Dokument: Regionalanästhesie bei Mamma-Operationen Nutzen eines paravertebralen Katheters zusätzlich zur Allgemeinanästhesie und die korrelierende Patientinnen-Zufriedenheit
| Titel: | Regionalanästhesie bei Mamma-Operationen Nutzen eines paravertebralen Katheters zusätzlich zur Allgemeinanästhesie und die korrelierende Patientinnen-Zufriedenheit | |||||||
| Weiterer Titel: | Regional Anaesthesia in Breast Surgery | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=47284 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20181001-100416-8 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Dr. med. Klein, Kathrin [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. med. Peter Kienbaum [Gutachter] Priv.-Doz. Dr. med. Ines Beyer [Gutachter] | |||||||
| Stichwörter: | Regionalanästhesie/ Mamma Operationen | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Für Brustoperationen kann zusätzlich zu einer Allgemeinanästhesie ein paravertebraler Katheter (PVK) zur intra- und postoperativen Analgesie eingesetzt werden, wodurch üblicherweise systemische Anästhetika, vor allem Opioide, eingespart werden können. In dieser Arbeit wurde untersucht, ob der Einsatz von Lokalanästhetika über einen paravertebralen Katheter zusätzlich zur Allgemeinanästhesie auch bei Brustoperationen den Opioidbedarf senkt und die Patientenzufriedenheit erhöht.
Es wurden Daten aller Patientinnen in diese retrospektive, nicht interventionelle klinische Untersuchung eingeschlossen, die vom 01.01.2008 bis 31.12.2012 in der Universitätsklinik Düsseldorf aufgrund eines Mamma-Tumors operiert wurden und eine Allgemeinanästhesie mit oder ohne PVK erhielten. Anhand der Narkoseprotokolle wurden als primäre Zielvariabel die Dosis an verabreichten Opioiden sowie als sekundäre Zielvariablen der intraoperativ gemessene Blutdruck, die Herzfrequenz, die Anästhesietiefe gemäß Bispektralem Index sowie der Medikamentenverbrauch analysiert. Zur Messung der Patientinnen-Zufriedenheit wurde im Anschluss ein Fragebogen entwickelt, versandt und ausgewertet. Insgesamt wurden 400 Patientinnen eingeschlossen. Davon erhielten 317 eine Allgemeinanästhesie und 83 eine Kombination aus Allgemeinanästhesie und PVK. Patientinnen mit PVK erhielten signifikant geringere Dosen an Opioiden (40 ug vs. 30 ug Sufentanil, p=0,008). Bei gleicher Anästhesietiefe (mittlerer Bispektraler Index von 34 in beiden Gruppen) waren der mittlere arterielle Druck und die Herzfrequenz in der PVK-Gruppe geringfügig höher (83 mmHg vs. 79 mmHg, p=0,001; 68 vs. 66 Schläge/Minute p=0,007) und der Anteil an Patientinnen mit postoperativer Antiemetika-Applikation signifikant geringer (4% in der Allgemeinanästhesie-Gruppe vs. 1% in der PVK-Gruppe, p=0,04). Demgegenüber berichteten Patientinnen mit PVK jedoch über eine geringere Zufriedenheit mit ihrer Narkose (94 vs. 83 auf einer numerischen Rating-Skala bis 100, p=0,013), verbunden mit dem punktionsbedingten Schmerz der PVK-Anlage. Zusammenfassend war der zusätzlich zu einer Allgemeinanästhesie eingesetzte PVK während Brustoperationen mit einem niedrigeren intraoperativen Opioid-Verbrauch und einem verminderten postoperativen Antiemetika-Bedarf assoziiert. Darüber hinaus war die Verwendung eines paravertebralen Katheters mit einer niedrigeren Zufriedenheit der Patientinnen verbunden.For breast surgery a paravertebral catheter can be used in addition to general anaesthesia for intra- and postoperative analgesia. We examined the influence of local anaesthesia with a paravertebral catheter in addition to general anaesthesia relating to the need of opioids and patient satisfaction. Our retrospective, non-interventional study included the data of all patients operated between 1st January 2008 and 31st December 2012 at University Hospital Düsseldorf due to a breast tumour with general anaesthesia or with a combination of general anaesthesia and paravertebral catheter. Based on the anaesthesia protocols the dose of opioids was defined as primary endpoint. As secondary endpoint the intraoperative blood pressure, heart rate, anaesthesia depth and the use of other medications than opioids were entitled. For the measurement of patient satisfaction, a questionnaire was developed, sent and interpreted. In total 400 patients were included. 317 of them had a general anaesthesia and 83 a combination with a paravertebral catheter. Patients with paravertebral catheter received a significant lower dose of opioids (40 ug vs. 30 ug Sufentanil, p=0,008). Despite the same depth of anaesthesia (average bispektral index of 34 in both groups) the average blood pressure and heart rate were higher in the PVK group (83 mmHg vs. 79 mmHg, p=0,001; 68 vs. 66 beats/minute p=0,007) and the number of patients with postoperative demand for antiemetics was significantly lower (4% in general anaesthesia group vs. 1% in PVK group, p=0,04). On the other hand, patients with a paravertebral catheter had a lower level of satisfaction (94 vs. 83 rating scale to max. 100, p=0,013), associated with the pain during the puncture. It can be summarised that the paravertebral catheter in addition to general anaesthesia during breast surgery was associated with a lower need for intraoperative opioids and a lower postoperative demand for antiemetics. Furthermore, the use of a paravertebral catheter was also associated with a lower level of patient satisfaction. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Bezug: | 2012-2018 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 01.10.2018 | |||||||
| Dateien geändert am: | 01.10.2018 | |||||||
| Promotionsantrag am: | 08.02.2018 | |||||||
| Datum der Promotion: | 26.09.2018 |
