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Rotatorenmanschettenrekonstruktion im AOP – zu schmerzhaft?

Eigene Daten und Literaturübersicht

Rotator cuff reconstruction in outpatient surgery—Too painful?

Own data and literature review

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die Daten unserer prospektiven Studie von ambulant durchgeführten Rekonstruktionen der Rotatorenmanschette (RM) zeigen bei Verzicht auf Leitungsanästhesien und periartikulären Injektionen an Tag 1 den höchsten Schmerzwert von 5,8 (VAS). Dieser Wert bestätigt die Notwendigkeit einer multimodalen Schmerztherapie nach RM-Operation. Trotz hoher Zufriedenheit der Patienten mit dem oralen Schmerzmanagement erscheint es daher sinnvoll, interventionelle Anästhesietechniken (interskalenärer Block, Supraskapularis-Axillaris-Block, [peri]artikuläre Injektionen) zu ergänzen. In unserer Studie war die Höhe des präoperativen Ruheschmerzes der stabilste Prädiktor für hohe postoperative Schmerzen. Da andere Studien zu ähnlichen Ergebnissen kommen, kann man davon ausgehen, dass diese Patientengruppe besonders von einer interventionellen Anästhesie profitieren würde. Einer grundsätzlichen Empfehlung für die Anwendung von Leitungsanästhesien bei ambulanter RM-Operation stehen jedoch Aufwand, Kosten und die spezifischen Risikopotenziale der Verfahren entgegen.

Abstract

The data from our prospective study on outpatient rotator cuff reconstruction without the use of conduction anesthesia and periarticular injections demonstrated a peak pain level of 5.8 (visual analogue scale, VAS) on day 1 following surgery. This value confirms the necessity of a multimodal pain regimen after rotator cuff surgery. Despite the high satisfaction of the patients with pain management by oral medication, it seems reasonable to supplement interventional anesthesia techniques (interscalene block, suprascapular nerve-axillary nerve block, periarticular and articular injections). In our study the level of pain at rest prior to surgery was the most stable predictor for high levels of postoperative pain. As other studies came to similar results, it can be assumed that this subgroup of patients would benefit the most from interventional anesthesia; however, a general recommendation for the use of conduction anesthesia in outpatient rotator cuff operations is counteracted by the effort, costs and the specific potential risk of the procedure.

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Authors and Affiliations

  1. Orthopädische Praxisklinik Neuss Düsseldorf (OPND), Breite Str. 96, 41460, Neuss, Deutschland

    Ralf Müller-Rath & Andrea Hannig

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  1. Ralf Müller-Rath
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  2. Andrea Hannig
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Correspondence to Ralf Müller-Rath.

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Interessenkonflikt

R. Müller-Rath und A. Hannig geben an, dass kein Interessenkonflikt besteht.

Die Studie wurde gemäß der ethischen Standards der Erklärung von Helsinki (1964) und ihrer folgenden Überarbeitungen durchgeführt. Ein Ethikvotum wurde eingeholt (Ärztekammer Nordrhein, Antragsnummer 2015015). Alle Studienteilnehmer wurden schriftlich aufgeklärt und gaben ihr schriftliches Einverständnis.

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T. Gensior

R. Müller-Rath, Neuss

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Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

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Müller-Rath, R., Hannig, A. Rotatorenmanschettenrekonstruktion im AOP – zu schmerzhaft?. Arthroskopie 37, 19–24 (2024). https://doi.org/10.1007/s00142-023-00645-8

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