Schmerztherapie bei videoassistierten Eingriffen am Thorax (VATS)

 

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Zusammenfassung

Videoassistierte Eingriffe am Thorax (VATS) können den operativen Stress durch Minimierung des Zugangstraumas reduzieren. Jedoch sind auch VATS-Eingriffe und dabei speziell die VATS-Lobektomie mit nicht unerheblichen akuten postoperativen Schmerzen verbunden. Ein Goldstandard zur Regionalanalgesie für videoassistierte Eingriffe ist bisher nicht beschrieben, da die Studienlage sehr inhomogen ist. Bei kleineren VATS-Eingriffen können die thorakale Paravertebralanalgesie (PVB) und analoge Kathetertechniken einen positiven Effekt auf die akuten postoperativen Schmerzen haben. Die thorakale Periduralanalgesie (PDA) bleibt unbestritten ein effektives Verfahren zur Schmerztherapie, zeigt sich jedoch anderen Schmerzverfahren gegenüber nicht als überlegen. Da die Anzahl der VATS-Eingriffe zunimmt, gibt es unter Chirurgen und Anästhesisten eine wachsende Forderung nach einem evidenzbasierten Schmerzverfahren für diese Eingriffe. Weitere Studien zu diesem Thema sind unabdingbar, um Richtlinien zur Schmerztherapie bei VATS-Eingriffen zu etablieren.

Abstract

Video-assisted thoracic surgery (VATS) procedures might reduce operative stress by minimising operative trauma. However VATS, in particular VATS lobectomy, is still associated with moderate acute postoperative pain. A gold standard for regional analgesia for VATS procedures has not yet surfaced, the studies published so far are very heterogeneous. PVB and catheter techniques might have a positive effect on pain scores in the first few hours of the postoperative period. Although thoracic epidural analgesia (TEA) may not have been shown to be superior to other analgesic regimens, it is undoubtedly efficient as an analgesic treatment. With the increasing popularity of VATS procedures, there is growing demand from both surgeons and anaesthesiologists for an evidence-based approach to pain management for these procedures. Further studies on this topic are crucial to establish guidelines for pain management in VATS procedures.

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