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Introduction. The prevalence of hemorrhoidal disease is 200 people per 1000 adult population, of which 75% are professionally active people. The choice of anesthetic support affects not only the effectiveness of the operation, but also the course of the early postoperative period. At the same time, regardless of the use of various variants of neuroaxial blockades, most authors indicate the development of complications such as acute urinary retention and severe postoperative pain syndrome in the postoperative period.Aim. To substantiate and evaluate the effectiveness of the proposed system of anesthesiological support for proctological operations.Material and methods. The study was conducted in 100 patients who were divided into two groups of 50 people. The operations were performed under conditions of combined anesthesia (spinal anesthesia + medical sedation). Spinal anesthesia was achieved with 0.5% isobaric bupivacaine solution, the average dose was 8.5 ± 0.12 mg. For drug sedation, a continuous infusion of propofol was used at a target concentration of 5–4–3 mg/kg per hour. The criterion for including patients in the main group was the appointment in the early postoperative period of the alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day.Results and discussion. The system of anesthetic support, including a combination of spinal anesthesia using an isobaric solution of bupivacaine at a dose of 7.5 to 10.0 mg and intravenous sedation with propofol at a target concentration of 5–4–3 mg/kg per hour, program of postoperative anesthesia based on a combination of multidirectional drug action and the appointment of alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day allows for high-quality and safe surgical treatment.Conclusion. The administration oftamsulosin hydrochloride at a dose of 0.4 mg prevented the development of acute urinary retention of patients.
Introduction. The prevalence of hemorrhoidal disease is 200 people per 1000 adult population, of which 75% are professionally active people. The choice of anesthetic support affects not only the effectiveness of the operation, but also the course of the early postoperative period. At the same time, regardless of the use of various variants of neuroaxial blockades, most authors indicate the development of complications such as acute urinary retention and severe postoperative pain syndrome in the postoperative period.Aim. To substantiate and evaluate the effectiveness of the proposed system of anesthesiological support for proctological operations.Material and methods. The study was conducted in 100 patients who were divided into two groups of 50 people. The operations were performed under conditions of combined anesthesia (spinal anesthesia + medical sedation). Spinal anesthesia was achieved with 0.5% isobaric bupivacaine solution, the average dose was 8.5 ± 0.12 mg. For drug sedation, a continuous infusion of propofol was used at a target concentration of 5–4–3 mg/kg per hour. The criterion for including patients in the main group was the appointment in the early postoperative period of the alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day.Results and discussion. The system of anesthetic support, including a combination of spinal anesthesia using an isobaric solution of bupivacaine at a dose of 7.5 to 10.0 mg and intravenous sedation with propofol at a target concentration of 5–4–3 mg/kg per hour, program of postoperative anesthesia based on a combination of multidirectional drug action and the appointment of alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day allows for high-quality and safe surgical treatment.Conclusion. The administration oftamsulosin hydrochloride at a dose of 0.4 mg prevented the development of acute urinary retention of patients.
Introduction. Desarterization of hemorrhoidal arteries with mucopexia, a pathogenetically caused minimally invasive operation, is more often performed in stationary conditions under regional or general anesthesia. Aim. To study the results of desarterization of hemorrhoidal arteries in patients with hemorrhoids operated on an outpatient basis under local anesthesia.Materials and methods. 459 patients with chronic hemorrhoids of stage 2–4 with varying degrees of node prolapse under local infiltration anesthesia with Ultracaine were operated on by one surgeon. The duration of the intervention, the intensity of the pain syndrome, and the complications of treatment were studied. Results. The median duration of the operation is 25 minutes, the intensity of pain during the operation on a 10-point scale is 2 points, on the 3rd day of the postoperative period-2 points. Complications occurred in 6 (1.3%) people, in the 1st urinary retention, paraproctitis, and in the 4th – bleeding. Discussion. The obtained results of a longer procedure in patients with stage II hemorrhoids are associated with the training period. The intensity of pain during the HAL-RAR procedure performed under local anesthesia, including in patients of stage III-IV and IV, was acceptable and was tolerated by patients satisfactorily. The structure of the complications that have arisen is limited by a narrow range of pathology: bleeding, acute urinary retention, paraproctitis. Conclusion. Hemorrhoidal artery desarterization is an effective method of treating patients with chronic hemorrhoids on an outpatient basis: low duration ofsurgery, low frequency of complications. Local anesthesia during the ligation of hemorrhoidal arteries with mucopexia provides adequate anesthesia, patients tolerate the procedure and pain in the postoperative period, regardless of the stage of the disease, therefore, this method of treatment is advisable to use in outpatient practice.
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