Regionalanästhesieassoziierte Nebenwirkungen in der erweiterten postoperativen Phase

Einleitung Kontinuierliche Regionalanästhesien („Schmerzpumpen“) haben sich als anerkannte und effektive Verfahren etabliert. Dennoch birgt die Regionalanästhesie (RA) ernst zu nehmende Risiken. Diese Risiken in Form von Komplikationen und Nebenwirkungen sind für den unmittelbaren postoperativen Z...

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Bibliographic Details
Main Author: Bender, Michael
Contributors: Eberhart, Leopold (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2011
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Background Continuous regional anesthesia (“pain pumps”) is approved as a recognized and effective treatment. Nevertheless Regional anesthetics imply serious risks. These risks, in the form of complications and side-effects during the immediate postoperative period, have been sufficiently described in literature. However, the extended postoperative period, during which the patient normally has already left the clinic, has not been sufficiently researched yet. Questions This thesis thus aims at descriptively determining 1. by which discomfort that can be possibly linked to the regional anesthetics is the patient still adversely affected during the extended postoperative period (up to 4 weeks); 2. about which general discomfort the patient complains during the extended postoperative period. Methods Patients with continuous regional anesthesia visited by the pain service of our clinic constituted the collective of this thesis (n=503). Restrictions concerning specific fields or operations have not been made. Data collection was established by means of interviews by phone 4 weeks postoperative. Results The results include the data of 409 interviewed patients. The approximately 20 parameters established during the interviews were completed by the documented data of the operation protocol as well as protocols of the catheter disposition and catheter ward round. We could point out that the patient satisfaction with the continuous regional anesthetics method was consistently very high (in median 1 according to school grades). However, among the problems in question sensation of pain ranked first (mentioned by 50% of the patients). Restrictions of the coarse motoric functions after blockades of the upper and lower extremities were perceived by over 80% after 4 weeks. Variances of the puncture in terms of infections after 4 weeks were mentioned by 3.4% of the patients. Other possible risks of the regional anesthetics, like allergic reactions, Horner syndrome, headache or micturition difficulties persisted in a minor percentage (below 2%) after 4 weeks. Discussion and conclusion The benefits of regional anesthesia are proven by numerous studies. Especially earlier mobilization, higher patient satisfaction and a better general outcome for patients whose postoperative analgesia was carried out without regional anesthetics, are to be stressed. However, our study reveals that half of all operated patients are still not free of pain after 4 weeks. 40% of the patients also complain about sensations of pain within the immediate postoperative days. Furthermore, despite the evidence for earlier mobilization and an improved outcome as a result of regional anesthesia, ¾ of all patients are still restricted in their daily life in terms of coarse motoric functions 4 weeks postoperative after extremity intervention. Prospect Based on the results of this thesis, further studies should be conducted. The high incidence of sensations of pain during the extended postoperative period reveals that studies contributing to a better understanding and to even more efficient pain therapies must follow. The frequency of neurological deficiency gives reason to enlarge on the causes of this complex of problems, especially in order to determine to which extent this deficiency is to be traced back to regional anesthetics.