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ZusammenfassungDie wahre Inzidenz von Infektionskomplikationen im Zusammenhang mit Regionalanästhesie und -analgesie ist unbekannt, aber wie bei allen invasiven Verfahren besteht die Gefahr schwerer Folgeschäden. Dieser Beitrag gibt einen Überblick zu Hygienemaßnahmen basierend auf der S1-Leitlinie „Hygieneempfehlungen für die Regionalanästhesie“, aktuellen Empfehlungen des Robert Koch-Instituts und aktuellen wissenschaftlichen Erkenntnissen. Grundlegende hygienische Standards (Ablegen von Schmuck, gründliche Händedesinfektion, saubere Umgebung) sind anzuwenden. Ein Mund-Nasen-Schutz, eine Kopfhaube und sterile Handschuhe sind ein essenzieller Bestandteil jeder Regionalanästhesie. Für Katheterverfahren soll zusätzlich ein steriler langärmliger Kittel getragen werden, außerdem ist ein steriler Überzug für die Ultraschallsonde zu verwenden (beim Legen eines Katheters auch eine sterile Ummantelung des Zuleitungskabels). Hautdesinfektionsmittel sollten alkoholbasiert sein und eine Substanz mit Remanenzwirkung enthalten (z. B. Chlorhexidin oder Octenidin). Bei thorakalen Epiduralanästhesien eignet sich das Tunneln zur Infektionsprophylaxe. Unter Berücksichtigung von patientenbezogenen Faktoren (Diabetes, Adipositas, Immunsuppression) und je nach Verfahren (geplante Katheternutzung > 4 Tage, Einstichstelle des Katheters) kann eine Antibiotika-Prophylaxe in Erwägung gezogen werden.

The true incidence of infectious complications related to regional anaesthesia and analgesia is not known but like any invasive procedure is has the potential for severe sequelae. This article gives an overview on hygiene requirements based on the S1-guideline "Hygiene recommendations on regional anaesthesia", current recommendations of the Robert Koch-Institute and current scientific insights. Basic hygienic standards (removal of jewellery, accurate hand disinfection, clean environment) are to be applied. A face mask to cover nose and mouth, a surgical hair cap and sterile gloves are essential parts of any block. For catheter placements a sterile gown with long arms is recommended and also a sterile cover for the ultrasound probe (including the cable when catheters are placed). Skin disinfectant should be alcohol-based and contain a remanent ingredient (chlorhexidine or octenidine). Catheter tunneling may be protective when thoracic epidural catheters are used. When patient related factors (diabetes, obesity, immune suppression) and procedural factors (intended catheter use 4 days, catheter site) are carefully weighed, an antibiotic prophylaxis may be taken into consideration.

Whether adults should be awake, sedated or anaesthetised during establishment of regional anaesthesia is still debated and there is little information on the relative safety of each. In paediatric practice, there is often little choice but to use sedation or anaesthesia as otherwise the procedures would be too distressing and patient movement would be hazardous.The objective of this study was to evaluate complications related to central and peripheral regional block and patient satisfaction in awake, sedated and anaesthetised adult patients.A retrospective registry analysis.The German Network of Regional Anaesthesia database was analysed between 2007 and 2012.We included data of 42 654 patients and defined three groups: group I awake (n = 25 004), group II sedated (n = 15 121) and group III anaesthetised (n = 2529) for block placement.Odds ratios [OR; 95% confidence interval (CI)] were calculated with logistic regression analysis and adjusted for relevant confounders to determine the risk of block-related complications in sedated or anaesthetised patients compared with awake patients.Rates of local anaesthetic systemic toxicity were comparable between the groups [awake 0.02% (95% CI: 0.002 to 0.0375), sedated 0.02% (0.003 to 0.042) and anaesthetised 0% (0 to 0.12%)], as were the rates of pneumothorax [awake 0.035% (0 to 0.074), sedated 0% (0 to 0.002) and anaesthetised 0.2% (0 to 0.56)]. Considering peripheral nerve blocks, sedated patients had a decreased risk for multiple skin puncture [adjusted OR: 0.78 (95% CI: 0.71 to 0.85), premature termination [0.45 (0.22 to 0.91)], primary failure [0.58 (0.40 to 0.83)] and postoperative paraesthesia [0.35 (0.28 to 0.45)], but an increased risk for a bloody tap [1.82 (1.50 to 2.21)]. General anaesthesia increased the risk of a bloody tap [adjusted OR: 1.33 (95% CI: 1.01 to 1.78)] and multiple skin puncture [1.28 (1.12 to 1.46)], but decreased the risk for postoperative paraesthesia [0.16 (0.06 to 0.38)]. In neuraxial sites, sedation increased the risk for multiple skin puncture [adjusted OR: 1.18 (95% CI: 1.09 to 1.29)], whereas block placement under general anaesthesia decreased the risk for multiple skin puncture [0.53 (0.39 to 0.72)] and bloody tap but significantly increased the risk for postoperative paraesthesia related to a catheter [2.45 (1.19 to 5.02)]. Sedation was associated with a significant improvement in patient satisfaction.Sedation may improve safety and success of peripheral nerve block placement. Block placement under general anaesthesia in adults should be reserved for experienced anaesthesiologists and special situations.

