Regionalanästhesie: Indikationen, Vorbereitung, Evaluation, Nachsorge, Dokumentation

  • Dietmar Craß
  • Florian GerheuserEmail author
  • Ulrich Schwemmer
Living reference work entry
Part of the Springer Reference Medizin book series (SRM)


Die Regionalanästhesie verlangt fundierte anatomische Kenntnisse, Geduld und Fingerspitzengefühl sowie die Bereitschaft zur psychischen Führung eines wachen Patienten. Ob die Wahl des Anästhesieverfahrens - Allgemeinanästhesie, Regionalanästhesie oder die Kombination aus Beidem - Auswirkungen auf die postoperative Morbidität und Letalität hat, ist Gegenstand einer langjährigen kontroversen Diskussion, die in diesem Kapitel skizziert wird. Daneben werden Vorbereitung, Evaluation, Dokumentation und Nachsorge dargestellt.


  1. 1.
    Gulur P, Nishimori M, Ballantyne JC (2006) Regional anaesthesia versus general anaesthesia, morbidity and mortality. Best Pract Res Anaesth 20:249–263CrossRefGoogle Scholar
  2. 2.
    Lattermann R et al (2005) The anticatabolic effect of neuraxial blockade after hip surgery. Anesth Analg 101:1202–1208CrossRefPubMedGoogle Scholar
  3. 3.
    Li Y, Zhu S, Yan M (2008) Combined general/epidural anesthesia (Ropivacaine 0.375 %) versus general anesthesia for upper abdominal surgery. Anesth Analg 106:1562–1565CrossRefPubMedGoogle Scholar
  4. 4.
    Lugli AK et al (2008) Epidural analgesia enhances the postoperative anabolic effect of amino acids in diabetes mellitus type 2 patients undergoing colon surgery. Anesthesiology 108:1093–1099CrossRefPubMedGoogle Scholar
  5. 5.
    Palomero Rodriguez MA et al (2008) Thoracic epidural anesthesia decreases C-reactive protein levels in patients undergoing elective coronary artery bypass graft surgery with cardiopulmonary bypass. Minerva Anestesiol 74:619–626PubMedGoogle Scholar
  6. 6.
    Rodgers A et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BJM 321:1–12CrossRefGoogle Scholar
  7. 7.
    Poepping DM et al (2008) Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery. Arch Surg 143:990–999CrossRefGoogle Scholar
  8. 8.
    Macfarlane AJR et al (2009) Does regional anaesthesia improve outcome after total hip arthroplasty? Br J Anaesth 103:335–345CrossRefPubMedGoogle Scholar
  9. 9.
    Parker MJ, Handoll HHG, Griffiths R (2004) Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev 4, CD000521Google Scholar
  10. 10.
    Nishimori M et al (2012) Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev 7:CD005059Google Scholar
  11. 11.
    Guay JJ et al (2016) Epidural local anesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting, and pain after abdominal surgery: a Cochrane review. Anesth Analg [0003-2999] 123(6):1591–1602CrossRefGoogle Scholar
  12. 12.
    Bardia AJ et al (2016) Combined epidural-general anesthesia vs general anesthesia alone for elective abdominal aortic aneurysm repair. JAMA Surg [2168-6254] 151(12):1116–1123CrossRefGoogle Scholar
  13. 13.
    Wu CL et al (2004) Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients. Reg Anesth Pain Med 29:525–533CrossRefPubMedGoogle Scholar
  14. 14.
    Wijeysundera DN et al (2008) Epidural anaesthesia and survival after intermediate-to-high risk non-cardiac surgery: a population-based cohort study. Lancet 372:562–568CrossRefPubMedGoogle Scholar
  15. 15.
    Barbosa FT et al (2010) Neuraxial anaesthesia for lower-limb revascularization. Cochrane Database Syst Rev 2010(1), CD007083Google Scholar
  16. 16.
    Guay J et al (2014) Neuraxial anesthesia for the prevention of postoperative mortality and major morbidity: an overview of Cochrane systematic reviews. Anesth Analg 119:716–725CrossRefGoogle Scholar
  17. 17.
    Bay-Nielsen M, Kehlet H (2008) Anaesthesia and post-operative morbidity after elective groin hernia repair: a nation-wide study. Acta Anaesthesiol Scand 52:169–174CrossRefPubMedGoogle Scholar
  18. 18.
