Vol 12, No 1 (2018)

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.

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.

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.

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.

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.