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Vol 12, No 1 (2018)

Articles

BOL' U REBENKA POSLE OPERATsII.KAK NAM EE OTsENIVAT'?

Ul'rikh G.E.

Abstract

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Regional Anesthesia and Acute Pain Management. 2018;12(1):4-5
pages 4-5 views

NEUROLOGICAL COMPLICATIONS OF REGIONAL ANESTHESIA

Ovechkin A.M., Politov M.E., Morozov D.V.

Abstract

In the review, neurological complications associated with regional anesthesia are discussed: epidural hematoma (frequency 0.0008 to 0.2%), spinal cord or peripheral nerves injury during puncture or catheter placement (frequency from 0.5 to 1%), post-dural puncture headache (frequency from 0.16 to 6% in obstetrics), transient neurologic syndrome (frequency from 0 to 37%, most often after spinal anesthesia with lidocaine), Horner’s syndrome (frequency from 0.13 to 2.5%). Epidemiology, risk factors, preventive measures, and management of neurological complications associated with regional anesthesia are presented.
Regional Anesthesia and Acute Pain Management. 2018;12(1):6-14
pages 6-14 views

REGIONAL ANESTHESIA OF THE TRIGEMINAL NERVE IN CRANIOFACIAL SURGERY

Zajcsev A.Y., Svetlov V.A., Dubrovin K.V.

Abstract

This article is devoted to the actual problem of regional blocks as a component of combined anesthesia with long andsuper-long surgical interventions in the maxillofacial region. The article describes in detail the anatomical and physiological features of the person’s innervation, the methods of performing regional blocks, describes the difficulties in performing them, the characteristics of performing neurostimulation, indications and probable complications. In particular, the incorrect interpretation of the appearance of a muscle response when stimulating the maxillary nerve is explained. The methods of neuroimaging are described in detail, from neurostimulation to ultrasound navigation and 3D-CT navigation.
Regional Anesthesia and Acute Pain Management. 2018;12(1):15-23
pages 15-23 views

LOCAL ANESTHESIA FOR VITREO-RETINAL SURGERY

Marova N.G., Vasilyev Y.I., Klyushnikova E.V., Kononov A.V., Polyakova T.S.

Abstract

Local anesthesia is used as a component of general anesthesia or self-sufficient technique of perioperative analgesia at the vitreo-retinal surgery. Its popularity originates from safety and simplicity of regional techniques which provide efficient analgesia, perfect surgical field and fast recovery. Most of injection techniques of ophthalmic regional anesthesia are single shot methods which could not provide effective analgesia in some patients who required anesthesia for a prolonged period. Implementation of catheter technique in daily practice could be solution to this problem. Infusion of local anesthetic through catheter possesses all advantages of single-shot techniques and provides virtually unlimited duration of analgesia.
Regional Anesthesia and Acute Pain Management. 2018;12(1):24-29
pages 24-29 views

EXPERIENCE OF THE USE OF LEVOBUPIVACAINE FOR SPINAL ANESTHESIA IN UROLOGICAL INTERVENTIONS

Garyaev R.V., Gruzdev V.E., Rychkov I.A.

