Skip to main content

Rückenmarknahe Regionalanästhesie: Spinalanästhesie

  • Living reference work entry
  • First Online:
Die Anästhesiologie

Part of the book series: Springer Reference Medizin ((SRM))

  • 1602 Accesses

Zusammenfassung

Bei der Spinalanästhesie wird durch Einbringen eines Lokalanästhetikums in den lumbalen Subarachnoidalraum eine regional begrenzte Anästhesie erzielt. Prinzipiell lassen sich alle Eingriffe an der unteren Extremität, am Perineum und im unteren Abdomen in Spinalanästhesie durchführen. Die intrathekale Einzelinjektion schafft je nach verwendetem Lokalanästhetikum und Höhe der erforderlichen Anästhesie beim Erwachsenen einen operativ nutzbaren Zeitraum von 1–2 h. Die Technik der Spinalanästhesie wird in diesem Kapitel umfassend erörtert.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Literatur

  1. Rieg AD, Dortgolz A, Macko S, Rossaint R, Schälte G (2017) In situ broken 27-gauge spinal needle in a repeated caesarean delivery: case report and literature review. Anesthesiologist 66(2):115–121

    CAS  Google Scholar 

  2. Kim JT, Bahk JH, Sung J (2003) Influence of age and sex on the position of the conus medullaris and Tuffier’s line in adults. Anesthesiology 99:1359–1363

    Article  PubMed  Google Scholar 

  3. Broadbent CR, Maxwell WB, Ferrie R et al (2000) Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia 55:1122–1126

    Article  CAS  PubMed  Google Scholar 

  4. Cousins MJ, Bridenbaugh PO (1998) Neural blockade in clinical anesthesia and management of pain, 3. Aufl. Lippincott-Raven, Philadelphia

    Google Scholar 

  5. Litz R, Koch T (2007) Steuerbarkeit der Spinalanästhesie – nach wie vor ein ungelöstes Problem? Anästh Intensivmed 48:404–418

    Google Scholar 

  6. Martin R et al (2000) Onset of spinal block is more rapid with isobaric than hyperbaric bupivacaine. Can J Anaesth 47:43–46

    Article  CAS  PubMed  Google Scholar 

  7. Higuchi H, Hirata JI, Adachi Y, Kazama T (2004) Influence of lumbosacral cerebrospinal fluid density, velocity, and volume on extent and duration of plain Bupivacaine spinal anesthesia. Anesthesiology 100:106–114

    Article  CAS  PubMed  Google Scholar 

  8. Van Zundert A, De Wolf A (1988) Extent of anesthesia and hemodynamic effects of subarachnoidal administration of bupivacaine with epinephrine. Anesth Analg 67:784

    PubMed  Google Scholar 

  9. Chan V et al (1998) A comparative study of low-dose hyperbaric spinal lidocaine 0,5 % vs. 5 % for continuous spinal anesthesia. Reg Anaesth Pain Med 23:164–169

    Article  CAS  Google Scholar 

  10. Stienstra R, Veering B (1998) Intrathecal drug spread: is it controllable? Reg Anaesth Pain Med 23:347–351

    CAS  Google Scholar 

  11. Casati A et al (2007) Spinal anesthesia with Lidocaine or preservative-free 2-Chlorprocaine for outpatient knee arthroscopy: a prospective, randomized, double-blind comparison. Anesth Analg 104:959–964

    Article  CAS  PubMed  Google Scholar 

  12. Boublik J, Gupta R, Bhar S, Atchabahian A (2016) Prilocaine spinal anesthesia for ambulatory surgery: a review of the available studies. Anaesth Crit Care Pain Med 35(6):417–421

    Article  PubMed  Google Scholar 

  13. Ostgaard G et al (2000) A randomised study of lidocaine and prilocaine for spinal anaesthesia. Acta Anaesthesiol Scand 44:436–440

    Article  CAS  PubMed  Google Scholar 

  14. Rätsch G, Niebergall H, Reber A (2007) Spinalanästhesie in der Tageschirurgie. Anaesthesist 56:322–327

    Article  PubMed  Google Scholar 

  15. Goldblum E, Atchabahian A (2013) The use of 2-chloroprocaine for spinal anaesthesia. Acta Anaesthesiol Scand 57:545–552

