RU2741225C1 - Method for painless finding and removing fixed intrapleural drainage devices after lung operations - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to surgery. For painless finding and removal of fixed intrapleural drainage devices after operations on lungs, puncture for parietal pleura with underlying tissues is introduced 10 ml of 0.5 % novocaine. Then 5 ml of 0.5 % novocaine and 5 ml of ethyl rectified 96 % ethyl alcohol are introduced through the same needle. In the centre of the formed drug infiltrate with a pierce ligature a round surgical needle is pierced to depth of 0.5 cm of a parietal pleura with underlying tissues followed by a puncture and a piercing ligature fixing the inner end of an intra pleural drainage device.EFFECT: method enables eliminating pain in points of fixation and removal of fixed inner ends of intrapleural drainage devices after lung operations.1 cl, 1 tbl, 1 ex

Description

The invention relates to medicine, namely to surgery.

After lung operations, two intrapleural drainage devices are installed.

The first intrapleural drainage device is for removing air from the pleural cavity, the inner end of which is fixed with a stitching ligature to the parietal pleura with underlying tissues in the region of the dome of the pleural cavity.

The second intrapleural drainage device is used to remove blood and pleural fluid, the inner end of which is fixed with a stitching ligature to the parietal pleura with underlying tissues in the area of the phrenic sinus of the pleural cavity. Both intrapleural drainage devices are brought out to the outer side of the chest wall and through a tee are connected to a system of constant aspiration from the pleural cavity of air, blood and intrapleural fluid [1, 4].

The inner ends of the intrapleural drainage devices are fixed with stitching ligatures to the tissues of the dome and the wall of the diaphragmatic sinus of the pleural cavity to exclude kinks of the intrapleural drainage devices and impairment of their drainage functions [2].

During the period when the inner ends of the intrapleural drainage devices are fixed to the parietal pleura with underlying tissues, they press on the parietal pleura and, before the removal of the intrapleural drainage devices, the patient experiences pain with limited respiratory movements and the development of hypoxia [1].

After 2-6 days, intrapleural drainage devices are pulled out by their outer parts and removed.

This method of removing intrapleural drainage devices, in places of separation from the parietal pleura with underlying tissues, fixing the inner ends of their stitching ligatures, is accompanied by pain and requires general anesthesia, which negatively affects the general condition of the operated patient.

The above method for finding and removing fixed intrapleural drainage devices after lung surgery, taken as a prototype, has the following disadvantages:

1.) While in the pleural cavity, the inner ends of the intrapleural drainage devices fixed with stitching ligatures press on the parietal pleura and, before the removal of the intrapleural drainage devices, the patient experiences pain with limited breathing and the development of hypoxia [1].

2.) Removal of intrapleural drainage devices by pulling their outer parts causes pain in places where they are separated from the parietal pleura with underlying tissues, fixed with stitching ligatures of their inner ends, which requires general anesthesia and negatively affects the general condition of the operated patient.

The aim of the invention is to provide a method for the long-term elimination of pain at sites and removal of the fixed inner ends of intrapleural drainage devices after lung surgery.

The essence of the invention lies in the fact that at the locations of the piercing ligatures fixing the inner ends of the intrapleural drainage devices, puncture drug infiltrates are created, consisting of a local anesthetic drug, for example, 0.5% novocaine solution mixed with durant, for example, ethyl 96 ° rectified alcohol [6], which leads to a quick and long-term painless stay, and the removal of fixed intrapleural drainage devices. At the same time, it should be borne in mind that the use of only a solution of novocaine for anesthesia is unacceptable due to the short duration of its action [5].

The method of painless finding and removal of fixed intrapleural drainage devices after lung operations is used as follows. After completing the operation on the lung, in the area of the dome of the pleural cavity, the parietal pleura with the underlying soft tissues is punctured with a syringe needle, then 10 ml is injected with a syringe attached to the needle. 0.5% novocaine solution. The syringe is disconnected from the needle, 5 ml is drawn into it. 0.5% solution of novocaine and 5 ml of ethyl 96 ° rectified alcohol. This mixture is slowly injected with a syringe through a needle left in the tissues. As a result of injections, a round infiltrate with a diameter of 4 cm to 5 cm and a depth of 1 cm is formed in the parietal pleura and underlying tissues.In the center of the infiltrate, the parietal pleura with the underlying tissues is punctured to a depth of 0.5 cm with a round surgical needle with a sutured ligature, followed by puncture, and the inner end of the intrapleural drainage device is fixed with a stitching ligature.

Using the same method, the inner end of the second intrapleural drainage device is fixed to the parietal pleura with the underlying tissues in the diaphragmatic sinus.

Both intrapleural drainage devices are brought out to the outer side of the chest wall and through a tee are connected to the system of constant aspiration of air, blood and intrapleural fluid from the pleural cavity.

The effectiveness of the invention was tested in 14 adult patients who underwent lower lobectomy for suppurative lung diseases.

