RU2284817C1 - Method for prolonged subpleural anesthetization - Google Patents

Abstract

FIELD: medicine, endoscopic surgery.

SUBSTANCE: the present innovation deals with treating traumas of organs of thoracic cavity. For this purpose, at the side of the lesion in V intercostal area along posterior axillary line one should apply a thoracoscope, then through jugular fossa at the root of a lung at the side of predominant lesion one should introduce a polyvinyl chloride catheter through which one should carry out a 2-h-long infusion of 0.25%-novocaine at the rate of 10 drops/min during the 1^st h. At the absence of Horner's syndrome at the side of the lesion 1 h after the onset of infusion it is necessary to increase the tempo of infusion up to 15 drops/min. At observing Horner's syndrome the tempo of infusion should be remained the same. Anesthetization should be repeated thrice for 5 d. The innovation enables to provide prolonged blockade of reflexogenous areas of mediastinum, regulate the volume of applied anesthetic depending upon the efficiency of observed analgesia and, also, decrease stress impact of curative procedures due to high accuracy of blockades without carrying out thoracotomy.

EFFECT: higher efficiency.

2 ex

Description

The invention relates to medicine, namely to endoscopic surgery, and can be used for prolonged subpleural anesthesia in the treatment of injuries of the chest cavity.

A known method of regional analgesia after intrathoracic surgery, achieved by epidural infusion of 0.01% morphine with an infusion rate of 2 ml / h on the first day after surgery and 1 ml / h on the second with additional single injections of 1% lidocaine solution of 10 ml [Matveev A. T. Regional analgesia after intrathoracic surgery. // Anesthesiology and resuscitation. 1990, No. 2.-C.71-75].

There is a method of subpleural anesthesia in the treatment of injuries of the chest cavity, in which the anesthetic is injected into the intercostal (subpleural) space from one point located in the region of the angle of the rib [Vagner EA, Matveev A.T. Methods of regional analgesia for closed chest injury. // Bulletin of the Academy of Medical Sciences of the USSR. 1990, No. 3. - S.40-43].

There is a method of sternum novocaine blockade in the position of the patient on the back. A roller is placed under the shoulders, the head is thrown back. In the region of the suprasternal fossa after intradermal anesthesia and the administration of up to 10 ml of novocaine, which extends the gap between the posterior wall of the sternum and vessels of the anterior mediastinum, a curved needle of 15-18 cm long is inserted. A long needle, sliding along the posterior wall of the sternum, enters the anterior mediastinum, and then 50-60 ml of a 0.5% solution of novocaine are introduced into the area of the aortic arch [Chernov V.N. et al. Emergency surgery. - Rostov-on-Don, Publishing House Rost University, 1997, 320 pp.].

A known method of prolonged subpleural anesthesia in the treatment of injuries of the chest cavity, in which under the control of a thoracoscope for blocking the phrenic nerve along its path above the pericardium, a 0.25% solution of novocaine in the amount of 10-15 ml is administered, and 60-80 ml is administered for the vagus nerve block 0.25% solution of novocaine under the pleura along the posterior surface of the root of the lung: on the right - under the arc of an unpaired vein, on the left - under the aortic arch. Blockade of the sympathetic trunk is performed by introducing 20-30 ml of a 0.25% solution of novocaine under the pleura along the nerve at the level of Th _III -Th _V [Avilova OM et al. Thoracoscopy in emergency breast surgery. -Kiev: Zdorov'ya, 1986. - C.57-58] (prototype).

The disadvantages of these methods include:

1) The methods do not allow to achieve a prolonged blockade of the reflexogenic zones of the mediastinum;

2) The methods do not allow you to adjust the amount of anesthetic administered depending on the effectiveness of the onset of analgesia;

3) The methods do not allow use during medical or diagnostic thoracoscopy;

4) The blockade of the reflexogenic zones of the mediastinum by known methods with high accuracy can be performed either when performing thoracotomy, or its accuracy is significantly reduced.

The objective of the invention is the elimination of these disadvantages due to the infusion of 0.5% solution of novocaine into the fiber of the root of the lung.

The task is achieved in that a thoracoscope is inserted into the V intercostal space on the side of the injury along the posterior axillary line, through the suprasternal fossa at the root of the lung, a polyvinyl chloride catheter is installed on the side of the prevailing damage and a 2-hour infusion of 0.25% novocaine is performed at a rate of 10 drops per minute during the first hour, while in the absence of Claude Bernard-Horner syndrome on the damage side, an hour after the start of the infusion, the infusion rate is increased to 15 drops per minute, and when this syndrome appears, the infusion rate of the remainder as before, anesthesia is repeated three times within 5 days.

The method is as follows.

