RU2283101C1 - Preventive combined analgesia method for treating patients for diaphyseal femur and shank fracture - Google Patents

Abstract

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.

Description

The present invention relates to medicine, in particular to methods of combined analgesia, and can be used to transport patients with diaphyseal fractures of the thigh and lower leg to the operating room, as well as to ensure optimal placement when performing central segmental blockade.

Closest to the proposed invention is blockade of the lower extremity by a local anesthetic - a solution of 1% or 2% novocaine in a dose of 20-50 ml to the hematoma at the fracture site - "anesthesia to hematoma" (see Selected lectures on disaster medicine / under Edited by Prof. S.V. Trifonov. -M.: GEOTAR-Med, 2001.-S.172).

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

The task of the invention is to provide adequate pain relief, reducing the risk of cardiac and neurotoxic reactions, reducing the dose and frequency of administration of narcotic analgesics after surgery.

The problem is solved due to the fact that before transportation, 100 mg of ketonal is intramuscularly injected into the operating room, and then regional blockade of the femoral or sciatic nerve is performed by the administration of 40 mg of a 0.2% solution of napropine.

The method is as follows: on the day of surgery, after standard premedication (Relanium 10 mg, Atropine 1 mg), the ketone 100 mg is intramuscularly administered to the patient, then femoral nerve blockade is performed with 0.2% napropine 40 mg solution or lateral blockade in the ward by inguinal access sciatic nerve 0.2% solution of napropine 40 mg. After 5-7 minutes, after the development of an adequate motor and sensory block, the patient is transferred to a gurney and transported to the operating room. In the operating room, laying on a healthy side and subarachnoid anesthesia is performed. In case of a hip fracture, it is enough to only block the femoral nerve. In the postoperative period, anesthesia is performed on demand with narcotic and non-narcotic analgesics.

Clinical example.

Patient T., 56 years old, May 28, 2003 as a result of an accident received a severe combined injury: a fracture of the right femur in the lower third, a comminuted fracture of the bones of the lower leg on the right.

Operation 11.06.2003: osteosynthesis of the femur and lower leg bones with plates.

Premedication - Atropine 1 mg, Relanium 10 mg. At 9 hours 20 minutes - an injection of ketonal - 100 mg intramuscularly. In the ward at 9.30 a.m., the blockade of the femoral and sciatic nerves was performed with a 0.2% solution of 40 mg of naropin. The development time of an adequate motor and sensory blockade is 5 minutes; shifting to a gurney, transportation is painless.

In the operating room, laying on a healthy side was performed, subarachnoid anesthesia at the level of L3-L4 (3.6 ml of a 0.5% solution of marcaine spinal). Sedation 20 mg Relanium. The duration of the operation is 2 hours 10 minutes. Consciousness translated into ICU.

After surgery: movements and sensitivity in the lower extremities recovered by 15 hours, hemodynamics remained stable (blood pressure - 120/80 mm Hg, heart rate - 80-90 per minute). Anesthesia on demand: 17 hours 30 minutes - moderate pain - omnopon 2% - 1 ml; 22 hours 30 minutes - omnopon 2% - 1 ml; the next day, before being transferred to the department of traumatology - analgin 50% - 2 ml. Subjective assessment of the patient - good analgesia, perioperative period did not cause negative emotions.

This method of pain relief was used in 28 patients with hip fractures and in 13 patients with leg fractures.

The method of preventing combined analgesia in patients with diaphyseal fractures of the hip or lower leg significantly increases the effectiveness of anesthesia by bringing a local anesthetic directly to the nerve trunk, which allows you to interrupt the flow of nociceptive impulses from the fracture zone to the spinal cord and prevent the formation of a “pathological” focus of pain. A low concentration of napropin prevents toxic side effects, which makes it possible to safely perform a blockade in the ward. The use of non-steroidal anti-inflammatory drug for pain relief before surgery can reduce the formation of inflammatory mediators, which ultimately reduces the severity of the pain syndrome. The combined use of a non-steroidal anti-inflammatory drug and regional blockade can significantly reduce the frequency of administration and dose of narcotic analgesics in the postoperative period.

Claims (1)

A method for preventing combined analgesia in patients with diaphyseal fractures of the thigh or lower leg, including lower extremity blockade with local anesthetics, characterized in that ketone is administered intramuscularly at a dose of 100 mg before the patient is transported to the operating room, and then a regional blockade of the femoral or sciatic nerves is administered with 40 mg 0 , 2% solution of napropine.