Vol 10, No 2 (2016)


Postoperative analgesia in plastic surgery

Ovechkin A.M., Zvizhuleva A.A.


The review is devoted to the questions of prophylaxis and treatment of postoperative pain in plastic surgery. The pain in plastic surgery remains a serious problem in particular after major reconstructive-reparative operations. It impedes patient timely discharge from hospital in same-day surgery. Postoperative pain in plastic surgery may become chronic in 10-40% cases especially after operations on mammary glands. The basis of postoperative analgesia in plastic surgery is combined using of nonopioid analgesics (NSAIDs, paracetamol, gabapentin) and different variants of regional analgesia. Opioid analgesics are considered as reserve drugs for cases when nonopioid analgesia isn't effective.
Regional Anesthesia and Acute Pain Management. 2016;10(2):82-96
pages 82-96 views

Analysis of critical incidents during spinal anesthesia in gynecologic patients with different sensitivity of peripheral chemoreflex

Golovataya M.V.


The critical incidents of spinal anesthesia were analyzed in gynecologic patients with different sensitivity of peripheral chemoreflex. It was proved that high sensitivity of the peripheral chemoreflex is related to hemodynamic instability reflecting in developing vasoplegia that is the risk factor of intraoperative critical incidents (hypotension) and postoperative complications (postoperative nausea and vomiting).
Regional Anesthesia and Acute Pain Management. 2016;10(2):97-104
pages 97-104 views

Anesthesia method for toe-to-hand transfer in children

Zabolotskii D.V., Koryachkin V.A., Ivanov M.D., Zaytseva N.V., Malashenko N.S.


Background: toe-to-hand transfer - an effective method of surgical reconstructive restoration of hand function in children, which is highly traumatic and characterized by complexity, duration and multiple stages. These aspects determine the importance and relevance of the choice of anesthesia method is not only in the perioperative period, but at the stage of rehabilitation in this group of the patients. Aim of the study: To evaluate the efficacy of the continuous regional blocks in pediatric toe-to-hand transfer. A total of 136 children had toe-to-hand transfer, and received general anesthesia with regional anesthesia (study group n = 84) and general anesthesia alone (control group n = 52). In the first group regional blockade was used on foot / feet, and continuous regional block of the brachial plexus. We studied the temperature and Doppler on the limbs at different accesses to the brachial plexus, the effect of regional anesthesia on hemostasis, compared intraoperative drug load in the groups, the level of awakening, the quality of early postoperative analgesia and the final outcome of the surgical treatment. The data of thermometry and Doppler showed increase in microcirculation in blocked limbs. Data from thromboelastography showed a tendency to hypocoagulation, due to the influence of regional blocks on the platelet aggregation. The effectiveness of regional block has reduced drug load in the perioperative period. The therapeutic effect of continuous regional blocks helped to reduce the number of surgical complications in 1.9 times.
Regional Anesthesia and Acute Pain Management. 2016;10(2):105-110
pages 105-110 views

Comparative assessment of peripheral blocade of sciastic nerve performed by subgluteal and popgluteal access using electrical stimulation of peripheral nerve under us guidance

Piacherski V.G., Marochkov A.V.


Goal. Compare the area of the sensor unit with the blockade of the sciatic nerve subgluteal and classic access. Achieved 60 blockades of the sciatic nerve in combination with femoral nerve blockade. In group A (30 patients) the blockade of the sciatic nerve was performed classical access, in group B (30 patients) - subgluteal access with the patient lying on his stomach. All of the blockade of the sciatic nerve were performed with 30 ml of 1% lidocaine (epinephrine 1: 200 000). Sensory block was evaluated in the foot, ankle, lower leg, popliteal fossa and hamstring. Evaluation of the sensory block was performed using prick. In group A complete motor block of the sciatic nerve occurred in all 30 patients. In those same 30 patients (100%) developed a full sensory block (++) in the area of the foot, lower leg, popliteal, posterior thigh. All patients had complete motor block of the sciatic nerve. In group B complete sensory block in the area of the foot, lower leg developed in all patients. In the popliteal fossa a full sensory block (++) did not develop in any patient, a partial unit + occurred in 22 patients (73.3%) and in 50 patients (26.7%) did not develop a sensor unit. In group B the sensor unit in the lower, middle and upper third Femur not developed (-) no patient. When the blockade of the sciatic nerve subgluteal access full sensor unit is not developed in the popliteal fossa and hamstring. When using the classic access sensor unit is developed in the popliteal fossa and hamstring
Regional Anesthesia and Acute Pain Management. 2016;10(2):111-115
pages 111-115 views

Nerve block anesthesia in gerontologic patients with purulent-necrotic lesions of the foot

Fomin A.A., Novikov U.V., Pershakov D.R., Vozgrin D.V.


