Diathesen

2011

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Neuraxial anesthesia is an established and safe procedure in perioperative pain therapy which can help to minimize complications and to improve perioperative outcome. In patients with acquired bleeding disorders by comorbidities or concomitant antithrombotic medication an individual decision should be made based on risks and benefits. A large number of literature references and guidelines help making a decision, for example the recently updated evidence-based guidelines of the American Society of Regional Anesthesia and Pain Medicine for patients receiving antithrombotic or thrombolytic therapy. However, no explicit recommendations or guidelines exist for patients with hemorrhagic diatheses, such as von Willebrand disease (vWD), hemophilia A and B and idiopathic thrombocytopenic purpura (ITP). Published data regarding the safety of neuraxial techniques in these patients is scarce. Neuraxial anesthesia in patients with vWD is only acceptable when coagulation is optimized (substitution of factor concentrates or hemostatic agents depending on the type of vWD) and monitored frequently during the procedure. The only exception might be obstetric patients with vWD type I as coagulation frequently normalizes at the end of pregnancy. In these patients neuraxial anesthesia can often be performed without supplementation of clotting factors.Neuraxial techniques in patients with hemophilia A or B are usually contraindicated. The procedure may only be acceptable if serious reasons exist against general anesthesia. Supplementation of the missing factor to normal levels and monitoring during procedure is essential if neuraxial block is performed.Patients with ITP often present with low platelet counts. Normally, spinal or epidural anesthesia is considered safe if the platelet count is over 80,000/µl. However, the consistently low platelet counts in ITP seem to be less problematic than rapidly falling values due to other diseases, because this is often accompanied by platelet dysfunction or coagulopathy. In several studies neuraxial anesthesia was successfully performed with platelet counts between 50,000 and 80,000/µl. Nevertheless, the minimum safe platelet count for neuraxial blockade remains undefined in these patients.Evidence-based recommendations for neuraxial anaesthesia in patients with hemophilia, vWD or ITP cannot be offered. Each patient has to be treated individually with appropriate caution. This overview is intended to assist in the decision for or against neuraxial anesthesia in these patients, with emphasis on the pathophysiological background, blood investigations and case reports from the literature.

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“…Mithilfe der "Loss-of-resistance"-Technik (Tuohy-17-G-Periduralnadel und Katheter, Fa. Arrow GmbH) konnten der Periduralraum nach 3 cm problemlos lokalisiert und der Katheter 5 cm in den Periduralraum eingeführt werden [8]. Nach der Gabe einer Testdosis von 3 ml 2%igem Lidocain, einschließlich Adrenalin 1:200.000, konnte die korrekte peridurale Lage des Katheters mit beidseitiger sensorischer Blockade vom vierten bis zum zwölften thorakalen Dermatom durch "Pin-prick"-Test verifiziert werden.…”

Section: Katheteranlage Und Verlaufunclassified

Entwicklung eines Weichteilulkus nach periduraler Langzeitinfusion

et al. 2008

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Local anaesthetic agents (LA) in clinical concentrations have the potential for tissue toxicity, although this is rarely observed in clinical practice. The case of a 74-year-old female patient (BMI 16.8 kg/m(2)) with a metastasising bronchial carcinoma is reported, who suffered from severe back pain due to tumour infiltration. For pain management a tunnelled continuous thoracic peridural catheter (PC) was placed and a mixture of bupivacaine 0.49%, morphine 0.0036% and clonidine 0.0001% was infused at 3 ml/h. After 8 weeks of continuous infusion an ulcer developed in the soft tissue close to the thoracic spine containing whitish crystalline material (CM). A computed tomography examination revealed a subcutaneously displaced PC with extensive fluid collection reaching down to the sacrospinalis muscle. Histologically an unreactive necrosis with enclosed CM of unknown etiology was found. The result of the chemical analysis of the deposits demonstrated bupivacaine, morphine and sodium chloride. It is concluded that the soft tissue ulcer was probably caused by precipitation of the LA mixture.

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Periduralanästhesie

Cited by 25 publications

References 71 publications

Bupivacaine crystal deposits after long-term epidural infusion

Bupivacaine crystal deposits after long-term epidural infusion

Rückenmarknahe Regionalanästhesie bei Patienten mit hämorrhagischen Diathesen

Entwicklung eines Weichteilulkus nach periduraler Langzeitinfusion

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