RU2651129C1 - Method for targeted single-dose epidural anesthesia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, to anesthesiology and reanimatology. Epidural puncture is carried out, a catheter is introduced into the epidural space in the direction of the head, with introduction of a drug through it. After an epidural puncture, a three-way "Discofix" 360 cock is attached to a cannula of the epidural needle. Straight pipe of the three-way cock is muffled with the locking IN-stopper, through the rubber membrane of which the catheter is introduced into the lumen of the epidural needle and push it beyond the needle tip toward the head for a distance of 4–5 cm inside the epidural space. Syringe with a saline solution is injected into the epidural catheter, and a syringe with a local anesthetic solution is slowly for 3 minutes injected into the side pipe of the three-way cock synchronously with introduction of the local anesthetic through the lumen of the epidural needle and physiological solution is injected through the catheter.

EFFECT: method allows one-way movement of the local anesthetic solution within the epidural space in a preselected direction, with restriction of movement in the opposite direction.

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Description

The invention relates to medicine, to anesthesiology-resuscitation and can be used as an anesthetic aid in operations on the musculoskeletal system, spine and chest.

A known analogue of the proposed method is a method of coaxially introducing a spinal needle through the lumen, or an end hole of the "back eye" type of the epidural needle, which is described for single-level combined spinal-epidural anesthesia [1].

The prototype of this method is the method of epidural anesthesia according to the patent [2], in which two catheters are carried out into the epidural space, the ends of which are oriented in the cranial direction, with a distance of 4-5 cm from each other. A solution of anesthetic and an indifferent solution is synchronously injected through these catheters, and, depending on the area of anesthesia, the anesthetic solution is injected through a catheter with a lower or higher end, respectively, an indifferent solution is injected through the other end.

The disadvantages of the method are the need to perform two invasive procedures in the form of punctures and the subsequent two catheterizations of the epidural space.

The invention is expressed by a combination of essential features, sufficient to achieve the desired technical result, namely: providing one-way movement of the local anesthetic solution within the epidural space in a preselected direction, with limited movement in the opposite direction.

The essence of the method of directed epidural anesthesia includes performing an epidural puncture, holding a catheter with its extension beyond the needle section to the head to a distance of 4-5 cm inside the epidural space, with the introduction of a drug through it. After an epidural puncture, a three-way DiscoFix 360 ° valve (B / Braun) is attached to the cannula of the epidural needle [3]. The straight-through pipe of a three-way valve is plugged with an IN-stopper (B / Braun), a locking blocking device, through the rubber membrane of which a catheter is inserted into the lumen of the epidural needle, and it is pulled out from the needle cut to the head to a distance of 4-5 cm inside the epidural space. A syringe with physiological saline is attached to the epidural catheter, and a syringe with a local anesthetic solution is connected to the lateral nozzle of the three-way valve. Slowly, for 3 minutes, simultaneously with the introduction of a local anesthetic through the lumen of the epidural needle, physiological saline is injected through the catheter.

The use of the three-way valve "Discofix" 360 ° (B / Braun) ensures the coaxiality of the introduction and separation of drugs using one epidural puncture.

Passing the epidural catheter through the lumen of the epidural needle and extending 4–5 cm beyond the cut inside the epidural space toward the head, allows laminar characteristics to flow into the epidural space, prevent them from mixing, and thus separate the flows into two mutually opposite directions.

A distance of 4-5 cm corresponds to the average height of the vertebra of the lumbar spine.

The introduction of the solution into the porous structure of the epidural space at a slow speed suppresses turbulence. In the absence of turbulence between the flows of solutions having laminar properties, a so-called “shear zone” is formed, which separates the solutions and prevents them from mixing [4].

An advantage of the proposed method is the absence of the need for two punctures and two catheterizations of the epidural space. Performing one epidural puncture reduces the amount of invasive intervention during the manipulation, shortens the time for it, the patient experiences less discomfort and anxiety than when performing two punctures, and the subsequent two catheterizations of the epidural space at two levels, while the procedure itself is cheaper by using one set epidural anesthesia instead of two.

The method is illustrated in the illustrations, where: in FIG. 1 - FIG. Figure 4 shows a bench model of the assembled device during the simultaneous introduction of working (colored) and indented (unpainted) solutions into the epidural space model (a transparent tube, loosely plugged with a bandage dipped in petroleum jelly).

