Combined regional anesthesia during vaginal hysterectomy, colpoperineorrhaphy with levatoroplasty

R.P. Chaplynskyi, V.M. Panov, R.A. Safonov, A.V. Omelchenko-Seliukova


The article presents original approach to anesthesia during vaginal hysterectomy with plasty. Nowadays, indications for vaginal hysterectomy are: the elderly age, morbid obesity, complete uterine prolapse, somatic condition of the patient, which allows for the operation. In order to prevent intraoperative and postoperative complications, it is very important to provide the patient with the most effective and safe method of anesthesia, which will minimize the use of analgesics during the surgery and in the early postoperative period. The purpose of the study was to evaluate the effectiveness of intraoperative and postoperative anesthesia when methods of regional anesthesia (subarachnoid anesthesia + caudal analgesia) are combined with ultrasound during vaginal hysterectomy with plasty. Combined regional anesthesia (spinal anesthesia + caudal analgesia) using ultrasound support was performed in 32 patients. Caudal block with visualization of the epidural space by means of ultrasound scanner allows it to be applied to almost all patients with nearly 100 % of success. The quality of anesthesia was determined by the well-being of the patients themselves, who noted the adequacy of anesthesia and comfort on the operating table and in the postoperative period. Pain relief after surgery was carried out without opioids. The caudal epidural block with visualization of the epidural space and determination of its width by means of ultrasound scanner allows using it in almost all patients to whom it was indicated. The exceptions are patients with anatomical defects of sacrum formation. Professional training does not take much time and was mastered by all, without exception, doctors from anesthesiology department. The scheme of combined regional anesthesia shows advantages over general anesthesia and isolated subarachnoid anesthesia in these groups of patients.


caudal analgesia; ultrasound support; introitus canalis sacralis; pelvis; visualization of the epidural space


Renfrew D.L. et al. Correct placement of epidural steroid injections: fluoroscopic guidance and contrast administration // American journal of neuroradiology. — 1991. — Т. 12, №. 5. — С. 1003-1007.

Stitz M.Y., Sommer H.M. Accuracy of blind versus fluoroscopically guided caudal epidural injection // Spine. — 1999. — Т. 24, № 13. — С. 1371.

Barham G., Hilton A. Caudal epidurals: the accuracy of blind needle placement and the value of a confirmatory epidurogram // European Spine Journal. — 2010. — Т. 19, № 9. — С. 1479-1483.

Klocke R., Jenkinson T., Glew D. Sonographically guided caudal epidural steroid injections // Journal of ultrasound in me­dicine. — 2003. — Т. 22, № 11. — С. 1229-1232.

Chen C.P. et al. Ultrasound as a screening tool for procee­ding with caudal epidural injections // Archives of physical medicine and rehabilitation. — 2010. — Т. 91, № 3. — С. 358-363.

Nikooseresht M. et al. Ultrasound as a screening tool for performing caudal epidural injections // Iranian Journal of Radiology. — 2014. — Т. 11, № 2.

Chen C.P.C. et al. Ultrasound guidance in caudal epidural needle placement // Anesthesiology: The Journal of the American Society of Anesthesiologists. — 2004. — Т. 101, № 1. — С. 181-184.

Blanchais A. et al. Feasibility and safety of ultrasound-guided caudal epidural glucocorticoid injections // Joint Bone Spine. — 2010. — Т. 77, № 5. — С. 440-444.

Yoon J.S. et al. The feasibility of color Doppler ultrasono­graphy for caudal epidural steroid injection // Pain. — 2005. — Т. 118, № 1–2. — С. 210-214.

Copyright (c) 2018 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2018


   Seo анализ сайта