    Article  CAS  PubMed  Google Scholar 

  16. Förster JG, Rosenberg PH (2011) Revival of old local anesthetics for spinal anesthesia in ambulatory surgery. Curr Opin Anesthesiol 24:633–637

    Article  Google Scholar 

  17. Förster JG et al (2013) Chloroprocaine 40 mg produces shorter spinal block than articaine 40 mg in day-case knee arthroscopy patients. Acta Anaesthesiol Scand 57:911–919

    Article  PubMed  Google Scholar 

  18. Breedbaart MB et al (2014) Intrathecal chloroprocaine vs. lidocaine in day-case surgery: recovery, discharge and effect of pre-hydration on micturition. Acta Anaesthesiol Scand 58:206–213

    Article  Google Scholar 

  19. Teunkens A, Vermeulen K, Van Gerven E, Fieuws S, Van de Velde M, Rex S (2016) Comparison of 2-Chloroprocaine, Bupivacaine, and Lidocaine for spinal anesthesia in patients undergoing knee arthroscopy in an outpatient setting. Reg Anesth Pain Med 41(5):576–583.

    Article  CAS  PubMed  Google Scholar 

  20. Gebhardt V, Mueller-Hansen L, Schwarz A, Bussen D, Weiss C, Schmittner MD (2017) Chloroprocaine 10 mg/ml for low-dose spinal anaesthesia in perianal surgery - a randomised dose finding study. Acta Anaesthesiol Scand 61(2):241–249

    Article  CAS  PubMed  Google Scholar 

  21. O’Donnell BD, Iohom G (2008) Regional anesthesia techniques for ambulatory orthopedic surgery. Curr Opin Anaesthesiol 21:723–728

    Article  PubMed  Google Scholar 

  22. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. S1-Leitlinie: Empfehlungen zur Durchführung der Spinalanästhesie bei ambulanten Patienten. 30.06.2013; http://www.awmf.org/leitlinien/detail/ll/001-022.html. Zugegriffen am 03.07.2017

  23. Gautier P et al (1999) Intrathecal ropivacaine for ambulatory surgery. Anesthesiology 91:1239–1245

    Article  CAS  PubMed  Google Scholar 

  24. Van Gessel E et al (1993) Influence of injection speed on the subarachnoidal distribution of isobaric bupivacaine 0,5 %. Anesth Analg 77:483–487

    PubMed  Google Scholar 

  25. Tuominen M et al (1992) Effect of speed of injection of 0,5 % plain bupivacaine on the spread of spinal anaesthesia. Br J Anaesth 69:148–149

    Article  CAS  PubMed  Google Scholar 

  26. Logan M et al (1986) Plain bupivacaine: an unpredictable spinal anaesthetic agent. Br J Anaesth 58:292–296

    Article  CAS  PubMed  Google Scholar 

  27. McDonald S et al (1999) Hyperbaric spinal ropivacaine. A comparison to bupivacaine in volunteers. Anesthesiology 90:971–977

    Article  CAS  PubMed  Google Scholar 

  28. Luck JF, Fettes PDW, Wildsmith JAW (2008) Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth 101:705–710

    Article  CAS  PubMed  Google Scholar 

  29. Urbanek B, Kapral S (2006) Levobupivacain in der Regionalanästhesie. Anaesthesist 55:296–313

    Article  CAS  PubMed  Google Scholar 

  30. Camorcia M et al (2007) The relative potencies for motor block after intrathecal Ropivacaine, Levobupivacaine, and Bupivacaine. Anesth Analg 104:904–907

    Article  CAS  PubMed  Google Scholar 

  31. De Kock M et al (2001) Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy. Anesthesiology 94:574–578

    Article  PubMed  Google Scholar 

  32. Casati A, Putzu M (2005) Bupivacaine, levobupivacaine and ropivacaine: are they clinically different? Best Pract Res Clin Anaesthesiol 19:247–268

    Article  CAS  PubMed  Google Scholar 

  33. Schug SA, Saunders D, Kurowski I, Paech MJ (2006) Neuraxial drug administration. A review of the treatment options for anaesthesia and analgesia. CNS Drugs 20:917–933

