Experience in the use of various methods of combined spinal epidural anesthesia in reconstructive surgeries on the arteries of the lower extremities
Background. In recent years, regional methods of anesthesia have taken several steps upward. In addition to the appearance of new drugs for introduction into the epidural and subarachnoid space, to date, there are a number of combined methods of regional anesthesia and analgesia, which include all the advantages of the methods used simultaneously. In our clinic at the premises of the vascular center, reconstructive surgery on the arteries of the lower extremities is carried out mainly under combined spinal epidural anesthesia (CSEA), which can be technically performed by one- and two-level technique. Materials and methods. Two groups of patients (39 people in each) were examined, they were subjected to surgery on the arteries of the lower extremities. In the first group, a single-level CSEA was conducted, in the second group, two-level CSEA was performed. Premedication in both groups 40 minutes prior to surgery included infulgan 100 ml intravenously, dexalgin 2.0 intramuscularly, osetron 4 mg intravenously. Pre-infusion was decided individually. The results were evaluated in terms of the effectiveness of intraoperative anesthesia, the time of resolution of the motor block, the effectiveness of postoperative analgesia on the visual analogue scale (VAS), and the adequacy of perfusion. Results. Intraoperatively in the group of single-level CSEA, 8 (20.5 %) patients required additional injection of anesthetic into the epidural space for anesthesia, in the second one — 10 patients (26 %). However, these parameters did not reach the statistical significance (p < 0.05), and this error is not significant. The complete resolution of the motor block in the postoperative period in both groups occurred in 4.0 ± 0.5 hours. Further analgesia in both groups was performed through the epidural catheter with intervals of every 4 hours, and did not exceeded 4 points on VAS; therefore, no additional prescription of narcotic analgesics was required in both groups. Conclusions. The techniques of one- and two-level CSEA allows achieving equally proper effect of intraoperative anesthesia, timely resolution of the motor block, as well as all the positive effects of prolonged epidural analgesia in the postoperative period.
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