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Aktuelle Urol 2004; 35(5): 418-425
DOI: 10.1055/s-2004-830030
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Regionalanästhesien bei urologischen Eingriffen im Kindesalter

Regional Anesthesia for Urologic Interventions in the Pediatric Age GroupA.  Reich1 , O.  A.  Brinkmann2
  • 1Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster (Direktor: Univ.-Prof. Dr. H. Van Aken)
  • 2Klinik und Poliklinik für Urologie, Universitätsklinikum Münster (Direktor: Univ.-Prof. Dr. L. Hertle)
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Publication History

Publication Date:
15 September 2004 (online)

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Zusammenfassung

Regionalanästhesietechniken sind in der Kinderanästhesie weit verbreitet und stellen ein hervorragendes Instrument der perioperativen Schmerztherapie dar. In den vergangenen Jahrzehnten hat ihre Anwendung stetig zugenommen und heutzutage können sie bei angemessenem Gebrauch bei fast jedem chirurgischen Eingriff eingesetzt werden. Obwohl sie lange Zeit als unzuverlässig und gefährlich angesehen wurden, sind sie mit dem heutigen Wissen der Physiologie und Pharmakologie sicher anwendbar. Gerade ambulant behandelte Kinder können von einer derartigen Schmerztherapie profitieren. Entweder wird der Eingriff ausschließlich in einer Regionalanästhesie durchgeführt oder was in der überwiegenden Anzahl der Kinder notwendig ist, in Kombination mit einer flachen Allgemeinanästhesie. Sowohl zentrale Blockaden, wie die Kaudalanästhesie, als auch periphere Nervenblockaden, wie der Peniswurzelblock, werden von kleinen Kindern und auch von Adoleszenten hervorragend toleriert. Sie sind technisch einfach und leicht durchführbar. Abgesehen von der genauen Anamneseerhebung sind bei sonst gesunden Kindern keine weiteren invasiven Test zur Bestimmung der Gerinnungsparameter erforderlich. Nach Abklingen der Wirkung einer Regionalanästhesie ist eine Fortführung der Akutschmerztherapie mit Nichtopioidanalgetika wie Paracetamol oder Ibuprofen sinnvoll.

Abstract

Regional anesthetic techniques are widely used in pediatric anesthesia since they represent excellent tools to prevent and treat postoperative pain. Their range of application has considerably expanded during the last decades, and virtually all aspects of surgical pain management can benefit from their appropriate use. Previously considered unreliable and potentially hazardous, regional anesthetic techniques have now been proven safe. Most children undergoing outpatient surgery can benefit from regional anesthetic techniques, either as the sole anesthetic regimen or, as usual in pediatric practice, in combination with light anesthesia. Central blocks as well as peripheral nerve blocks are well tolerated by infants and young children. They are easy to perform and show a high level of efficacy. Only the patient's history has to be available. No tests, such as invasive blood coagulation screening, are required. Subsequent to a regional anesthesia, non-opioid analgetics, e. g., paracetamol or ibuprofen, have to be used for further pain management.

Schlüsselwörter

Operation: Kinder - Anästhesie: regional, lokal - Analgesie: postoperative - Kinder: Nervenblock

Key words

Surgery: pediatrics - anesthesia: regional, local - analgesia: postoperative - child: nerve block

