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Eine Alternative bietet die zeitnahe Versorgung in der Notaufnahme. Es wird \u00fcber die mehrj\u00e4hrige Erfahrung mit einem Behandlungsalgorithmus berichtet, bei dem Notfallpatienten zeitnah in axill\u00e4rer Plexusblockade (APB) in der Notaufnahme ohne weitere An\u00e4sthesiebegleitung versorgt wurden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methoden<\/jats:title><jats:p>Patienten wurden auf die prinzipielle Eignung f\u00fcr eine Versorgung au\u00dferhalb des allgemeinen Operationsbetriebes vom Operateur vorausgew\u00e4hlt. Nach Ausschluss an\u00e4sthesiologischer und chirurgischer Kontraindikationen erfolgte in der \u201eholding area\u201c des OP-Bereichs die sonographisch gef\u00fchrte axill\u00e4re Plexus-Blockade (APB) in Einzelinjektionstechnik unter Standardmonitoring. Nach \u00dcberpr\u00fcfung der Blockade erfolgte die weitere Versorgung in der Notaufnahme unter Aufsicht des verantwortlichen Chirurgen ohne An\u00e4sthesiebegleitung.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ergebnisse<\/jats:title><jats:p>Von Januar 2013 bis November 2017 wurden 566 Patienten (46,4\u202fJ [11\u201388], 174,9\u202fcm [140\u2013211], 80,8\u202fkg [42\u2013178], ASA-Status 1\/2\/3 [190\/338\/38]) nach dem beschriebenen Behandlungsalgorithmus versorgt. Die APB wurden von 74 An\u00e4sthesisten mit maximal 100\u202fmg Ropivacain, 1\u202f%ig, und 400\u202fmg Prilocain, 2\u202f%ig, durchgef\u00fchrt. Bei 5\u202f% der Patienten war die Blockade nach 20\u202fmin unzureichend, sodass eine Nachinjektion mit maximal 2\u20133\u202fml Prilocain, 1\u202f%ig, pro entsprechendem Nerv erfolgte. Danach konnte die chirurgische Versorgung bei allen Patienten ohne zus\u00e4tzliche Analgetika oder Nachinfiltrationen durchgef\u00fchrt werden. Komplikationen der APB wurden nicht beobachtet.<\/jats:p><\/jats:sec><jats:sec><jats:title>Schlussfolgerung<\/jats:title><jats:p>Wir konnten zeigen, dass die Versorgung ausgew\u00e4hlter Patienten au\u00dferhalb des OP mit einem definierten Behandlungsalgorithmus in einer APB sicher und zuverl\u00e4ssig ohne dauerhafte An\u00e4sthesiepr\u00e4senz m\u00f6glich war. Unabdingbare Voraussetzungen f\u00fcr ein solches Vorgehen sind aber die sorgf\u00e4ltige Patientenselektion, die Patientenzustimmung, die sichere, effektive Durchf\u00fchrung der APB sowie die verl\u00e4ssliche Absprache mit dem Operateur.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00101-020-00772-z","type":"journal-article","created":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T17:02:33Z","timestamp":1588093353000},"page":"388-396","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ambulante Versorgung akuter Verletzungen der oberen Extremit\u00e4t in der Notfallambulanz in axill\u00e4rer Plexusan\u00e4sthesie \u2013 Ist das ohne durchgehende An\u00e4sthesiebegleitung machbar?","Outpatient treatment of acute injuries of upper extremities with axillary plexus anesthesia in the emergency department\u2014Is that possible without continuous anesthesia attendance?"],"prefix":"10.1007","volume":"69","author":[{"given":"A.","family":"Rand","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. 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