RU2135222C1 - Method of balanced regional anesthesia - Google Patents

Abstract

FIELD: anesthesiology. SUBSTANCE: premedication is accomplished by applying clofelin in dose 0.075-0.15 mg sublingually 30 min before operation or in dose 0.1-0.2 mg intravenously immediately before anesthesia, the latter being performed by combining local anesthetic in accepted doses and 0.1-0.2 mg clofelin to its summary dose 2-4 mg/kg. EFFECT: prevented respiratory depression and hemodynamic disorders, and prolonged anesthesia.

Description

 The invention relates to medicine, in particular to anesthesiology.

 There are various methods of regional anesthesia, when a solution of local anesthetic is injected along the nerve trunks or plexuses, providing complete surgical anesthesia due to blockade of pain impulse while maintaining normal vital functions of the body (trunk, plexus anesthesia) (Pashchuk A.Yu. Regional anesthesia. M. : Honey., 1987 and others.].

 One of the disadvantages of this method is the negative psychoemotional background of the patient before and after performing anesthesia, the effect of the patient’s “presence” during surgery, the appearance of pain after the end of local anesthetics, hemodynamic instability due to psycho-emotional stress, resorptive action of local anesthetics, etc. [Hapiy XX Modern methods of regional anesthesia: complications, their prevention and treatment. M., 1988 and others].

 Closest to the claimed method is the so-called. modern balanced regional anesthesia [Tomlin & Gjes-sing, 1978.- Cit. by V.I. Zagrekov. Abstracts X All-Russian. Plenum Anest. and rean., N. Novgorod, 1995, p. 19-20], which includes, along with analgesia, plegia and muscle relaxation, achieved using a combination of local anesthetic, narcotic analgesic and adrenaline, administered perineurally, also the problem of the patient’s “presence” in the operating room, which is solved by intravenous administration of narcotic analgesics, sedatives funds, and often ketamine with sub-narcotic doses.

 The disadvantages of the prototype are an increase in cases of intra- and postoperative respiratory depression and hemodynamics, which negatively affects regional blood circulation, microcirculation and tissue metabolism [Ryabov G. A. Hypoxia of critical conditions. M.: Med., 1988, etc.] and ultimately determines the outcome of the disease, the timing of recovery, and also increases the risk of anesthesia. In addition, perineural administration of narcotic analgesics to prolong regional anesthesia can also lead to the aforementioned complications, especially in malnourished patients, in elderly patients, and the use of adrenaline in a local anesthetic solution not only does not reduce the resorption of the latter from tissues [Bernard J.V. et al. Ann. fr. Anesth. Reanim 1989, Vol. 8, Suppl.l, P. 196], but also, especially if the recommended proportions are not observed, it can lead to ischemic lesions of the nerve trunks [Selander D. et al. Acta Anaesth. Scand. 1979, Vol. 23, N l, P. 27-33], as well as uncontrolled hyperdynamic reactions.

 The objective of the invention is the provision of balanced regional (plexus, stem) anesthesia with deep neurovegetative protection, patient sedation during surgery without respiratory depression and hemodynamics, good postoperative analgesia, prolongation of the duration of anesthesia by combining local anesthetic with central adrenomimetic clonidine and intravenously perivenurally .

 The task is carried out in that premedication is carried out by administering clonidine 0.075-0.15 mg sublingually 30 minutes before surgery or 0.1-0.2 mg intravenously immediately before anesthesia is performed, and the anesthesia itself is performed using a combination of local anesthetic in generally accepted dosages and 0.1-0.2 mg of clonidine. the total dose of clonidine is 2-4 mg / kg weight.

 The proposed method of balanced regional (stem, plexus) anesthesia is based on the current understanding of the adrenergic mechanisms of nociception and antinociception [Ignatov Yu. D., Zaitsev A. A. Neurochemical analysis of the role of adrenergic processes in pain regulation. L., 1986].

