Vol 10, No 1 (2016)

The review is concerned with the summarizing, systematization and analysis of the results of current clinical studies of the use of regional techniques of anesthesia during the spine surgery and spinal cord surgery on the intraoperative stage, as well as regional techniques of postoperative pain management. The current review represents new data concerning description of various regional techniques of anesthesia, the different choice of anesthesia and analgesia, depending on the type of surgery and used drugs. The present overview will focus on possibilities of the use of regional anesthesia at various stages of surgery, including prolonged analgesia in the postoperative period and options combinations of drugs and techniques themselves. We have suggested that there are new opportunities to improve the safety of anesthesia, reduce the number of side effects, as well as finding new solutions for collaborative use of regional anesthesia and neurophysiological monitoring, development of optimal schemes of anesthesia, which should contribute to a better understanding of the issue and expand the possibilities of using the achievements of anesthesiology in medical practice. Although regional techniques are increasingly demonstrating its advantages over general anesthesia, including spine surgery, further research is mandatory in this field of medicine to determine their influence on the surgery outcome of the treatment and the patient's recovery as a whole.

Modern postoperative analgesia - is an individual selection of optimal doses of analgesics in order to obtain high efficiency of analgesia with minimal side effects. The quality and safety of postoperative pain is largely dependent on the severity of pain immediately after the operation. The aim of the study was to compare the efficacy of visual analogue scale (VAS) and the new scale of efficiency and safety (ESS) of postoperative analgesia in predicting of the severity of pain and postoperative complications. The study was conducted in 209 patients (mean age (66-77) years), in which a major surgery on the abdominal organs were routinely performed. Patients were randomized into two groups, depending on the method of evaluating of the quality of analgesia: in group 1 is controlled via ESS (n = 102), the 2nd group - by VAS (n = 105). Postoperative complications were recorded: nausea and vomiting, respiratory failure (need for noninvasive or invasive ventilation), delirium, cardiac arrhythmias, ileus. ESS and VAS demonstrated good prediction of the effectiveness of pain relief (AUROC 0,973, [0,913-0,996] and 0.976 [0,913-0,997], respectively). ESS showed a good prediction of the complicated postoperative period (AUROC = 0,924, [0,856-0,967]), as opposed to the VAS (AUROC = 0,649, [0,548-0,741]). Baseline ESS and VAS score equally effective in predicting the intensity of pain in the early postoperative period. ESS advantage, compared to VAS, is the ability to predict complicated postoperative period and postoperative complications. ESS score for more than 17 is a risk factor for postoperative complications associated with inadequate analgesia.

At 190 patients with carotid endarterectomy the relative assessment of total intravenous anaesthesia with use propofol, penetrating blockage of a cervical plexus and inhalation sevofluran is made. Cerebral circulation parametres, markers of cerebral damage, a state of the highest mental functions were investigated. It is shown that for each kind of anaesthesia specific changes of parametres of the cerebral blood-groove, defining level neuronal damages that affects on a state of number and character of postoperative complications are characteristic.

The article is devoted to summing up the work of the Federation of anesthesiologists and reanimatologists of Russia and proposing the prospects of its development.