Preventive combined analgesia method for treating patients for diaphyseal femur and shank fracture

FIELD: medicine.

SUBSTANCE: method involves intramuscularly introducing 100 mg of Ketonal before transporting patient to operating room. Then, regional block of femoral and sciatic nerve is carried out by introducing 40 mg of 0.2% Naropin solution. The patient is transported to operating room next to it.

EFFECT: enhanced effectiveness of anesthesia.

 

The present invention relates to medicine, in particular to methods combined analgesia, and can be used for transporting patients with diaphyseal fractures of the femur and tibia in the operating room, as well as to ensure optimal packing when performing Central segmental blocks.

Closest to the proposed invention is the blockade of the lower limb of the local anesthetic solution 1%or 2%procaine dose of 20-50 ml / hematoma at the site of fracture - "anesthesia in the hematoma" (see Selected lectures on disaster medicine / Ed. by Prof. Svetlanova. -M.:GEOTAR-Med, 2001.-P.172).

However, put into the hematoma local anesthetic may not block all nerve endings in the fracture area that does not provide adequate pain relief. Soaked from the introduction of local anesthetics can cause systemic neurotoxic and cardiotoxic effect, manifested by hypotension, bradycardia, seizures and impaired consciousness. In addition, the introduction of anesthetic directly into the area of surgical intervention can lead to infection. Novocaine, being a short-acting anesthetic that causes the development of siege lasting 30-40 minutes and does not affect the formation of postoperative pain.

Object of the present invention is both the biscuits adequate pain management, reducing the risk of cardio - and neurotoxic reactions, decrease the dose and frequency of injection of narcotic analgesics after surgery.

The problem is solved due to the fact that before transporting the patient into the operating intramuscularly injected with 100 mg ketonala, and then perform regional blockade of the femoral or sciatic nerve by the introduction of 40 mg of 0.2%aqueous solution naropin.

The method is as follows: on the day of surgery after standard premedication (Relanium (diazepam) 10 mg, atropine 1 mg) to the patient intramuscularly Ketonal 100 mg, then in the house inguinal access perform the blockade of the femoral nerve of 0.2%solution naropin 40 mg or side access blockade of the sciatic nerve of 0.2%solution naropin 40 mg. After 5-7 minutes, after adequate development of motor and sensory block, the patient is placed on a gurney and transported to the operating room. In the operating perform laying on the healthy side and subarachnoid anesthesia. When hip fracture enough to run the blockade of only the femoral nerve. In the postoperative period spend analgesia on demand narcotic and non-narcotic analgesics.

Clinical example.

Patient T., 56, 28.05.2003 in a traffic accident suffered severe combined trauma: fracture of the right femur in the lower third, comminuted fracture of the spines of the tibia on the right.

Operation 11.06.2003: osteosynthesis of the femoral bone and the Shin bone plates.

Premedication - atropine 1mg, Relanium 10 mg In 9 hours 20 minutes - injection ketonala 100 mg intramuscularly. In the house in 9 hours 30 minutes, made the blockade of the femoral and sciatic nerves - 0,2%dissolve rum naropin 40 mg Time development of adequate motor and sensory blockade - 5 minutes; shifting on the stretcher, transport painless.

In the operating room made laying on the healthy side, subarachnoid anesthesia at the level of L3-L4 (3.6 ml of 0.5%solution marcaine spinal). Sedation 20 mg Relanium. Surgery duration 2 hours 10 minutes. The consciousness is transferred to the ICU.

After surgery: movement and sensation in the lower extremities rebounded to 15 hours, hemodynamics remained stable (BP - 120/80 mm RT. senior HR - 80-90 per minute). Analgesia on demand: 17 hours 30 minutes - pain is moderate - omnopon 2% - 1 ml; 22 hours 30 minutes - omnopon 2% - 1 ml; the next day, before transfer to the Department of traumatology - analgin 50% - 2 ml Subjective evaluation of the patient anesthesia good, negative emotions perioperative period is not triggered.

This method of anesthesia used in 28 patients with hip fractures and in 13 patients with fractures of the tibia.

The way of warning combined analgesia in patients with diaphyseal fractures of the femur or holenineteen increases the effectiveness of pain relief by summing up the local anesthetic directly to the nerve trunk, that allows you to interrupt the flow of nociceptive impulses from the zone of fracture in the spinal cord and prevent the formation of a pathological lesion pain. Low concentration of naropin prevents toxic side effects that allows you to safely run the blockade in the house. Use prior to surgery non-steroidal anti-inflammatory drug for pain helps reduce the formation of inflammatory mediators, which ultimately decreases the intensity of pain syndrome. The combined use of non-steroidal anti-inflammatory drugs and regional blockade can significantly reduce the administration frequency and dose of narcotic analgesics in the postoperative period.

The way of warning combined analgesia in patients with diaphyseal fractures of the femur or tibia, including the blockade of the lower limb local anesthetics, characterized in that before transporting the patient into the operating intramuscularly Ketonal at a dose of 100 mg, and then perform regional blockade of the femoral or sciatic nerves, the introduction of 40 mg of 0.2%aqueous solution naropin.



 

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