In FIG. 1 - the beginning of the introduction of solutions;

In FIG. 2, FIG. 3 - stages of the introduction of solutions.

The method is used as follows.

For epidural anesthesia under aseptic conditions and under local anesthesia (lidocaine 0.5% - 5.0), epidural space is catheterized at the L3-L4 level. A puncture of the epidural space is performed with a Tuohy needle. 4-5 ml of 2% lidocaine is administered as a so-called test dose in order to identify an accidental and unintentional puncture of the dura mater. In the case of a negative test, a three-way DiscoFix 360 ° valve (B / Braun) is connected to the needle pavilion, the straight-through pipe of the three-way valve is plugged with an IN stopper (B / Braun), through which a catheter is inserted into the epidural needle through a rubber membrane and the catheter is pulled out for a needle cut to a distance of 4-5 cm inside the epidural space towards the head. A syringe with 15 ml of physiological (indifferent) solution is attached to the epidural catheter. A syringe with a local anesthetic (working) preparation (15 ml of 0.75% ropivacaine, or 0.5% bupivacaine, or 2% lidocaine) is attached to the side of the three-way valve. The control valve of the three-way valve "Discofix" is installed in a position that allows you to enter two solutions at the same time. Solutions are administered slowly over 3 minutes. After 15-20 minutes, the lumbar and sacral spinal nerves, once in the block area, are anesthetized, and the height of the epidural block is limited by the level of L1, which corresponds to the location of the end of the catheter inside the epidural space. After the introduction of the solutions, the needle along with the catheter located in it is removed and an aseptic dressing is applied to the skin of the back at the puncture site.

Clinical examples.

1. Patient Mr. V.K., 63, was admitted with a fracture of the right femur on 12/10/2015. Concomitant diseases: chronic coronary heart disease. The operation of osteosynthesis of a bone fracture under epidural anesthesia according to the claimed method. Catheterization of the epidural space at the L3-L4 level and single-level epidural puncture were performed. An epidural catheter was passed through the lumen of the epidural needle and extended beyond its section to a distance of 4-5 cm inside the epidural space toward the head. Synchronously and coaxially, slowly, over 3 minutes, injected saline through a catheter, and locally anesthetic solution through the lumen of the epidural needle. The operation was performed. Hemodynamics is stable, blood loss of about 200 ml, the patient was transferred after surgery to the specialized department in a satisfactory condition.

2. Patient K. in R.I., 50 years old, was admitted with a fracture of the left tibia 12/12/2015. Concomitant diseases: hypertension 2 tbsp. An osteosynthesis of a fracture of the left tibia was performed. Under epidural anesthesia according to the claimed method, catheterization of the epidural space at the level of L3-L4 and single-level epidural puncture was performed. An epidural catheter was passed through the lumen of the epidural needle and extended beyond its section to a distance of 4-5 cm inside the epidural space toward the head. Synchronously and coaxially, slowly, over a period of 3 minutes, physiological saline was injected through a catheter, and locally anesthetic solution was injected through the lumen of the epidural needle. During the operation and upon completion of hemodynamics is stable, blood loss of about 100 ml, the patient was transferred to the relevant department in a satisfactory condition.

Information sources

1. Cook T.M. Combined spinal-epidural techniques / T.M. Cook // Anaesthesia. - 2000. - Vol. 55. - P. 42-64.

2. RF patent No. 2185199, A61M 25/01, BI No. 20, 2002

3.http: //www.medpostav.ru/bbraun_price.htm

4. Anisimov O.G. Optimization of regional anesthesia in traumatology and orthopedics (experimental clinical study): Diss. Dr. med. Sciences / Oleg Georgievich Anisimov. - SPb., 2011 .-- 254 p.

Claims (1)

A method of directed epidural anesthesia, including performing an epidural puncture, conducting a catheter into the epidural space towards the head, with the introduction of a drug through it, characterized in that after an epidural puncture, a three-way valve “Discofix” 360 is connected to the cannula of the epidural needle, the straight-through tube of the three-way valve is plugged an IN stopper locking device, through the rubber membrane of which a catheter is inserted into the lumen of the epidural needle, and is pulled out by the side of the needle heads at a distance of 4-5 cm inside the epidural space, a syringe with saline solution is attached to the epidural catheter, and a syringe with a solution of local anesthetic is attached to the side pipe of the three-way valve, slowly, for 3 minutes, simultaneously with the introduction of local anesthetic through the lumen of the epidural needle, injected saline through a catheter.

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