RU2406545C2 - Method of two-level epidural anesthesia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to anesthesiology and resuscitation science, and can be used in necessity of anesthesia before surgery, during it and after it. For this purpose 10-15 minutes before incision 0.75% ropivacaine solution in volume 3.0-4.0 ml is introduced between spinous processes Th2-Th3 and 4.0-5.0 ml between spinous processes Th6-Th7. During narcosis anesthesia is supplemented with introduction of 3-5 mg of morphine hydrochloride solution. In resuscitation department between spinous processes Th6-Th7 0.2% ropivacaine solution is introduced at rate 4.0-6.0 ml per hour during 3-4 days, and between spinous processes Th2- Th3 0.2% ropivacaine solution is introduced in dose 3.0-4.0 ml up to three times per day during 3-4 days. Anesthesia is supplemented by introduction of 3-5 mg of morphine hydrochloride solution. After transferring patient to surgery department, anesthesia is carried out by constant introduction at the same levels of 0.2% ropivacaine solution at rate 6.0-8.0 ml per hour during 3-4 days, also introducing morphine hydrochloride solution in dose 3-5 mg per day.

EFFECT: method allows to ensure adequate anesthesia at all stages of treatment due to continuous and prolonged dosing of medications.

Description

The invention relates to medicine, namely to analgesia - to reduce pain sensitivity and anesthesia - to pain relief.

It is known that the outcome of surgery is significantly affected by correctly performed pain relief. Modern anesthesiology has the classic methods of analgesia, proven practice and applied in the required situations.

However, in the anesthetic literature there is little coverage of the peculiarities of pain relief for cancer patients. Previously, it was believed that such features do not exist, but the severe complications that develop during anesthesia and the increase in complex operations in cancer patients require a review of the attitude to methods of pain relief in oncology.

Well-known and necessary methods of anesthesia used in oncology are both before and during oncological operations and after they are completed, during the period when the patient is in intensive care, and then after his transfer to the surgical department.

However, at each stage - pre- and surgical, resuscitation and subsequent - anesthesia is carried out separately at each stage with a separate choice of painkillers, equipment and dosage regimens for their administration, time of administration and concentration of painkillers in the absence of medical consistency for painkillers during patient transfer from one stage to another.

There is a method of two-level epidural anesthesia (the space between the spinous processes of the spine, the expression was used earlier - epidurally), taken by us as a prototype (B.E. Peterson et al. "Intensive care in oncology". M. 1975, p.21), in which two catheters are used to expand the anesthesia zone to administer the anesthetic at two epidural levels.

However, this method of two-level epidural analgesia is characterized by all of the listed disadvantages of phased anesthesia. For this reason, and also taking into account the fact that previously there were no effective painkillers and devices for their continuous prolonged dosing, this method has not been effectively used in clinical oncological surgery.

The essence of the proposed method as a single one for all stages is that anesthesia is carried out at the pre- and surgical stages by the introduction of a 0.75% solution of ropivacaine (napropin Astra Zeneka, Sweden) with a volume of 3.0-4.0 ml at the upper level between the T ₂ -T ₃ process of the spine and 4.0-5.0 ml at the lower T6-T7 level 10-15 minutes before the incision with additional anesthesia with morphine hydrochloride 3-5 mg during anesthesia and additional administration, if necessary, of half the volume of a 0.2% ropivacaine solution to the required level, and at the resuscitation stage by ( from using a syringe pump “perfuzor compoct C” from Braun) at the lower level of a 0.2% ropivacaine solution at a rate of 4.0-6.0 ml per hour for 3-4 days and at the upper level of a 0.2% ropivacaine solution at 3.0-4.0 ml up to three times a day for 3-4 days with the addition of morphine hydrochloride 3-5 mg per day, and after transferring the patient to the surgical department, anesthesia is carried out continuously by the introduction (using a single-use infusion pump (VIP) of the company "Vogt Medical") at two levels of a 0.2% solution of ropivacaine at a rate of 6.0-8.0 ml per hour with morphine hydrochlor 3-5 mg per day for 3-4 days.

