Conducting brachial plexus blockade under control of ultrasound imaging and neurostimulation

The article reviews successful experience of brachial plexus blockade under ultrasound control and describes this technique. The authors give evidence, that using both ultrasonic imaging and neurostimulation during brachial plexus blockade allows to improve significantly (by 31,6 %) quality of blockade (p, = 0,01) and to decrease (by 21,4 %) the risk of purposeless vessels puncture (p= 0,02)

Arthroscopic anterior cruciate ligament reconstruction in adolescents. What to choose for anesthesia?

The purpose - to optimize the quality of perioperative management of adolescents with damage of the anterior cruciate ligament of the knee. Material and methods: Perioperative methods of anesthesia in 71 patients were estimated. Psycho-emotional status was evaluated on the basis of determining the level of reactive anxiety (Spielberg Hanin scale) and intraoperative anesthesia (unilateral spinal anesthesia or combined) has been chosen. Results: According to the results of lactate and glucose levels in the blood the efficacy of unilateral spinal anesthesia during surgery was demonstrated. Visual analog scale revealed the advantage of extended continuous iliofascial block over an isolated femoral nerve blockade for adequate analgesia for postoperative period. The advantages of the performing continuous iliofascial block under ultrasound were demonstrated

Особенности тромбоэластографического профиля пациентов с COVID-19 в условиях ОРИТ

The objective: to study the hemostatic system of patients diagnosed with the novel new coronavirus infection and compare the data obtained with hemostatic system parameters in patients with advanced deep vein thrombosis/pulmonary embolism without COVID-19.Subjects and methods. A single-center prospective study with retrospective control was conducted in Anesthesiological and Intensive Care Department No. 1 of Kuvatov State Medical University (Ufa) in April - May 2020, the objective of the study was to investigate the hemostatic system of patients with confirmed new coronavirus infection, patients diagnosed with venous thrombosis in 2012-2014, and a group of healthy volunteers.Results. Evaluation of the hemostasis system in patients with thrombosis and patients with COVID-19 demonstrates the same type of changes: MA, Angle, G indices increase according to thromboelastography results, as well as D-dimer and fibrinogen levels increase, while antithrombin III activity decreases.Conclusion. Thus, TAG may be crucial for accurate identification of patients with advanced increased risk of thrombosis and thus possibly avoid unnecessary anticoagulation in patients at low risk of thrombosis.Цель: изучение системы гемостаза пациентов с установленной новой коронавирусной инфекцией и сопоставление полученных данных с результатами показателей системы гемостаза пациентов с состоявшимся тромбозом глубоких вен / тромбоэмболией легочной артерии без COVID-19.Материалы и методы. В рамках одноцентрового проспективного исследования с ретроспективным контролем на базе анестезиолого-реанимационного отделения № 1 ГБУЗ «РКБ им. Г. Г. Куватова» в апреле ‒ мае 2020 г. проведено исследование системы гемостаза пациентов с подтвержденной новой коронавирусной инфекцией, в 2012‒2014 гг. ‒ пациентов с диагностированным венозным тромбозом и группы здоровых добровольцев.Результаты. Оценка системы гемостаза у пациентов с тромбозом и пациентов с COVID-19 демонстрирует однотипные изменения: увеличиваются показатели МА, Angle, G по данным тромбоэластографии, а также повышаются уровни D-димера, фибриногена и снижается активность антитромбина III.Заключение. Тромбоэластография может иметь решающее значение для точной идентификации пациентов с повышенным риском тромбоза и тем самым, возможно, позволяет избежать ненужной антикоагулянтной терапии у пациентов с низким риском тромбоза

Блокада грудных нервов как компонент мультимодальной анальгезии при операциях по поводу рака молочной железы