Abstract

The prospective study included data obtained during the surgical treatment of 55 urological patients. In the X10 group (n = 25) for spinal anesthesia used 2 ml of a 0.5% isobaric solution of levobupivacaine (10 mg), in the X15 group (n = 30) - 3 ml of a similar solution (15 mg). Results. The time to the motor blockade of Bromage I in the study groups was 9 ± 3 min versus 8 ± 3 min, p = 0.154, to Bromage III - 18 ± 7 min versus 13 ± 3 min, p = 0.001. In group X10 motor blockade did not develop in 1, reached only the first degree - in 1, only the second degree - in 5 patients. In the X15 group, all patients underwent motor blockade of the third degree, except for 2 patients, in whom block reached only the second degree. The maximum level of sensory blockade in the group X10 was Th8, X15 - Th9. In the X10 group, the upper blockade level, not exceeding Th11, was observed in 11 (44%), and in the X15 group - in 17 (57%) patients. In 6 cases of the X10 group (24%) and 5 cases of the X15 group (17%) had to add sedation or general anesthesia. The duration of motor blockade before the beginning of recovery was 163 ± 57 min versus 195 ± 66 min, p = 0.076, until the motor block regressed completely - 219 ± 66 min versus 290 ± 90 min, p = 0.002. Arterial hypotension was observed in one patient group X10 (4%) and 0 group X15, bradycardia in 7 (28%) and 7 (23%) patients, respectively. There were no transient neurologic symptoms in any cases. Conclusions. Spinal anesthesia with isobaric levobupivacaine was characterized by a slow development of the complete motor block, unpredictably low upper level of the sensory blockade and a long-lasting motor block. It can be used in patients with high risk of arterial hypotension or transient neurologic symptoms, provided sufficient time is available before the operation, the possibility of sedation and / or the addition of general anesthesia.
Regional Anesthesia and Acute Pain Management. 2018;12(1):30-36
pages 30-36 views

ASSESSMENT OF RECTUS SHEATH BLOCK EFFECTIVENESS AFTER MAJOR ABDOMINAL SURGERY

Sholin I.Y., Avetisyan V.A., Ezugbaia B.S., Zhikharev V.A., Koryachkin V.A.

Abstract

Objective. Assessment of rectus sheatus block effectiveness after major abdominal surgery. Material and methods. 120 patients after gastrectomy and pancreatoduodenal resections were examined. In the postoperative period, patients of the 1st group (n = 40) were given epidural infusion of 0.2% solution of ropivacaine 5 ml / h, patients of the 2nd (n = 40) and 3rd groups (n = 40) in the rectus sheatus introduced 10 ml of a 0.375% solution of ropivacaine with an interval of 8 hours and a constant infusion of 0.2% solution of ropivacaine 5 ml/h were bolus administered respectively. The intensity of the pain syndrome was assessed at rest and during mobilization, and frequency the need for additional of narcotics, suppuration, and patient satisfaction. Results. The intensity of the pain syndrome for 48 hours had no significant difference. The need for drugs in the 2nd group was less than in the 1st and 3rd groups. The incidence of wound suppuration between the groups did not differ significantly. The patient’s satisfaction with analgesia was 3.8 ± 0.44 points in the 2nd group, 2.7 ± 0.88 points and 2.6 ± 0.73 points in the 1st and 2nd groups (p <0, 05). Conclusion. The bolus injection of a local anesthetic solution into the of rectus sheatus after extensive abdominal operations provides postoperative analgesia comparable to epidural analgesia, does not require special skills from an anesthesiologist, is safe and effective.
Regional Anesthesia and Acute Pain Management. 2018;12(1):37-40
pages 37-40 views

PREVENTION OF POSTOPERATIVE DELIRIUM IN PATIENTS OF ELDERLY AND SENILE AGE IN ORTHOPEDIC PRACTICE

Sokolov S.V., Zabolotskii D.V., Koryachkin V.A.

Abstract

The aim of the study was to reduce the frequency of postoperative delirium development in elderly and elderly patients who underwent operative intervention on the hip and knee joints, acetabulum, tubular bones of the lower limb by epidural morphine administration. Materials and methods: a retrospective analysis of the medical records of 113 patients of the Department of Traumatology and Orthopedics was performed, during which two groups of patients were compared, in one of which epidural analgesia was supplemented with the administration of 3 mg of morphine epidurally, in the second, regional anesthesia combined with a systemic introduction of analgesics; the obtained data were processed using statistical analysis methods. Conclusion: the study found that in patients who underwent analgesia by epidural administration of 3mg of 1% morphine solution, the frequency of postoperative delirium development was significantly lower than in the group with systemic analgesia.
Regional Anesthesia and Acute Pain Management. 2018;12(1):41-46
pages 41-46 views

THE CENTRAL HEMODYNAMIC STATE IN DIABETES PATIENTS DURING LOW LIMB SURGERY

Sokologorskiy S.V., Sheina M.A., Zvyagin A.A., Orudzheva S.A.