Patients of group 1 (7 patients) after the operation were installed two intrapleural drainage devices according to the traditional method, taken as a prototype.

Patients of the second group (7 patients) after the operation were installed two intrapleural drainage devices according to the proposed method for the invention.

On the third day after the operation, all 14 patients underwent an assessment of the intensity of pain in the locations and removal of intrapleural drainage devices according to the scale of vertebral assessments (SVO) in points [3]. The results of assessing the intensity of pain in the operated patients are presented in Table 1.

Table 1.

Evaluation of pain intensity according to the SEW in points at the locations and removal of intrapleural drainage devices on the third day after lung operations.

Pain intensity in points The first group of patients (n = 7) Second group of patients (n = 7) Pain at the sites of fixed intrapleural drainage devices Pain at the sites of removal of fixed intrapleural drainage devices Pain at the sites of fixed intrapleural drainage devices Pain at the sites of removal of fixed intrapleural drainage devices 0-no pain - - 0 points in 7 patients 0 points in 7 patients 1-mild pain - - - - 2-moderate pain
In 5 patients - 10 points - - - 3-severe pain In 2 patients - 6 points 1 patient - 3 points - - 4-unbearable pain - In 6 patients - 24 points - - TOTAL 16 points 27 points 0 points 0 points

Table 1 shows that in all operated patients of group 1 during the period of finding fixed intrapleural drainage devices, pain syndrome of moderate or severe pain (16 points) was determined; during the period of removal of fixed intrapleural drainage devices, the pain was generally unbearable, which required the use of general anesthesia ( score of 27 points).

In patients of the second group, the location and removal of intrapleural drainage devices was painless and assessed at 0 points.

Here is an example of a specific implementation of the claimed method.

Example.

Patient T, 42 years old, was admitted to the clinic of the Far Eastern Scientific Center of Physiology and Pathology of Respiration with a diagnosis of bronchiectasis of the lower lobe of the right lung in the stage of suppuration.

Against the background of antibacterial and detoxification therapy, the patient was operated on, and a lower lobectomy of the right lung was performed. After the main operation - lower lobe ° , in the area of the dome of the pleural cavity, 10 ml was injected under the parietal pleura with the underlying tissues by puncture. 0.5% novocaine solution, then a mixture of 5 ml was introduced through the same needle. 0.5% novocaine solution and 5 ml. durant - ethyl 96 ° rectified alcohol. In the center of the formed medicinal infiltrate, the inner end of the intrapleural drainage device was fixed with a round surgical needle with a sutured ligature to a depth of 0.5 cm. The parietal pleura with the underlying tissues was then punctured and sutured with a suture ligature. Using the same method, the inner end of the second intrapleural drainage device was fixed to the parietal pleura with the underlying tissues in the diaphragmatic sinus.

Both intrapleural drainage devices were brought out to the outer side of the chest wall and through a tee were connected to the system of constant aspiration from the pleural cavity of air, blood and intrapleural fluid.

On the third day after surgery (lower lobectomy), the intrapleural drainage devices were removed. The intensity of pain at the locations and removal of the inner ends of the intrapleural drainage devices was assessed according to the scale of vertebral assessments (SVO) in points. At the same time, pain in the places where the fixed inner ends of the intrapleural drainage devices were located was 0 points, the pain in the places where the inner ends of the intrapleural drainage devices were removed was 0 points.

The given example confirms the high efficiency of the method according to the invention.

Information sources used:

1. Bogush L.K. Surgical treatment of pulmonary tuberculosis. M., "Medicine", 1979. S. 170-171, 271.

2. Zavarzina E.V. Drainage of pleural cavities after lung surgery with removable drainage devices: Ph.D. thesis. honey. sciences. Vladivostok, 2006.156 p.

3. Kogonia L.M., Voloshin V.G., Larionova V.B. Practical recommendations for the treatment of chronic pain syndrome in cancer patients // Malignant tumors. 2016. No. 4, special issue 2. P. 474-485.

4. Kuzyukovich P.M. Surgical treatment of patients with common forms of pulmonary tuberculosis. Minsk: Publishing House "Belarus", 1973. S. 175-176.

5. Shevkunenko V.N. A short course of operative surgery with topographic anatomy. M.: Mediz, 1947.S. 22.

6. Shnee A.Ya., Chakhunashvili O.S. Long-term local anesthesia as a therapeutic method, M .: State publishing house of medical literature, 1963. 87 p.

Claims (1)

A method of painlessly finding and removing fixed intrapleural drainage devices after lung operations, characterized in that 10 ml of 0.5% novocaine solution is injected under the parietal pleura with the underlying tissues, then a mixture of 5 ml of 0.5% novocaine solution is injected through the same needle and 5 ml of ethyl 96% rectified alcohol; in the center of the formed medicinal infiltrate, the parietal pleura with underlying tissues is pierced to a depth of 0.5 cm with a round surgical needle with a stitching ligature, followed by a puncture and a stitching ligature to fix the inner end of the intrapleural drainage device.