Literatur

  • 1 Adewale L, Dearlove O, Wilson B, Hindle K, Robinson D N. The caudal canal in children: a study using magnetic resonance imaging.  Paediatr Anaesth. 2000;  10 (2) 137-141
    CrossrefPubMedGoogle Scholar
  • 2 Ala-Kokko T I, Karinen J, Raiha E, Kiviluoma K, Alahuhta S. Pharmacokinetics of 0.75 % ropivacaine and 0.5 % bupivacaine after ilioinguinal-iliohypogastric nerve block in children.  Br J Anaesth. 2002;  89 (3) 438-441
    CrossrefPubMedGoogle Scholar
  • 3 Ala-Kokko T I, Partanen A, Karinen J, Kiviluoma K, Alahuhta S. Pharmacokinetics of 0.2 % ropivacaine and 0.2 % bupivacaine following caudal blocks in children.  Acta Anaesthesiol Scand. 2000;  44 (9) 1099-1102
    CrossrefPubMedGoogle Scholar
  • 4 Amory C, Mariscal A, Guyot E, Chauvet P, Leon A, Poli-Merol M L. Is ilioinguinal/iliohypogastric nerve block always totally safe in children?.  Paediatr Anaesth. 2003;  13 (2) 164-166
    PubMedGoogle Scholar
  • 5 Anatol T I, Pitt-Miller P, Holder Y. Trial of three methods of intraoperative bupivacaine analgesia for pain after paediatric groin surgery.  Can J Anaesth. 1997;  44 (10) 1053-1059
    PubMedGoogle Scholar
  • 6 Berde C. Regional anesthesia in children: what have we learned?.  Anesth Analg. 1996;  83 (5) 897-900
    PubMedGoogle Scholar
  • 7 Bichel T, Rouge J C, Schlegel S, Spahr-Schopfer I, Kalangos A. Epidural sufentanil during paediatric cardiac surgery: effects on metabolic response and postoperative outcome.  Paediatr Anaesth. 2000;  10 (6) 609-617
    PubMedGoogle Scholar
  • 8 Constant I, Gall O, Gouyet L, Chauvin M, Murat I. Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children.  Br J Anaesth. 1998;  80 (3) 294-298
    PubMedGoogle Scholar
  • 9 Da Conceicao M J, Coelho L. Caudal anaesthesia with 0.375 % ropivacaine or 0.375 % bupivacaine in paediatric patients.  Br J Anaesth. 1998;  80 (4) 507-508
    PubMedGoogle Scholar
  • 10 Da Conceicao M J, Coelho L, Khalil M. Ropivacaine 0.25 % compared with bupivacaine 0.25 % by the caudal route.  Paediatr Anaesth. 1999;  9 (3) 229-233
    PubMedGoogle Scholar
  • 11 Dalens B, Vanneuville G, Dechelotte P. Penile block via the subpubic space in 100 children.  Anesth Analg. 1989;  69 (1) 41-45
    PubMedGoogle Scholar
  • 12 De Saint Blanquat L, Simon L, Laplace C, Egu J F, Hamza J. Preoperative coagulation tests in former preterm infants undergoing spinal anaesthesia.  Paediatr Anaesth. 2002;  12 (4) 304-307
    PubMedGoogle Scholar
  • 13 Ecoffey C, Dubousset A M, Samii K. Lumbar and thoracic epidural anesthesia for urologic and upper abdominal surgery in infants and children.  Anesthesiology. 1986;  65 (1) 87-90
    PubMedGoogle Scholar
  • 14 Flandin-Blety C, Barrier G. Accidents following extradural analgesia in children. The results of a retrospective study.  Paediatr Anaesth. 1995;  5 (1) 41-46
    PubMedGoogle Scholar
  • 15 Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists.  Anesth Analg. 1996;  83 (5) 904-912
    PubMedGoogle Scholar
  • 16 Haberkern C M, Lynn A M, Geiduschek J M, Nespeca M K, Jacobson L E, Bratton S L, Pomietto M. Epidural and intravenous bolus morphine for postoperative analgesia in infants.  Can J Anaesth. 1996;  43 (12) 1203-1210
    PubMedGoogle Scholar
  • 17 Hager H, Marhofer P, Sitzwohl C, Adler L, Kettner S, Semsroth M. Caudal clonidine prolongs analgesia from caudal S(+)-ketamine in children.  Anesth Analg. 2002;  94 (5) 1169-1172, table of contents
    PubMedGoogle Scholar
  • 18 Holder K J, Peutrell J M, Weir P M. Regional anaesthesia for circumcision. Subcutaneous ring block of the penis and subpubic penile block compared.  Eur J Anaesthesiol. 1997;  14 (5) 495-498
    CrossrefPubMedGoogle Scholar
  • 19 Irwin M G, Cheng W. Comparison of subcutaneous ring block of the penis with caudal epidural block for post-circumcision analgesia in children.  Anaesth Intensive Care. 1996;  24 (3) 365-367
    PubMedGoogle Scholar
  • 20 Ishigooka M, Yaguchi H, Hashimoto T, Hayami S, Sasagawa I, Nakada T, Mitobe K. Penile block via subpubic space for children who underwent superficial operation of the penis.  Urol Int. 1994;  53 (3) 147-149
    PubMedGoogle Scholar
  • 21 Ivani G, Lampugnani E, de Negri P, Lonnqvist P A, Broadman L. Ropivacaine vs bupivacaine in major surgery in infants.  Can J Anaesth. 1999;  46 (5 Pt 1) 467-469
    PubMedGoogle Scholar
  • 22 Ivani G, Lampugnani E, Torre M, Calevo Maria G, DeNegri P, Borrometi F, Messeri A, Calamandrei M, Lonnqvist P A, Morton N S. Comparison of ropivacaine with bupivacaine for paediatric caudal block.  Br J Anaesth. 1998;  81 (2) 247-248
    PubMedGoogle Scholar