The proposed method of two-level analgesia is as follows.

In the operating room, the epidural space is punctured and catheterized with a Portex epidural kit at the thoracic level between 2-3 (upper level) and 6-7 (lower level) by the spinous processes of the spine, which corresponds to the combined treatment of cancer of the thoracic and abdominal esophagus, and with other types of surgical interventions, the levels (T) may be different and are determined by the anatomical picture of the surgical intervention. Diagnostic measures for finding a catheter are carried out, the necessary test doses of drugs are introduced. After the catheters are fixed, the main dose of a 0.75% solution of ropivacaine (napin Astra Zeneka, Sweden) with a volume of 3.0-4.0 ml into the upper catheter and 4.0-5.0 ml into the lower catheter 10-15 minutes before the incision is introduced. Anesthesia is supplemented with morphine hydrochloride 3-5 mg during anesthesia. If necessary, during the operation, an additional half of the initial volume, but already 0.2% ropivacaine solution, is added to the required level.

In the postoperative period, when a patient is admitted to the intensive care unit, they immediately begin introducing a 0.2% ropivacaine solution at a rate of 4.0-6.0 ml per hour for 3-4 days into the epidural space using a perfuzor compoct C syringe pump from Braun (Germany) . In the upper catheter, a 0.2% ropivacaine solution of 3.0-4.0 ml is fractionally injected up to three times a day for 3-4 days. Anesthesia is supplemented with morphine hydrochloride 3-5 mg per day.

After transferring the patient from the intensive care unit to the surgical department, continuous introduction of, for example, a Vogt Medical single-use infusion pump (IPR) into both catheters of a 0.2% ropivacaine solution at a rate of 6.0-8.0 ml per hour with morphine hydrochloride 3-5 mg per day for 3 days.

After a full cycle of analgesia, the epidural catheters are removed and a sterile dressing is applied.

A description of the constructive implementation of the used metering devices and the principle of their action is not given in connection with their popularity and the availability of instructions for their use. However, for example, the use of a disposable infusion pump (IPR) is justified by the fact that after the patient is transferred from intensive care to the surgical department, the patient with the IPR fixed to it allows free movement, the IPR does not need an energy source, which allows it to be used in "field" conditions. trihedral tubes for supplying painkillers eliminate their kink, allows the patient to regulate the flow of painkillers on the recommendation of a doctor.

The proposed method of two-level epidural anesthesia provides succession at all stages of anesthesia, and the claimed parameters — concentration, quantity, type of the anesthetized drugs claimed, the time and speed of their administration at each stage — have been worked out and tested in the clinical conditions of the Republican Cancer Center of Kazan and have shown high efficiency and the applicability of the proposed method of analgesia for various types of surgery, for example, Torek surgery, laryngopharyngoesophageectomy, externalization of medium thoracic esophagus with simultaneous plastic, mezhpodvzdoshno-abdominal amputation of the lower limbs, and others.

Claims (1)

A method of two-level epidural analgesia, including the introduction of painkillers at all stages of surgical treatment using dosing devices, characterized in that 10-15 minutes before the incision, a 0.75% solution of ropivacaine with a volume of 3.0-4.0 ml is injected between the spinous processes of Th2 -Th3 and 4.0-5.0 ml between the spinous processes of Th6-Th7; during anesthesia, anesthesia is supplemented with 3-5 mg of morphine hydrochloride solution; at the resuscitation stage, between the spinous processes of Th6-Th7 0.2% solution of ropivacaine is administered at a rate of 4.0-6.0 ml per hour for 3-4 days, and between the spinous processes of Th2-Th3 0.2% solution of ropivacaine is administered 3.0-4.0 ml up to three times a day for 3-4 days, anesthesia is supplemented by the introduction of 3-5 mg of morphine hydrochloride solution; after transferring the patient to the surgical department, anesthesia is carried out by continuous administration of 0.2% ropivacaine solution at the same levels at a rate of 6.0-8.0 ml per hour for 3-4 days, and a solution of morphine hydrochloride 3-5 mg per day.