BackgroundCatheter-related infection is a serious complication of continuous regional anesthesia. The authors tested the hypothesis that single-dose antibiotic prophylaxis is associated with a lower incidence of catheter-related infections.MethodsOur analysis was based on cases in the 25-center German Network for Regional Anesthesia database recorded between 2007 and 2014. Forty thousand three hundred sixty-two surgical patients who had continuous regional anesthesia were grouped into no antibiotic prophylaxis (n = 15,965) and single-dose antibiotic prophylaxis (n = 24,397). Catheter-related infections in each group were compared with chi-square test after 1:1 propensity-score matching. Odds ratios (ORs [95% CI]) were calculated with logistic regression and adjusted for imbalanced variables (standardized difference more than 0.1).ResultsPropensity matching successfully paired 11,307 patients with single-dose antibiotic prophylaxis (46% of 24,397 patients) and with 11,307 controls (71% of 15,965 patients). For peripheral catheters, the incidence without antibiotics (2.4%) was greater than with antibiotic prophylaxis (1.1%, P < 0.001; adjusted OR, 2.02; 95% CI, 1.49 to 2.75, P < 0.001). Infections of epidural catheters were also more common without antibiotics (5.2%) than with antibiotics (3.1%, P < 0.001; adjusted OR, 1.94; 95% CI, 1.55 to 2.43, P < 0.001).ConclusionsSingle-dose antibiotic prophylaxis was associated with fewer peripheral and epidural catheter infections.

Catheter-related infections are a serious complication of continuous thoracic epidural analgesia. Tunnelling catheters subcutaneously may reduce infection risk. We thus tested the hypothesis that tunnelling of thoracic epidural catheters is associated with a lower risk of catheter-related infections.Twenty-two thousand, four hundred and eleven surgical patients with continuous thoracic epidural analgesia included in the German Network for Regional Anaesthesia registry between 2007 and 2014 were grouped by whether their catheters were tunnelled (n=12 870) or not (n=9541). Catheter-related infections in each group were compared with Student's unpaired t and χ(2) tests. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic regression, adjusting for potential confounding factors, including age, ASA physical status score, use of catheter for ≥4 days, multiple skin puncture, hospital, and surgical department.There were fewer catheter-related infections in patients with tunnelled catheters (4.5 vs 5.5%, P0.001). Mild infections were also less common (4.0 vs 4.6%, P=0.009), as were moderate infections (0.4 vs 0.8%, P0.001). After adjustment for potential confounding factors, tunnelling remained an independent prevention for any grade of infection (adjusted OR 0.51, 95% CI 0.42-0.61, P0.001) and for mild infections (adjusted OR 0.54, 95% CI 0.43-0.66, P0.001) and moderate and severe infections (adjusted OR 0.44, 95% CI 0.28-0.70, P=0.001).Tunnelling was associated with a lower risk of thoracic epidural catheter-related infections.

Background Obesity is believed to increase the risk of surgical site infections and possibly increase the risk of catheter-related infections in regional anesthesia. We, therefore, analyzed the influence of obesity on catheter-related infections defined within a national registry for regional anesthesia. Methods The German Network for Regional Anesthesia database with 25 participating clinical centers was analyzed between 2007 and 2012. Exactly, 28,249 cases (13,239 peripheral nerve and 15,010 neuraxial blocks) of patients ≥ 14 years were grouped in I: underweight (BMI 13.2–18.49 kg/m2, n = 597), II: normal weight (BMI 18.5–24.9 kg/m2, n = 9272), III: overweight (BMI 25.0–29.9 kg/m2, n = 10,632), and IV: obese (BMI 30.0–70.3 kg/m2, n = 7,744). The analysis focused on peripheral and neuraxial catheter-related infections. Differences between the groups were tested with non-parametric ANOVA and chi-square (P

Purpose of review As the increased use of new oral anticoagulants may put patients at particular risk of bleeding, experts suggested strategies to perform neuraxial anesthesia as well tolerated as possible. This review summarizes different approaches. Recent findings Data from licensing studies, drug pharmacology, registries, authorities and expert opinions are available and covered by the article. Spinal epidural hematoma formation associated with neuraxial blocks is rare. There has been no epidural hematoma described in the scientific literature with the concurrent use of new oral anticoagulants and neuroaxial anesthesia yet. Summary A simplified approach covering recent recommendations is given which may aid well tolerated use of neuraxial blocks in patients taking new oral anticoagulants.

The incidence of infectious complications associated with continuous regional anesthesia techniques is a matter of concern. Our objective was to determine whether patients suffering from diabetes are at an increased risk of catheter-related infectious complications.The German Network for Regional Anaesthesia database was analyzed between 2007 and 2012. After proof of plausibility, data of 36,881 patients undergoing continuous regional anesthesia were grouped in I: no diabetes (n = 32,891) and II: any diabetes (n = 3990). The analysis focused on catheter-related infections after strict definition. Differences among the groups were tested with t and χ tests. Odds ratios were calculated with logistic regression and adjusted for potential confounders.Patients with a diagnosis of diabetes had an increased incidence of catheter-related infections (no diabetes 3.0% vs any diabetes 4.2%; P0.001). Among all patients, diabetes remained an independent risk factor for infections for all sites after the adjustment for potential confounders (odds ratio [OR] = 1.26; 95% confidence interval [95% CI], 1.02-1.55; P = 0.036). The risk of infection was significantly increased in peripheral catheters only in the lower limb (adjusted OR = 2.42; 95% CI, 1.05-5.57; P = 0.039). If neuraxial catheters were used, the risk was significantly increased only in lumbar epidural (adjusted OR = 2.09; 95% CI, 1.18-3.73; P = 0.012) for diabetic patients compared with nondiabetic patients.The presence of diabetes is associated with an increased risk for catheter-related infections in lower limb and lumbar epidural. Specific care should be taken to avoid and detect infections in this population.