 The use of clonidine central adrenomimetic (as part of premedication and perineurally) provides an increase in the threshold of pain sensitivity, sedation of varying severity up to superficial sleep from the moment the patient enters the operating room, good neurovegetative defense, prolongation of local anesthetics, and pronounced postoperative analgesia. This result is explained by the effect of clonidine on the adrenergic structures of the nociceptive and antinociceptive systems at the segmental and suprasegmental levels.

 Studies have shown that clonidine at a dose of 2-4 μg / kg does not have a depressing effect on hemodynamic parameters, stabilizing blood pressure in somatically healthy patients and slightly lowering it (by 15-20%) in hypertensive patients, provided that they were not taken him constantly. With threatening bradycardia, cholinolytics were used intraoperatively after clonidine administration (atropine 0.5-1.0 mg intravenously).

 The method is as follows. Clonidine at a dose of 0.075 - 0.15 mg sublingually 30 minutes before surgery or 0.1-0.2 mg iv slowly (1-2 mg / kg) immediately in the operating room before anesthesia is included in premedication. Conduction (trunk, plexus) anesthesia is performed by any method, and a solution of local anesthetic is administered perineurally in the usual dosage with the addition of 0.1-0.2 mg (1-2 mg / kg) of clonidine. The total dose of clonidine administered is therefore 2-4 mg / kg. During the operation, infusion corrective therapy, monitoring of blood pressure, pulse oximetry, and, if necessary, ECG, hourly diuresis are performed.

 In all patients with the use of regional (stem, plexus) anesthesia using clonidine, there were no significant signs of respiratory depression. There was no decrease in tidal volume, decrease in respiratory rate, changes in physiological dead space, KHS, saturation of arterial blood with oxygen (SpO2). Changes in the gas composition of arterial and venous blood suggest a decrease in shunting and an increase in oxygen utilization in tissues.

 It was noted that the course of regional (stem, plexus) anesthesia was prolonged by an average of 1.4-1.6 times compared with the classical anesthesia technique with the combination of local anesthetic + narcotic analgesic + adrenaline.

 Example. Patient K., 24 years old, weight 70 kg, was operated on for a closed fracture of the right shoulder in the middle third. Operation - osteosynthesis of the humerus with a metal plate. Duration of operation 90 min. In the ward 30 minutes before anesthesia (BP 125/75 mm Hg, heart rate 72 beats / min) received 0.15 mg of clonidine sublingually. In the operating room, in a state of moderate sedation, plexus anesthesia of the right brachial plexus according to Kulenkampfu. After receiving paresthesia, perineurally administered 40 ml of 1% solution of lidocaine and 1 ml of 0.01% solution of clonidine. The patient did not experience a negative attitude to the procedure. Anesthesia after 12 minutes of good quality (muscle relaxation, plegia of the limbs, anesthesia) lasted for 3.5 hours. During the operation, the patient was in a state of light sleep. Hemodynamics is stable. HELL 120/70 mm. Hg. Art., heart rate 64 beats / min. No respiratory depression was noted. BH 16 per minute, SpO2 99%. The postoperative period was characterized by postanalgesia - once per day of night surgery, promedol 20 mg IM was administered, and further use of narcotic analgesics was not required. The wound healed by first intention, the sutures were removed on the 7th day, the patient was discharged on the 10th day.

 The method was applied in 24 patients during orthopedic operations on the limbs at the State Scientific and Clinical Center for Miners' Health.

 The use of clonidine as a component of balanced regional (stem, plexus) anesthesia provided an even postoperative period, characterized by various degrees of analgesia, which can dramatically reduce the need for analgesics, including narcotic drugs, or completely abandon them. In addition, improved microcirculation creates good conditions for improving reparative processes, which is important in various fields of surgery.

Claims (1)

 A method of balanced regional (stem, plexus) anesthesia, including perineural administration of a local anesthetic, characterized in that premedication is carried out by administering clonidine 0.075-0.15 mg sublingually 30 minutes before surgery or 0.1-0.2 mg intravenously immediately before anesthesia, and the anesthesia itself is performed by a combination of local anesthetic in generally accepted dosages and 0.1-0.2 mg of clonidine, while the total dose of clonidine is 2-4 mg / kg of body weight.