The victim is laid on his back, a roller is placed under his shoulders, his head is thrown back. A 2.8 mm trocar is placed in the region of the suprasternal fossa. A thoracoscope is inserted into the V intercostal space on the side of the lesion along the posterior axillary line, through a 2.8 mm trocar installed in the suprasternal fossa, a colored green diamond-colored polyvinyl chloride conductor is inserted into the posterior mediastinum, under the control of the thoracoscope, the conductor is subpleurally inserted to the lung root on the side of the predominant damage. A polyvinyl chloride catheter is installed along the conductor under the control of the thoracoscope. The catheter is connected to the infusion system, a 2-hour infusion of 0.25% novocaine is performed at a rate of 10 drops per minute for the first hour, while in the absence of Claude Bernard-Horner syndrome on the injured side, an hour after the start of the infusion, the infusion rate is increased to 15 drops per minute, and when this syndrome appears, the infusion rate is left unchanged, anesthesia is repeated three times within 5 days.

The method was tested in 9 patients in OMST GorbSMP №2, Rostov-on-Don.

An example of a specific implementation of the method.

Example 1. Patient G-s, 45 years old, medical history No. 56/38, was admitted to OMST GORBSMP No. 2 8.01.2004 years with a closed chest injury complicated by pleuropulmonary shock. From the history of injury it is known - beaten by unknowns. On the chest x-ray, there are fractures of the III-VIII ribs in the middle axillary line on the left, a fracture of III-IV ribs in the middle axillary line on the right, left-side hemopneumothorax. The victim was laid on his back and put into anesthesia. They put a roller under his shoulders, his head was thrown back. A 2.8 mm trocar was placed in the region of the suprasternal fossa. A thoracoscope was inserted into the V intercostal space along the posterior axillary line on the left, through a 2.8 mm trocar installed in the suprasternal fossa, under the control of the thoracoscope, a PVC-colored conductor painted with brilliant green was introduced into the posterior mediastinum, the conductor was subpleurally introduced to the root of the left lung. A polyvinyl chloride catheter was installed along the conductor under the control of a thoracoscope. The catheter was connected to the infusion system. The right pleural cavity was drained through a trocar incision in the V intercostal space along the posterior axillary line. The infusion rate of 0.25% novocaine is 10 drops per minute. Claude Bernard-Horner syndrome on the left appeared after 1 hour, the rate of infusion was the same, the duration of the infusion was 2 hours. Claude Bernard-Horner syndrome on the left appeared after 1 hour, the rate of infusion was the same. Pleuropulmonary shock stopped. Prolonged subpleural anesthesia was repeated three times for 5 days. At the follow-up examination after 6 months, the patient's condition is satisfactory, no complaints. Continues to work in the specialty.

Example 2. Patient L-s, a medical history No. 343/198, was admitted to the Department of Oncology and Mental Health, GFSPS No. 2 on March 6, 2004 with a closed chest injury complicated by pleuropulmonary shock. From the history of injury it is known - accident. On the chest x-ray, there are fractures of the III-IX ribs in the middle axillary line on the right, a fracture of III-IV ribs in the middle axillary line on the left, middle right hemopneumothorax. The victim was laid on his back and put into anesthesia. They put a roller under his shoulders, his head was thrown back. A 2.8 mm trocar was placed in the region of the suprasternal fossa. A thoracoscope was inserted into the V intercostal space along the posterior axillary line on the right, through a 2.8 mm trocar installed in the suprasternal fossa, under the control of the thoracoscope, a PVC-colored conductor painted with brilliant green was introduced into the posterior mediastinum, the conductor was subpleurally introduced to the root of the right lung. A polyvinyl chloride catheter was installed along the conductor under the control of a thoracoscope. The catheter was connected to the infusion system. The right pleural cavity was drained through a trocar incision in the V intercostal space along the posterior axillary line. The infusion rate was 0.25% novocaine 10 drops per minute, Claude Bernard-Horner syndrome was not detected on the right after 1 hour, the infusion rate was increased to 15 drops per minute, Claude Bernard-Horner syndrome appeared on the right, the total duration of the infusion was 2 hours. The postoperative period without complications. At the follow-up examination after 6 months, the patient's condition is satisfactory, no complaints. Continues to work in the specialty.

Thus, in comparison with the prototype method has the following advantages:

1) The method does not allow to achieve a prolonged blockade of the reflexogenic zones of the mediastinum when performing therapeutic or diagnostic thoracoscopy;

2) The method allows you to adjust the amount of anesthetic administered depending on the effectiveness of the onset of analgesia;

3) The blockade of the reflexogenic zones of the mediastinum is achieved with high accuracy without performing thoracotomy, which significantly reduces the overall aggressiveness of therapeutic effects.

The above advantages of the method can improve the quality of surgical care for patients with a closed chest injury, providing optimal blockade of the reflexogenic zones of the mediastinum, especially with pleuropulmonary shock.

Claims (1)

A method of prolonged subpleural anesthesia under the control of a thoracoscope, characterized in that the thoracoscope is inserted into the V intercostal space on the side of the lesion along the posterior axillary line, a polyvinyl chloride catheter is inserted through the suprasternal fossa at the root of the lung on the side of the prevailing lesion and a 2-hour infusion of 0.25% novocaine into at a rate of 10 drops per minute for the first hour, while in the absence of Claude Bernard-Horner syndrome on the damage side, an hour after the start of the infusion, the infusion rate is increased to 15 Apel per minute, and when this syndrome appears, the rate of infusion is left unchanged, anesthesia is repeated three times within 5 days.