Regionalanästhesie in der präklinischen Notfallmedizin

Schmerz ist häufig das führende Symptom traumatisierter Patienten. Obwohl die periphere Regionalanästhesie innerklinisch eine schnelle, sichere, effektive Analgesie ermöglicht, stellt ihr Einsatz außerhalb des perioperativen Settings in Deutschland bisher eine Seltenheit dar. Dies gilt insbesondere für die präklinische Patientenversorgung durch den Rettungsdienst. Ziel dieses Artikels ist es, auf die Option einer präklinischen Regionalanästhesie hinzuweisen und mögliche Versorgungskonzepte für Traumapatienten unter Einsatz peripherer Nervenblockaden zu diskutieren.

Abstract

Pain is often the main symptom in trauma patients. Although peripheral nerve blocks (PNB) provide fast, safe, and adequate analgesia, they are currently only rarely used outside the perioperative setting. In Germany, intravenous analgesia with non-opioid analgesics (NOPA) and strong opioids is the main treatment concept for prehospital pain. However, the use of highly potent opioids can be associated with significant side effects, especially in emergency patients. Therefore, PNBs are used in many hospitals for the treatment of perioperative pain. As with perioperative use, the advantages of early PNB in the prehospital analgesic treatment of trauma patients are obvious, especially for elderly and multimorbid patients. Early prehospital PNB can also facilitate the reduction of dislocated fractures or dislocated joints as well as the technical rescue of trauma patients. Common geriatric fractures, such as proximal femur or humerus fractures, can be treated appropriately and adequately with PNB.

In this article, we show which PNB procedures can be useful in prehospital patient care and which requirements should be met for their safe use. We also present a concept for assessing whether and to what extent the prehospital use of PNB is indicated and appropriate. The aim of this article is to draw attention to PNB as a possible part of prehospital care concepts for trauma patients and to discuss its prehospital use.

Kernaussagen

• In Deutschland ist die präklinisch durchgeführte periphere Nervenblockade (PNB) zur Analgesie nach Extremitätenverletzung bisher unüblich.

• Bisherige Daten konnten für präklinisch durchgeführte PNB eine Reduktion des Schmerzscores und eine hohe Patientenzufriedenheit zeigen.

• Hüftnahe Femurfrakturen zählen zu den häufigsten Frakturen in Deutschland. Die Fascia-iliaca-Kompartment-Blockade (FICB) könnte eine angemessene Alternative oder Erweiterung bestehender Behandlungskonzepte darstellen.

• Eine SOP sowie ein „Vorab-Check“ im Sinne eines Team-Time-outs können sichere Rahmenbedingungen für eine strukturierte Durchführung präklinischer PNB schaffen.

• In immer mehr Rettungsdienstbereichen sind mobile Ultraschallgeräte verfügbar (z. B. für POCUS, eFAST), die auch bei der Durchführung einer präklinischen PNB eingesetzt werden könnten.

Schlüsselwörter

prähospitales Schmerzmanagement - Akutschmerztherapie - Rettungsdienst - prähospitale Analgesie - Nervenblockade - pain therapy in trauma

Keywords

prehospital nerve block - acute pain therapy - emergency medical services - prehospital analgesia

Publication History

Article published online:
24 June 2024

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