Regional anesthesia was performed in 278 patients with feet gangrene. The nerve block was performed using ultrasound navigation and neurostimulation. The results of regional anesthesia and spinal anesthesia were compared in economic and clinical conditions (quality of analgesia), oxygenation and microcirculation levels were also assessed. As a result the last two were practically the same in the compared groups, bur the painless rate was higher in regional anesthesia group, so as the last one is cheaper. It's used to be mentioned, that patients after regional anesthesia being performed were active since 30 minutes after leaving the operation room, but analgesia was stable in next 12 hours.
Regional Anesthesia and Acute Pain Management. 2016;10(2):116-120
pages 116-120 views

Features of the development of thoracic paravertebral blockade as a component of anesthesia in radical mastectomy

Yaskevich V.V., Marochkov A.V.


The aim of this work is the study of thoracic paravertebral blockade (PVB) in different anatomical parts of the chest. The usage of the PVB for 31 women was analysed. PVB was performed at the levels of Th1, Th2, Th3, Th4, Th5 and Th6, under ultrasound guidance. 1.5 ml of local anesthetic (0,75% solution of ropivacaine) was introduced on each level. The borders of altered pain sensitivity was evaluated using "pin prick" at the notional vertical lines of the chest (paravertebral, scapular, posterior axillary, mid-axillary, midclavicular and sternal). The obtained distances were measured by centimeter ruler. After blockade of spinal nerves from Th1 through Th6, the extent of the blockade of the pain sensitivity was reveded: paravertebral line at 21.7±3.9 cm, along the scapular line is a distance of 19.1±3.6 cm, on posterior axillary line of 14.5±2.6 cm, on an mid-axillary line - of 14.9±3.3 cm on the midclavicular line is 11.9±4.2 cm, sternal line - 5.4±3,3 cm. The decrease in the severity of the blockade on pain sensitivity in the midclavicular line from central to peripheral anatomical areas was observed. 71% of patients on the first day after surgery was not required additional analgesia, in 16% of cases the period of analgesia ranged from 6 to 18 hours. The decrease of the size of analgesia takeplace surface when moving from the spine to the sternum that can significantly affect the quality of anesthesia during operations on the thorax. PVB intercostal nerve Th1-Th6 with small doses of local anesthetic anesthetic is effective in ensuring operations in the amount of radical mastectomy.
Regional Anesthesia and Acute Pain Management. 2016;10(2):121-127
pages 121-127 views

Pain as a symptom of tuberculosis spondylitis (complex analysis on the mono-central cohort study)

Pulkina O.N., Mushkin A.U., Ulrikh G.E., Kuklin D.V., Kalinin U.V.


Goal of the research: to evaluate intensity and pain components in patients with tuberculous spondylitis addmited to the hospital for planned surgical treatment. Patients (n=115) with tuberculous spondylitis, addmited to the planned radical reconstructive surgery. Before surgery pain intensity in patients was evaluated according to VAS, as well as senso-discriminative, affective and cognitive components of pain, the presence of neuropathic component, the level of anxiety and depression being also evaluated. Patients addmited to the planned surgical treatment have multiple comorbidities, chronic pain of average intensity, in which there is a 48% neuropathic component, more than 60% of patients have an affective component and there are also numerous predictors of formation of high-pain intensity in the postoperative period. The assessment of pain in patients with tuberculous spondylitis should be carried out using both a visual analogue scale and complex questionnaires to identify the nature and components of pain, the presence of neuropathic and affective component with a view of corresponding correction of the treatment.
Regional Anesthesia and Acute Pain Management. 2016;10(2):128-133
pages 128-133 views

Experience of applying spinal anesthesia for Cesarean section in patient of 118 cm height

Matkovskiy A.A., Bykov A.S., Aleksandrov I.V., Matkovskaya L.I., Kulikov A.V.


Successes of modern medicine give possibility to women with dwarfism to bear pregnancy. However questions of anesthetic protection for this patient category are not solve to date. The author presented an experience of Ekaterinburg perinatal center concerned perioperative support and anesthesiological tactics applied for women with dwarfism.
Regional Anesthesia and Acute Pain Management. 2016;10(2):134-138
pages 134-138 views

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