Adequate analgesia determines the success of the performed surgical intervention. In modern surgery, most of postoperative complications are directly related to ineffective therapy of pain syndrome in the perioperative period. The main principle of modern analgesia is its multicomponence, when analgesia, neurovegetative blockade and relaxation are achieved and potentiated by different drugs and methods. The blockade of nociceptive impulses with a local anesthetic at the transmission stage provides effective, targeted analgesia, hyporefl exia and muscle relaxation, prevents the sensitization of neuroaxial structures, hyperalgesia and the development of postoperative chronic pain syndrome. At the same time, providing analgesia with drugs of central action leads to the ineffectiveness of therapy in 80 % of cases, which has serious consequences.The aim. According to the literature review, to evaluate the effectiveness and safety of peripheral blockades on the example of performing a blockade of the pterygopalatine ganglion.Conclusion. The pterygopalatine blockade has broad indications for use in ophthalmology, which is explained by the complex structure of the pterygopalatine ganglion and the possibility of simultaneous infl uence on sympathetic, parasympathetic and nociceptive innervation. All the presented methods of pterygopalatine blockade performance have their advantages and disadvantages. Ultrasound navigation eliminates technical difficulties and the possibility of damage of the pterygopalatine fossa anatomical structures, ensuring the effectiveness and safety of the pterygopalatine blockade.
To analyze the advantages of ultrasound-guided catheterization of the internal jugular vein in patients with scoliotic deformity. Material and Methods. Patients with scoliotic deformity (n = 366), aged 16 months to 18 years were divided into two groups. The study group included patients (n = 128) in whom ultrasound guided approach to the internal jugular vein was used. Out of them 79 patients underwent classical catheterization over the guidewire with aspiration sample, and 49-intravasal insertion of J-guidewire without aspiration sample. The control group included patients (n = 238) who underwent catheterization without ultrasound control with aspiration sample over the guidewire. Results. Ultrasound-guided puncture and catheterization of the internal jugular vein decreases complication rate and shortens the time of preoperative preparation. Conclusion. The study showed that puncture in Trendelenburg's position improves verification of the internal jugular vein. Ultrasound control allows performing catheterization over guidewire without aspiration sample with low rate of complications.
Objective. Evaluation of the effectiveness of drug prevention of bone cement implantation syndrome in hip joint arthroplasty. Material and methods. A retrospective analysis of 400 medical records of patients who underwent hip arthroplasty was performed. In the main group (n = 200), the prevention of bone cement implantation syndrome was carried out using popular drugs (mafusol, reamberin, antihistamines, glucocorticoids). In the control group (n = 200), these drugs were not used. Blood pressure, heart rate, blood saturation were evaluated intraoperatively. In the postoperative period, fixed complications associated with anesthesia and surgery. Results. The volume of intraoperative blood loss, mean arterial pressure, heart rate and blood saturation in the main and control groups did not have significant differences. At the stage of cementing the bone canal, hypotension developed in 95% and 95.5% of cases, respectively. 2 patients (1.0%) of the first group developed a stress-related ulcer bleeding on the 3rd day of the postoperative period, one patient (0.5%) had an Ischemic stroke on the 5th day after the operation, in three patients (1.5%) atrial fibrillation paroxysm during the week after surgery. Three (1.5%) patients developed a skin allergic reaction to reamberin. In the second group, there were two cases (1.0%) of Ischemic stroke within a week after surgery and one cases (0.5%) of acute myocardial infarction on the 5th day after surgical treatment. Conclusion. There is no need for intraoperative drug prevention of bone cement implantation syndrome. Additional pharmacological load increases the risk of side effects and complications.
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