    Afolabi BB, Lesi FEA, Merah NA (2006) Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2006(4), CD004350Google Scholar
  19. 19.
    Werawatganon T, Charuluxananan S (2005) Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 1, CD004088Google Scholar
  20. 20.
    Wu CL et al (2005) Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesthesiology 103:1079–1088CrossRefPubMedGoogle Scholar
  21. 21.
    Gottschalk A et al (2006) Preventing and treating pain after thoracic surgery. Anesthesiology 104:594–600CrossRefPubMedGoogle Scholar
  22. 22.
    Joshi GP et al (2008) A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 107:1026–1040CrossRefPubMedGoogle Scholar
  23. 23.
    Tenenbein PK et al (2008) Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery. Can J Anesth 55:344–350CrossRefPubMedGoogle Scholar
  24. 24.
    Andreae MH et al (2008) Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery. Cochrane Database Syst Rev 2008(2), CD007105Google Scholar
  25. 25.
    Swenson B et al (2010) Intravenous lidocaine is as effective as epidural bupivacaine in reducing ileus duration, hospital stay, and pain after open colon resection. Reg Anesth Pain Med 35:370–376CrossRefPubMedGoogle Scholar
  26. 26.
    Ilfeld BM et al (2008) Ambulatory continuous femoral nerve blocks decrease time to discharge readiness after tricompartment total knee arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology 108:703–712Google Scholar
  27. 27.
    Ilfeld BM et al (2008) Ambulatory continuous posterior lumbar plexus nerve blocks after hip arthroplasty. Anesthesiology 109:491–501CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Basse L et al (2002) Accelerated postoperative recovery program after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 89:446–453CrossRefPubMedGoogle Scholar
  29. 29.
    Bryson GL, Wyans A (2006) Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth 53:669–677CrossRefPubMedGoogle Scholar
  30. 30.
    Chang CC et al (2010) Anesthetic management and surgical site infections in total hip or knee replacement. Anesthesiology 113:279–284CrossRefPubMedGoogle Scholar
  31. 31.
    Yeager MP, Carli F (2004) Anesthesia and surgical outcomes: an Orphean ambition. Reg Anesth Pain Med 29:515–519PubMedGoogle Scholar
  32. 32.
    Cakmakkaya OS et al (2014) Anaesthetic techniques for risk of malignant tumour recurrence. Cochrane Database Syst Rev (11). Art. No.: CD008877Google Scholar
  33. 33.
    Yeager MP, Rosenkranz KM (2010) Cancer recurrence after surgery – a role for regional anesthesia? Reg Anesth Pain Med 35:483–484CrossRefPubMedGoogle Scholar
  34. 34.
    Biki B et al (2008) Anesthetic technique for radical prostatectomy surgery affects cancer recurrence. Anesthesiology 109:180–187CrossRefPubMedGoogle Scholar
  35. 35.
    Exadactylos AK et al (2006) Can anesthetic technique for primary breat cancer surgery affect recurrence or metastasis? Anesthesiology 105:660–664CrossRefGoogle Scholar
  36. 36.
    Deegan CA et al (2010) Anesthetic technique and the cytokine and matrix metalloproteinase response to primary breast cancer surgery. Reg Anesth Pain Med 35:490–495CrossRefPubMedGoogle Scholar
  37. 37.
    Forget P et al (2011) Do intraoperative analgesics influence oncological outcomes after radical prostatectomy for prostate cancer? Eur J Anaesthesiol 28:830–835CrossRefPubMedGoogle Scholar
  38. 38.
    Cummings K et al (2012) A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy. Anesthesiology 116:797–806CrossRefPubMedGoogle Scholar
  39. 39.
    Grewal S, Hocking G, Wildsmith JAW (2006) Epidural abscesses. Br J Anaesth 96:292–302CrossRefPubMedGoogle Scholar
  40. 40.
    Wang L et al (1999) Incidence of spinal epidural abscess after epidural analgesia. Anesthesiology 91:1928–1936CrossRefPubMedGoogle Scholar
  41. 41.
