Evaluation of the efficiency of spinal anaesthesia in operations on the lower limbs in patients of working age
Background. The issues of perioperative analgesia for injuries of the lower limbs have received much attention recently. The most effective and safe method of anaesthesia during these operations has not been conclusively established. Most scientists and practitioners believe that conduction and neuraxial anaesthesia methods are most consistent with these requirements, however, additional research is required to finally resolve this issue. The study aimed to identify the clinical effectiveness of spinal anaesthesia techniques separately and in combination with sedation during surgical interventions on the lower limbs in traumatology according to the indicators of anaesthesia adequacy, pain intensity and the study of patient anxiety. Materials and methods. The study included 35 patients aged 18–59 years, who underwent metallic osteosynthesis of the lower limbs. The patients were divided into two groups: group I (n = 17) included the patients operated under spinal anaesthesia and group II involved the patients (n = 18), who were operated under spinal anaesthesia followed by sedation with 1% propofol. The patients of both groups matched in age and anthropometric data. The pain intensity was evaluated using a Visual Analogue Scale (VAS) before and on the first day after the operation, the level of personal and situational anxiety according to Spielberger-Khanin anxiety inventory was also determined at these stages. Spearman’s test was used to identify the relationship between VAS parameters and anxiety level. Results. The spinal anaesthesia combined with intravenous sedation with propofol was associated with the decrease of the pain intensity after surgery in patients. In patients of both groups, a correlation was found between the VAS indicator and situational anxiety before surgery (r = 0.50; p < 0.05). In patients with isolated spinal anaesthesia, the VAS indicators after surgery and situational anxiety for the operation correlated (r = 0.51; p < 0.05); the VAS scores after surgery and situational anxiety level after surgery correlated (r = 0.53; p < 0.05). In patients with spinal anaesthesia with additional sedation, there was no correlation between VAS after surgery and personal and situational anxiety. Conclusions. The study made it possible to recommend spinal anaesthesia in combination with intravenous sedation as a method of choice for injuries of the lower limbs, especially in patients with increased anxiety.
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