Objective: to evaluate the efficacy and safety of adding pectoral nerve block to anesthesia regimen in radical mastectomy.Subjects and methods. 65 female patients underwent unilateral radical mastectomy under general anesthesia. All patients enrolled into the study were divided into two groups. Group 1 included patients (the main one, n = 33) who had PEC block and general anesthesia; Group 2 (the control one, n = 32) had general anesthesia only.Results. The group of patients with PEC block versus the Control Group, demonstrated a lower score of the visual analogue scale at all stages of the study. The intra-operative fentanyl consumption was statistically significantly lower in Group 1 versus the Control Group (290.91 ± 67.84 and 393.75 ± 66.90 μg, respectively, p < 0.033). The consumption of opioid analgesics during the 1st day in the Main Group was 2-fold lower compared to the Control Group – 30.91 ± 12.34 and 63.75 ± 9.42 mg, respectively (p < 0.026). In Group 1, the time till the first analgesia with promedol made 309.55 ± 56.59 minutes.Conclusions. Pectoral nerves block combined with general anesthesia provides effective analgesia during breast surgery with axillary lymph node dissection.Цель исследования: оценить эффективность и безопасность включения блокады грудных нервов в схему обезболивания при радикальной мастэктомии.Материал и методы: 65 пациенткам выполнена односторонняя радикальная мастэктомия под общей анестезией. Все пациентки, включенные в исследование, разделены на две группы. В 1-ю группу включены пациентки (основная, n = 33), которым проведены PEC block и общая анестезия; во 2-й группе (контрольная, n = 32) проведена только общая анестезия.Результаты. В группе пациентов с PEC block в сравнении с контрольной группой выявлен более низкий показатель по визуально-аналоговой шкале на всех этапах исследования. Интраоперационная потребность в фентаниле статистически значимо была меньше в 1-й группе по сравнению с контрольной (290,91 ± 67,84 и 393,75 ± 66,90 мкг соответственно, p < 0,033). Потребность в опиоидных анальгетиках в 1-е сут в основной группе была в 2 раза меньше, чем в контрольной ‒ 30,91±12,34 и 63,75 ± 9,42 мг соответственно (p < 0,026). Время до первого обезболивания промедолом в 1-й группе составило 309,55 ± 56,59 мин.Выводы. Блокада грудных нервов в комбинации с общей анестезией обеспечивает эффективную анальгезию при операции на молочной железе с подмышечной лимфодиссекцией

Planning of surgical treatment of upper extremity in patients with cerebral palsy

The purpose - to devise the algorithm of patient examination with spastic hand to determine what the variant of surgical treatment is indicated. The variant of surgical treatment and it's results are depend on the cause of upper extremity deformation. Materials and methods. This study is based on a survey of children with cerebral palsy with lesions of the upper extremity. The main criterion for the selection of patients was the presence of the combined lesion of the upper extremity, where the cause of dysfunction hands are not only fixed contractures, but primary tonic. Was to survey 47 patients with spastic forms of cerebral palsy with the defeat of the upper limb, but the study group included only 26 of them in the ages of 7 to 18 years (average 12,1), as having the clinical picture both types of contractures. We have developed and applied a system of examinations, modeling expected outcome of selective neurotomy motor nerves of the upper limb, which allows to estimate the possible result of such treatment, and clearly differentiate tonic and fixed contracture. Results and conclusions. Based on the results of study we supposed that, using diagnostic blockade motor nerve at the period of planning surgical treatment help us to create temporary reversible model of selective neurotomy motor nerve branches and identify the type of contracture, degree of manifestation and functional perspective

Specific parameters of the thromboelastographic profile of patients with COVID-19 in the intensive care unit

The objective: to study the hemostatic system of patients diagnosed with the novel new coronavirus infection and compare the data obtained with hemostatic system parameters in patients with advanced deep vein thrombosis/pulmonary embolism without COVID-19.Subjects and methods. A single-center prospective study with retrospective control was conducted in Anesthesiological and Intensive Care Department No. 1 of Kuvatov State Medical University (Ufa) in April - May 2020, the objective of the study was to investigate the hemostatic system of patients with confirmed new coronavirus infection, patients diagnosed with venous thrombosis in 2012-2014, and a group of healthy volunteers.Results. Evaluation of the hemostasis system in patients with thrombosis and patients with COVID-19 demonstrates the same type of changes: MA, Angle, G indices increase according to thromboelastography results, as well as D-dimer and fibrinogen levels increase, while antithrombin III activity decreases.Conclusion. Thus, TAG may be crucial for accurate identification of patients with advanced increased risk of thrombosis and thus possibly avoid unnecessary anticoagulation in patients at low risk of thrombosis

INFLUENCE OF THE SPHEROPALATINE BLOCKADE ON THE CHANGE IN OXIDATION-REDUCTION POTENTIAL IN THE SURGICAL TREATMENT OF CONGENITAL CATARACT