  • 23 Johr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child.  Anesth Analg. 1999;  88(5) 1051-1052
    PubMedGoogle Scholar
  • 24 Koinig H, Krenn C G, Glaser C, Marhofer P, Wildling E, Brunner M, Wallner T, Grabner C, Klimscha W, Semsroth M. The dose-response of caudal ropivacaine in children.  Anesthesiology. 1999;  90 (5) 1339-1344
    CrossrefPubMedGoogle Scholar
  • 25 Lee H M, Sanders G M. Caudal ropivacaine and ketamine for postoperative analgesia in children.  Anaesthesia. 2000;  55 (8) 806-810
    CrossrefPubMedGoogle Scholar
  • 26 Lim S L, Ng Sb A, Tan G M. Ilioinguinal and iliohypogastric nerve block revisited: single shot versus double shot technique for hernia repair in children.  Paediatr Anaesth. 2002;  12 (3) 255-260
    PubMedGoogle Scholar
  • 27 Machotta A, Risse A, Bercker S, Streich R, Pappert D. Comparison between instillation of bupivacaine versus caudal analgesia for postoperative analgesia following inguinal herniotomy in children.  Paediatr Anaesth. 2003;  13 (5) 397-402
    PubMedGoogle Scholar
  • 28 Macpherson D S. Preoperative laboratory testing: should any tests be “routine” before surgery?.  Med Clin North Am. 1993;  77 (2) 289-308
    PubMedGoogle Scholar
  • 29 Motsch J, Bottiger B W, Bach A, Bohrer H, Skoberne T, Martin E. Caudal clonidine and bupivacaine for combined epidural and general anaesthesia in children.  Acta Anaesthesiol Scand. 1997;  41 (7) 877-883
    PubMedGoogle Scholar
  • 30 Murthy B V, Pandya K S, Booker P D, Murray A, Lintz W, Terlinden R. Pharmacokinetics of tramadol in children after i. v. or caudal epidural administration.  Br J Anaesth. 2000;  84 (3) 346-349
    PubMedGoogle Scholar
  • 31 O'Connor M E, Drasner K. Preoperative laboratory testing of children undergoing elective surgery.  Anesth Analg. 1990;  70 (2) 176-180
    PubMedGoogle Scholar
  • 32 Ozbek H, Bilen A, Ozcengiz D, Gunes Y, Ozalevli M, Akman H. The comparison of caudal ketamine, alfentanil and ketamine plus alfentanil administration for postoperative analgesia in children.  Paediatr Anaesth. 2002;  12 (7) 610-616
    PubMedGoogle Scholar
  • 33 Roux C L, Lejus C, Surbleb M, Renaudin M, Guillaud C, Windt A, Lasnier B, Pinaud M. Is haemostasis biological screening always useful before performing a neuraxial blockade in children?.  Paediatr Anaesth. 2002;  12 (2) 118-123
    PubMedGoogle Scholar
  • 34 Samuel M, Hampson-Evans D, Cunnington P. Prospective to a randomized double-blind controlled trial to assess efficacy of double caudal analgesia in hypospadias repair.  J Pediatr Surg. 2002;  37 (2) 168-174
    CrossrefPubMedGoogle Scholar
  • 35 Semple D, Findlow D, Aldridge L M, Doyle E. The optimal dose of ketamine for caudal epidural blockade in children.  Anaesthesia. 1996;  51 (12) 1170-1172
    PubMedGoogle Scholar
  • 36 Sengebusch U. Gerinnungswerte vor Kaudalanästhesie?.  Anaesthesist. 2000;  49 (5) 476-477
    CrossrefPubMedGoogle Scholar
  • 37 Smith T, Moratin P, Wulf H. Smaller children have greater bupivacaine plasma concentrations after ilioinguinal block.  Br J Anaesth. 1996;  76 (3) 452-455
    PubMedGoogle Scholar
  • 38 Somri M, Gaitini L A, Vaida S J, Yanovski B, Sabo E, Levy N, Greenberg A, Liscinsky S, Zinder O. Effect of ilioinguinal nerve block on the catecholamine plasma levels in orchidopexy: comparison with caudal epidural block.  Paediatr Anaesth. 2002;  12 (9) 791-797
    PubMedGoogle Scholar
  • 39 Suraseranivongse S, Chowvanayotin S, Pirayavaraporn S, Kongsayreepong S, Gunnaleka P, Kraiprasit K, Petcharatana S, Montapaneewat T. Effect of bupivacaine with epinephrine wound instillation for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy.  Reg Anesth Pain Med. 2003;  28 (1) 24-28
    PubMedGoogle Scholar
  • 40 Verghese S T, Hannallah R S, Rice L J, Belman A B, Patel K M. Caudal anesthesia in children: effect of volume versus concentration of bupivacaine on blocking spermatic cord traction response during orchidopexy.  Anesth Analg. 2002;  95 (5) 1219-1223, table of contents
    PubMedGoogle Scholar
  • 41 Wulf H, Peters C, Behnke H. The pharmacokinetics of caudal ropivacaine 0.2 % in children. A study of infants aged less than 1 year and toddlers aged 1 - 5 years undergoing inguinal hernia repair.  Anaesthesia. 2000;  55 (8) 757-760
    CrossrefPubMedGoogle Scholar

Dr. med. Alexander Reich

Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin · Universitätsklinikum Münster

Albert-Schweitzer-Straße 33

48129 Münster

Deutschland

Phone: ++49-251-8347255

Fax: ++49-251-9348667

Email: reich@anit.uni-muenster.de

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