    Brull R et al (2007) Neurologic complications after regional anesthesia: contemporary estimates of risk. Anesth Analg 104:965–974CrossRefPubMedGoogle Scholar
  42. 42.
    Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 101:950–959CrossRefPubMedGoogle Scholar
  43. 43.
    Bateman BT et al (2013) The risk and outcomes of epidural hematomas after perioperative and obstetric epidural catheterization: a report from the Multicenter Perioperative Outcomes Group Research Consortium. Anesth Analg 116:1380–1385CrossRefPubMedGoogle Scholar
  44. 44.
    Cook TM, Counsell D, Wildsmith JA (2009) Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth 102:179–190CrossRefPubMedGoogle Scholar
  45. 45.
    Lim G, Zorn JM, Dong YJ, DeRenzo JS, Waters JH (2016) Subdural hematoma associated with labor epidural analgesia: a case series. Reg Anesth Pain Med 41(5):628–631. Scholar
  46. 46.
    Cuypers V, Van de Velde M, Devroe S (2016) Intracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases. Int J Obstet Anesth 25:58–65CrossRefPubMedGoogle Scholar
  47. 47.
    Hermanides J et al (2012) Failed epidural: causes and management. Br J Anaesth 109:144–154CrossRefPubMedGoogle Scholar
  48. 48.
    Rawal N (2012) Epidural technique for postoperative pain – gold standard no more? Reg Anesth Pain Med 37:310–317CrossRefPubMedGoogle Scholar
  49. 49.
    Kooij F et al (2014) Does regional analgesia for major surgery improve outcome? Focus on epidural analgesia. Anaesth Analg 119:740–744CrossRefGoogle Scholar
  50. 50.
    Horlocker T, Kopp S (2013) Epidural hematoma after epidural blockade in the United States: it’s not just low molecular heparin following orthopedic surgery anymore. Anesth Analg 116:1195–1197CrossRefPubMedGoogle Scholar
  51. 51.
    Memtsoudis S, Liu S (2014) Do neuraxial techniques affect perioperative outcomes? The story of vantage points and number games. Anesth Analg 119:501–502CrossRefPubMedGoogle Scholar
  52. 52.
    Kerwat K et al (2015) Hygieneempfehlungen für die Regionalanästhesie. Anästh Intensivmed 56:34–40Google Scholar
  53. 53.
    Berufsverband Deutscher Anästhesisten und Berufsverband der Deutschen Chirurgen (1993) Vereinbarung zur Organisation der postoperativen Schmerztherapie. Zugegriffen am 14.05.2018
  54. 54.
    Berufsverband Deutscher Anästhesisten, Deutsche Gesellschaft für Gynäkologie und Geburtshilfe und Berufsverband der Frauenärzte (1996) Vereinbarung über die Zusammenarbeit in der operativen Gynäkologie und in der Geburtshilfe. Zugegriffen am 14.05.2018
  55. 55.
    Christie IW, McCabe SM (2007) Major complications of epidural analgesia after surgery: results of a six-year survey. Anaesthesia 62:335–341CrossRefPubMedGoogle Scholar
  56. 56.
    Waurick K et al (2014) Rückenmarksnahe Regionalanästhesien und Thrombembolieprophylaxe/antithrombotische Medikation. Anästh Intensivmed 55:464–492; Association of Anaesthetists of Great Britain and Ireland, Obstetric Anaesthetists’ Association and Regional Anaesthesia UK (2013) Regional anaesthesia and patients with abnormalities of coagulation. Anaesthesia 68:966–972Google Scholar

Copyright information

© © Springer-Verlag GmbH Deutschland 2016

Authors and Affiliations

  • Dietmar Craß
    • 1
  • Florian Gerheuser
    • 2
    Email author
  • Ulrich Schwemmer
    • 3
  1. 1.Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin & SchmerztherapieKlinikum Friedrichshafen GmbH/Klinik Tettnang GmbH/14 Nothelferkrankenhaus Weingarten GmbHFriedrichshafen/BodenseeDeutschland
  2. 2.Zentralklinikum Augsburg, Klinik für Anästhesiologie und Operative IntensivmedizinAugsburgDeutschland
  3. 3.Kliniken des Landkreises Neumarkt i.d. Opf., Klinik für Anästhesiologie u. IntensivmedizinNeumarkt i.d.OPf.Deutschland

Section editors and affiliations

  • Christian Werner
    • 1
  1. 1.Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für AnästhesiologieMainzDeutschland

Personalised recommendations