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Perioperative Schmerzbehandlung in der Schulterchirurgie

Pain management in shoulder surgery

  • Schwerpunkt: Orthopädische Schmerztherapie
  • Published:
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Zusammenfassung

Schultergelenknahe Operationen zählen zu den schmerzhaftesten Eingriffen der orthopädischen Chirurgie. Aus diesem Grund hat sich neben der intravenösen Schmerztherapie mit Opioiden die Blockade des Plexus brachii als wirksames Analgesieverfahren etabliert.

Hochauflösender Ultraschall bietet die Möglichkeit, Nervenblockaden unter visueller Kontrolle durchzuführen. Untersuchungen zur sonographisch geführten Interskalenusblockade zeigen sowohl die hohe Effizienz der Blockaden als auch die Sicherheit des Verfahrens. Klinisch evidente Schädigungen von Nerven sind unter Verwendung der Methode nicht aufgetreten.

Kleinere Operationen können in der Regel mit einer perioperativen Single-shot-Blockade ausreichend behandelt werden. Umfangreiche Operationen, bei denen starke Schmerzen über mehrere Tage zu erwarten sind, erfordern ebenso wie Eingriffe mit vorbestehender Schultersteife das Katheterverfahren zur kontinuierlichen Schmerztherapie.

Eine erfolgreiche Rehabilitation nach Schulteroperationen setzt eine konsequente perioperative Schmerzblockade voraus, die in erster Linie durch eine interskalenäre Plexusblockade gewährleistet wird.

Abstract

Surgical procedures in the region of the shoulder joint are among the most painful interventions in orthopedic practice. For this reason, in addition to intravenous pain therapy with opioids, blockade of the brachial plexus has become established as an effective method to provide analgesia.

High-resolution ultrasound offers the possibility of performing nerve blockades under visual monitoring. Studies on interscalene blockade performed under sonographic control provide evidence for both the high efficacy and safety of the procedure. Clinically manifest signs of nerve damage have not appeared with use of this method.

Smaller operations can usually be adequately managed with perioperative single-shot blockade. More extensive operations for which severe pain lasting for several days can be expected and surgical interventions involving preexistent shoulder stiffness necessitate catheterization for uninterrupted pain therapy.

Successful rehabilitation after shoulder surgery requires diligent perioperative pain blockade, which can primarily be provided by interscalene plexus blockade.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg

    U. Schwemmer, C. A. Greim, T. Papenfuss, C. K. Markus & N. Roewer

  2. Orthopädische Klinik König-Ludwig-Haus, Universität Würzburg

    T. D. Boehm & F. Gohlke

  3. Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum, Josef-Schneider-Straße 2, 97080 , Würzburg

    U. Schwemmer

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  1. U. Schwemmer
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  2. C. A. Greim
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Correspondence to U. Schwemmer.

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Schwemmer, U., Greim, C.A., Boehm, T.D. et al. Perioperative Schmerzbehandlung in der Schulterchirurgie. Schmerz 18, 475–480 (2004). https://doi.org/10.1007/s00482-004-0329-z

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  • DOI: https://doi.org/10.1007/s00482-004-0329-z

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