    Article  CAS  PubMed  Google Scholar 

  34. Meylan N et al (2009) Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials. Br J Anaesth 102:156–167

    Article  CAS  PubMed  Google Scholar 

  35. Axelsson K, Gupta A (2009) Local anaesthetic adjuvants: neuraxial versus peripheral nerve block. Curr Opin Anaesthesiol 22:649–654

    Article  PubMed  Google Scholar 

  36. Eisenach J (2001) Lipid soluble opioids do move in cerebrospinal fluid (Editional). Reg Anaesth Pain Med 26:296–297

    Article  CAS  Google Scholar 

  37. Swenson J et al (2001) The effect of distance from injection site to the brainstem using spinal sufentanil. Reg Anaesth Pain Med 26:306–309

    Article  CAS  Google Scholar 

  38. Cossu AP, De Giudici, Piras D, Mura P et al (2015) A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia. Int J Obstet Anesth 24(3):237–246.

    Article  CAS  PubMed  Google Scholar 

  39. Förster JG (2014) Short-acting spinal anesthesia in the ambulatory setting. Curr Opin Anesthesiol 27:597–604

    Article  Google Scholar 

  40. Borghi B, Wulf H (2010) Spinalanästhesie – Vorteile der unilateralen Spinalanästhesie. Anasthesiol Intensivmed Notfallmed Schmerzther 45:182–186

    Article  PubMed  Google Scholar 

  41. Nair GS et al (2009) Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy. Br J Anaesth 102:307–315

    Article  CAS  PubMed  Google Scholar 

  42. Cuvas O et al (2009) The use of low dose plain solutions of local anaesthetic agents for spinal anaesthesia in the prone position: bupivacaine compared with levobupivacaine. Anaesthesia 64:14–18

    Article  CAS  PubMed  Google Scholar 

  43. Standl T et al (1999) Ist die Spinalanästhesie bei Eingriffen in Bauchlage ein empfehlenswertes Verfahren? Anaesthesist 48:242–250

    Article  CAS  PubMed  Google Scholar 

  44. Palmer CM (2010) Continuous spinal anesthesia and analgesia in obstetrics. Anesth Analg 111:1476–1479

    Article  PubMed  Google Scholar 

  45. Reina M et al (1997) New perspectives in the microscopic structure of human dura mater in the dorsolumbar region. Reg Anesth 22:161–166

    Article  CAS  PubMed  Google Scholar 

  46. Kopp SL et al (2005) Cardiac arrest during neuraxial anesthesia: frequency and predisposing factors associated with survival. Anesth Analg 100:855–865

    Article  PubMed  Google Scholar 

  47. Mackey D et al (1989) Bradycardia and asystole during spinal anesthesia: a report of three cases without morbidity. Anesthesiology 70:866–868

    Article  CAS  PubMed  Google Scholar 

  48. Pollard JB (2001) Cardiac arrest during spinal anesthesia: common mechanisms and strategies for prevention. Anesth Analg 92:252–256

    Article  CAS  PubMed  Google Scholar 

  49. Carpenter R et al (1992) Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 76:906–916

    Article  CAS  PubMed  Google Scholar 

  50. Lim H et al (2000) The use of intravenous atropine after a saline infusion in the prevention of spinal anesthesia-induced hypotension in elderly patients. Anesth Analg 91:1203–1206

    CAS  PubMed  Google Scholar 

  51. Lovstadt R et al (2000) Bradycardia and asystolic cardiac arrest during spinal anaesthesia: a report of five cases. Acta Anaesthesiol Scand 44:48–52

    Article  Google Scholar 

  52. Auroy Y et al (1997) Serious complications related to regional anesthesia. Anesthesiology 87:479–486

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Florian Gerheuser .

Editor information

Editors and Affiliations

Section Editor information

1 Elektronisch zusatz-materialien

Below is the link to the electronic supplementary material.

Die Spinalanästhesie (WMV 9791 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2016 © Springer-Verlag GmbH Deutschland

About this entry

Cite this entry

Craß, D., Gerheuser, F., Schwemmer, U. (2016). Rückenmarknahe Regionalanästhesie: Spinalanästhesie. In: Rossaint, R., Werner, C., Zwißler, B. (eds) Die Anästhesiologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45539-5_51-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-45539-5_51-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-45539-5

  • Online ISBN: 978-3-662-45539-5

  • eBook Packages: Springer Referenz Medizin

Publish with us

Policies and ethics