Abstract

Background: As diabetes takes on pandemic proportions, more than 1000000 patients undergo some kind of low limb surgery yearly. While peripheral hemodynamic state during such kind of surgery in these patients has been studied quite well in various anesthesia technique, the central hemodynamic state and systemic oxygen delivery remain unclear. Objective: To evaluate a single-injection nerve block vs spinal anesthesia influence on central and peripheral hemodynamics and systemic oxygen delivery during low limb surgery in diabetes patients. Design: A prospective cohort study. Setting: Federal scientific centre. Patients: 31 diabetes patients during elective low limb surgery under single-injection nerve block and spinal anesthesia. Intervention: Patients were randomly allocated to one of the two groups according the anesthesia technique - either a single-injection nerve block or spinal anesthesia. Main outcome measures: Levels of cardiac index mean arterial pressure, oxygen delivery index, glycaemia and VAS scores were evaluated on five time points: 24 hours before surgery, during surgery, before discharging from operating room, 6 and 24 hours after surgery respectively. Results. Levels of cardiac, systemic vascular resistance and oxygen delivery indexes together with mean arterial pressure had no statistically significant differences in time points in group received single-injection nerve block technique. These patients had full pain relief even in 6 hours after surgery and 24 hours after surgery their VAS pain scores were not more than 3. A single-injection nerve block technique shown its prolonged pain-relief effect with minimal systemic side effect. In patients with spinal anesthesia technique statistically significant decreases of mean arterial pressure and systemic vascular resistance with parallel cardiac index increase in time points were observed. In 6 hours after surgery, their VAS pain scores were not more 2 and 24 hours after surgery not more than 4. Spinal anesthesia once more shown to be reliable and effective but not long-acting intraoperative anesthesia technique. Additional postoperative pain relief necessity is a specific spinal technique problem. Conclusion: The results of the study showed that a single-injection nerve block technique due to its low influence on systemic circulation is more preferable in patients with compromised circulation system, while spinal technique may be used in patients with no heart and vascular disturbances. More clinical investigations must be done to evaluate central hemodynamic changes during these types of anesthesia in diabetes patients more precisely.
Regional Anesthesia and Acute Pain Management. 2018;12(1):47-54
pages 47-54 views

CAUDAL EPIDURAL ANESTHESIA IN PEDIATRIC PATIENTS

Matinyan N.V., Zabolotski D.V., Martynov L.A., Letyagin I.A.

Abstract

Caudal epidural block is the most widely used regional anesthetic technique in children. Its popularity in pediatric anesthesia is mainly due to its broad spectrum of indications, high success rates, and a relative low incidence of complications. The caudal epidural block is generally used for not only lower abdominal or lower extremity surgery but also for upper abdominal surgery via administration of adjuncts such as morphine, which has hydrosoluble potential. The indications, contraindications and technique of caudal epidural block are presented.
Regional Anesthesia and Acute Pain Management. 2018;12(1):55-63
pages 55-63 views

THE OLD TECHNIQUE OF COMBINED SPINAL-EPIDURAL ANESTHESIA AND NEW OPPORTUNITIES FOR ITS IMPLEMENTATION

Ovechkin A.M., Sokologorskiy S.V.

Abstract

The article contains brief information about the history of combined spinalepidural anesthesia (CSEA), the main areas of its application and the main techniques for its implementation with analysis of their advantages and disadvantages. In addition, there is provided the information on the emergence of a new set for CSEA implementation on Russian market that allows to improve the efficiency and safety of this technique.
Regional Anesthesia and Acute Pain Management. 2018;12(1):64-67
pages 64-67 views

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