Purpose of the study was to evaluate the influence of the spheropalatine blockade on the state of redox potential in the surgical treatment of congenital cataract in children. Materials and methods. A prospective, nonrandomized study included 52 patients who underwent planned surgery. The first group ( n = 26) included patients underwent anesthesia based on sevorane in combination with spheropalatine blockade as a regional component; a distinctive feature of 2nd group ( n = 28) was the implementation of a retrobulbar blockade as a regional component. The integral index in the form of the redox coefficient (FORD / FORT) before and after operation was estimated. The characteristic of heart rate variability in the frequency domain with the analysis of low frequency / high frequency parameters and the stress index of autonomic system was studied. Results and discussion. The obtained results convincingly show that the use of the spheropalatine blockade is accompanied by adequate antinociceptive protection of the body at the stage of the operative intervention and in the early postoperative period. The positive effect of prolonged regional analgesia is due to blockade not only of nociceptive pathways, but also of sympathetic innervation due to the effect on the periarterial sympathetic plexus of the internal carotid artery. The antioxidative and antinociceptive efficacy of the spheropalatine blockade is consistent with the positive dynamics of clinical indices. Thus, spheropalatine blockade in the surgery of congenital cataract in children is not only a method of postoperative analgesia, but also a therapeutic factor that has a significant positive effect on the outcome of surgical treatment in general

THE USE OF PROLONGED BLOCK OF PLEXUS AXILLARIS IN CHILDREN WITH EXTENSION CONTRACTURES OF THE ELBOWS DUE TO ARTHROGRYPOSIS

Elbow deformities is one of the most widespread pathologies in patients with arthrogryposis. In the majority of the cases children have extension contractures. Most of the children have limitation of active and passive movements in elbow. The aim of this research was to establish the efficiency of prolonged block of plexus axillaris in children with extension contractures of the elbows due to arthrogryposis. From 2010 to 2011 we performed prolonged block of plexus axillaris in 23 children with arthrogryposis after mobilization of elbow. During catheterization of perineural space we use ultrasound navigation and neurostimulation. We carry out elbow capsulotomy and V-Y triceps lengthening with (or without) transposition muscles. Prolonged block of plexus axillaris after these operation helps to improve passive movements in the elbow (the average passive flexion was 80-50°, passive extension was 170-160°). The mean time of rehabilitation was 3 weeks. Combination of this method with physiotherapy helps to restore range of motion in elbow in patients with arthrogryposis

Antiinflammatory effect of pterygopalatine blockade for anesthetization in ophthalmic surgery

Purpose: to evaluate the effectiveness of analgesic and anti-inflammatory effects of pterygopalatine blockade in the surgical treatment of cataract in children. Materials and methods. A comparative analysis of the efficacy of intraoperative anesthesia and the course of the postoperative period was carried out in 52 patients of two clinical groups that were formed depending on the method of anesthesia. The first clinical group included 26 patients who underwent a pterygopalatine blockade as a regional component of general anesthesia, the second comparison group was formed of 28 patients undergoing retrobulbar blockade. To assess the adequacy of anesthesia, the concentration of plasma cortisol and oxidation-reduction profile was determined before and after the operation, the intensity of the pain syndrome, the extent of the inflammatory reaction of the eye after surgery were assessed. The results showed a decrease in the concentration of cortisol and increased antioxidant capacity of the organism after surgery in patients of the first group. In patients of the 1st clinical group, the Tyndal phenomenon of the 1st degree was revealed in 15.3 % of cases, the remaining patients had no signs of inflammation. Each second patient of 2nd group had a moderate degree of inflammatory reaction, and in 7 % of cases significant exudative phenomena were noted in the form of the Tyndall II degree phenomenon. Conclusion. The use of vesicle blockade in the surgical treatment of cataracts allowed improving the quality of rehabilitation of a patient with congenital cataract, both in the early and late postoperative period

Pectoral nerves block as a component of multimodal analgesia in breast cancer surgery

Objective: to evaluate the efficacy and safety of adding pectoral nerve block to anesthesia regimen in radical mastectomy.Subjects and methods. 65 female patients underwent unilateral radical mastectomy under general anesthesia. All patients enrolled into the study were divided into two groups. Group 1 included patients (the main one, n = 33) who had PEC block and general anesthesia; Group 2 (the control one, n = 32) had general anesthesia only.Results. The group of patients with PEC block versus the Control Group, demonstrated a lower score of the visual analogue scale at all stages of the study. The intra-operative fentanyl consumption was statistically significantly lower in Group 1 versus the Control Group (290.91 ± 67.84 and 393.75 ± 66.90 μg, respectively, p < 0.033). The consumption of opioid analgesics during the 1st day in the Main Group was 2-fold lower compared to the Control Group – 30.91 ± 12.34 and 63.75 ± 9.42 mg, respectively (p < 0.026). In Group 1, the time till the first analgesia with promedol made 309.55 ± 56.59 minutes.Conclusions. Pectoral nerves block combined with general anesthesia provides effective analgesia during breast surgery with axillary lymph node dissection