Vol 8, No 4 (2014)

The goal of the study was to determine recommendations to improve the effectiveness and safety of anesthetic management during surgical procedures on the clavicle. The article analyzes results of completed regional blockade of brachial plexus in 67 patients. Group A consisted of 27 patients who underwent brachial plexus block with ropivacaine 0.75% in the volume of 30.0 ml. Group B included 27 patients who underwent blockade of ventral spinal nerves C5, C6, C7, C8, Th1 and anesthesia superficial cervical plexus branches. Group С included 13 patients who underwent blockade of ventral spinal nerves C5, C6, C7, C8, Th1. It was found that the most effective and safe anesthesia for clavicle area surgery includes brachial plexus block of ventral spinal nerves performed with minimal doses administration of local anesthetics at C5, C6, C7, C8, Th1 level and additional block of branches of superficial cervical plexus. This technique reduces incidence of complications associated with systemic toxicity and other side effects of local anesthetic.

Saddle block is a form of selective spinal anesthesia used during proctological, urological, and gynecological surgeries. A prospective randomized trial included 45 patients who had been operated on for hemorrhoids. According to the volume of an anesthetic injected into the subarachnoid space, the patients were randomized to 3 groups: 1) 15 patients received 1 ml (5 mg) of hyperbaric bupivacaine solution; 2) 15 had 1.5 ml (7.5 mg); 3) 15 had 2 ml (10 mg). The development of spinal saddle anesthesia was dose-dependent. Raising the dose of the hyperbaric solution of a local anesthetic resulted in an increase in the volume and duration of spinal anesthesia. Painful sensations appeared in 13.6% of the patients receiving its dose of 5 mg. The use of 10 mg of the anesthetic led to the development of the spinal anesthesia exceeding the volume of saddle block. The optimal dose for selective saddle anesthesia is 7.5 mg of hyperbaric bupivacaine solution.

The guidelines present approaches to indication and interruption of long-term antithrombotic and anticoagulant therapy in perioperative period, as well as current concepts of performing regional anesthesia in patients, receiving antithrombotic and anticoagulant therapy. The guidelines are based on the Guidelines, issued by European Society of Anesthesiology, 2010, and analytical overview of recommendations of various national societies of regional anesthesia.

The paper presents short historical review devoted to the methods and techniques of local and regional anesthesia and analgesia in pediatrics. The material covers the period beginning from the end of XIX century up to nowadays time and includes reports about landmark events and studies, taken place all over the world.