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Vol 14, No 1 (2020)

Cover Page

Editorial

Peripheral nerve blocks and ultrasound navigation

Koryachkin V.A.

Abstract

The use of ultrasound in anesthetic practice has contributed to the creation of new techniques for blocking peripheral nerves (PEC I, PEC II, TAP-block, QL-block, IPACK). At the same time, the creation of new blocks with ultrasound navigation deepens the gap between more experienced anesthesiologists and their younger colleagues who prefer to avoid the use of regional anesthesia. A way out of this situation seems to us to create and introduce into practice a list of “basic” methods of regional anesthesia, which can provide anesthesia during the most frequently performed surgical interventions. We believe that there is every reason to change the paradigm «many blockades for the elite» to «several blockades for all».

Regional Anesthesia and Acute Pain Management. 2020;14(1):4-5
pages 4-5 views

Reviews

Regional anesthesia and COVID-19

Safin R.R., Koriachkin V.A., Geraskov E.V., Zabolotskii D.V.

Abstract

In the light of the spread of COVID-19, the anesthesiology services has been challenged with an urgent need to ensure safety of the practicing professionals. Suggesting no manipulations on face-to-face contacts, regional anesthesia has proved to be the most appropriate method of anesthesia in the situation of the COVID-19 pandemic. The review outlines indications for recommending regional anesthesia to patients diagnosed with COVID-19 and offers safety rules of its conduction. Any detailed and substantiated treatment plan for the patient category under discussion shall enable not only the recovery of the patient, but also the safety of the medical workers.

Regional Anesthesia and Acute Pain Management. 2020;14(1):6-11
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Original articles

Effects of different analgesia methods on early mobilization after knee join replacements

Morozov D.V., Boronina I.V., Ryabtseva A.A.

Abstract

Rationale. Knee join replacement is accompanied by intensive pain syndrome. Prolonged blocks of branches of sciatic and femoral nerves are the most effective. Apart from sensory block and analgesia some types of blocks cause motor block of lower extremities, particularly quadriceps muscle of thigh which may prevent patients’ mobilization. In this connection, the choice of anesthesia strategy is significant concerning the use of prolonged blocks of the branches of sciatic and femoral nerves maintaining the motor function of the lower extremities with adequate analgesia.

The goal of the study is to select a method of pain relief after knee replacement that provides adequate analgesia while maintaining the motor function of the lower limb muscles.

Material and methods. The investigation was carried out in patients undergone knee join replacement according to standard procedure. The operation was performed under combined anaesthesia: spinal anaesthesia plus prolonged block of tibial nerve and femoral nerve or femoral triangle block with perineural space catheterization. The block with the use of local anesthetic in the analgesic concentration for postoperative analgesia during 3 postoperative days. All participants were divided into four groups according to the combinations of the blocks.

Results. The combination of block of branches of sciatic and femoral nervessignificantly improves the quality of postoperative analgesia on the first postoperative day. The block in femoral triangle (subsartorial) in comparison with the block of femoral nerve is accompanied by significantly less weakness of quadriceps muscle of thigh at the equal analgesic potency.

Conclusions. Maintaining the motor function of quadriceps muscle of thigh with the use of the prolonged block in femoral triangle for analgesia can be of certain advantage for patients’ mobilization in the early postoperative period (fast track).

Regional Anesthesia and Acute Pain Management. 2020;14(1):12-18
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Neuroaxial methods analgesia of labour

Nejmark M.I., Ivanova O.S.

Abstract

The aim of study is a comparative evaluation of the efficacy and safrty of ultra-low-dose spinal analgesia, epidural and paravertebral analgesia to labor pain relief.

Material and methods. Four groups of 40 women tookpart in the study: one group is 40 patients, the labor pain was relieved by epidural analgesia. The second group consisted of 40 women in labor, anesthesia was carried out with ultra-low-dose spinal analgesia, 3rd group is 40 women who were anesthetized with paravertebral analgesia. The control group is 40 patients without anesthesia. The parameters of central hemodynamics were monitored: heart rate, blood pressure, mean arterial pressure. The motor block was estimated on the Bromag escale. The dynamics of the opening of the cervix, the duration of the first and second stages of labor was estimated. Implications and negative inluence of the anesthesia, the effect of analgesia on the fetus were also registered.

Results. Epidural analgesia showed high efficiency and safety, but the frequency of hypotension in this group was significantly higher than in other groups, an inrease in the positivity of the exacerbation period was found. Ultra-low-dose spinal analgesia also had a sufficient analgesic effect in the first stage of labor. However, short-termeffect did not always provide effective analgesia of the second period of labor in comparison with other methods. In general the advantages of paravertebral analgesia in the form of a significant acceleration of cervical dilatation and a decrease in the time of delivery are revealrd. There were no cfses with score of «2» of Bromage scale of a motor block with paravertebral analgesia, while in the epidural group and the ultra-low-dose spinal analgesia isolated cases with a score of «1» and «2» were encountered. Paravertebral analgesia does not result to hypotensionas against other neuro-axial methods of analgesia.

Conclusion. Neuroaxialmethods provide a sufficient level of analgesia can reduse anomalies of labor and do not affect negatively the fetus. All presented methods of analgesia have their place in obstetric anesthesiology. There is the possibility of choosing the most appropriate method of anesthesiain every obstetrical situation.

Regional Anesthesia and Acute Pain Management. 2020;14(1):19-25
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Case report

Dexmedetomidine as an adjuvant to local anesthetics in ophthalmic surgery

Oleshchenko I.G., Zabolotskii D.V., Iureva T.N., Koryachkin V.A., Kuzmin S.V.

Abstract

Vitreoretinal surgery aims to restore the structural relationships of the posterior segment of the eye, with the possibility of partial or complete restoration of visual functions, and imposes certain requirements to the anesthetic support of operations. These are injuries, operations length, age, and concomitant pathology of organs and systems of patients. In this regard, there is a recent tendency to use different pharmacological groups as adjuvants to local anesthetics to enhance or prolong their analgesic effect. Purpose to evaluate the effectiveness of dexmedetomidine as an adjuvant in retrobulbar blockades. Materials and methods. Retrobulbar block bupivacaine with dexmedetomidine at a dose of 0.25 mg/kg was performe in the 1st group (n = 22), retrobulbar block was performed with a mixture of bupivacaine in the 2nd group (n = 22). Changes in hemodynamics at the stages of surgery were evaluated. To assess the oxidative status, the evaluation of the redox coefficient (FORT/FORD) was conducted before and after the surgery. The level of comfort of the operation by the surgeon and the patient. Assessment of pain was performed by a VRS in the points. Results. In patients of the 1st group the decrease in SAD was more pronounced and persisted throughout the entire period of surgical treatment. 54.5% of patients of group 1 and 18% of group 2 had no pain 8 hours after the surgery. 82% of patients of group 2 reported moderate pain that required medication (p < 0,05). In patients of group 1, it increased from 0.45 ± 0.5 to 0.62 ± 0.2 (p < 0,005) by 37% of the initial value, in patients of group 2, it was shown to decrease by 5% (p > 0,05). In group 1, the comfort of the operation was estimated by ophthalmic surgeons as «satisfactory» in 77.3%, and in group 2 in 54.5% (p < 0,05). Conclusion. The use of dexmedetomidine as an adjuvant of local anesthetics in ophthalmic surgery provides the necessary analgesia, hemodynamic profile of the patient, antioxidant effect and affects the quality of the surgeon’s work, which affects the duration of operations.

Regional Anesthesia and Acute Pain Management. 2020;14(1):26-32
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Epidural analgesia for childbirth in pregnant with COVID-19

Oreshnikov E.V., Denisova T.G., Vasilyeva E.N., Safin R.R.

Abstract

One clinical case is presented. Specific feature of this case was the presence of COVID-19. She-patient was suffering during painful and severe course of labor. Childbirth was successfully performed under epidural analgesia. Epidemiological anamnesis of this she-patient and necessarity to work according to special regulations in third-level protective equipment determined the specificity and exclusive feature of this clinical case.

Regional Anesthesia and Acute Pain Management. 2020;14(1):33-35
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Chest pain after thyroidectomy (examination of a clinical case)

Bayalieva A.Z., Gardanov S.D., Surikov A.A.

Abstract

Our patient’s early post-operative period was complicated by severe pain behind the sternum not associated with acute coronary syndrome. On the 7th day after the operation, the patient died of mediastinitis, which was complicated by severe sepsis and multiple organ failure. On autopsy, the damage to the posterior wall of the esophagus occurred as a result of compression trauma against cervical and thoracic spine osteophytes during hemithyroidectomy.

Regional Anesthesia and Acute Pain Management. 2020;14(1):36-40
pages 36-40 views

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