EPIDURAL ANALGESIA WITH LOCAL ANAESTHETICS AND PROMEDOL AS A COMPONENT OF OPTIMISATION OF MANAGEMENT OF PATIENTS WITH ISCHEMIC PAINS OF THE LOWER LIMBS IN THE PREOPERATIVE PERIOD
DOI:
https://doi.org/10.21638/11701/spbu11.2017.411Abstract
Comparative analysis of two methods of pain relief in critical ischemia of lower limbs in patients with
obliterating atherosclerosis of vessels of lower extremities was implemented. In group I, the parenteral
infusion of a set of compounds, which included non-narcotic analgesics (non-opioids) and promedol was used, in II group — epidural analgesia with local anaesthetic (ropivacaine or bupivacaine) in combination
with promedol. Comprehensive assessment of the pain syndrome in case of critical ischemia of the lower extremities, including qualitative and quantitative evaluation of pain by patients, studies of hemodynamic, neuroendocrine and metabolic parameters was carried out. On the basis of the data obtained, one-way ANOVA was completed, which confirmed the influence of the type of analgesia on the severity of ischemic pain on the dynamics of recorded parameters with a high degree of approximation of the analysis. Convincing data about the greater effectiveness of epidural analgesia with local anaesthetics and promedol compared to parenteral infusion of promedol and other analgesics not only in the treatment of pain and improve quality of life, but also in the correction of adverse reactions of cardiovascular system were received. Prolonged epidural block in the preoperative period contributed to the improvement of neuroendocrine status, metabolism and oxygen transport. Comparison of bupivacaine and ropivacaine used in epidural analgesia revealed the equal efficacy of these drugs. Bupivacaine more often caused a more prolonged motor block. Refs 23. Tables 5.
Keywords:
obliterating atherosclerosis, critical ischemia of lower limbs, pain syndrome, epidural analgesia, promedol, local anaesthetics
Downloads
References
References
ischaemia as a consequence of inadequate treatment of patients with chronic obliterating diseases of lower
limb arteries in outpatient]. Angiol. vascular. surgery, 2004, vol. 10, no. 1, p. 11. (In Russian)
N., Mercuri M. The use of prolonged peripheral neural blockade after lower extremity amputation:the effect on symptoms associated with phantom limb syndrome. Anesth. Analg., 2014, vol. 11, no. 5,pp. 1308–1315.
rheumatology]. Moscow,Infra-M Publ., 2017. 77 p. (In Russian)
sindroma u bol’nykh s kriticheskoi ishemiei nizhnikh konechnostei [Multimodal therapy of chronic pain
syndrome in patients with critical ischemia of lower extremities]. Sib. med. J., 2008, no. 2, pp. 47–51.(In Russian)
with ropivacaine plus fentanyl and ropivacaine plus clonidine for lower abdominal and lower limb surgeries. J. Dent. Medical Sc., 2015, vol. 14, pp. 19–26.
treatment algorithms for neuropathic pain]. RMJ, 2008. 11 р. (In Russian)
of the proximal gastrointestinal in patients with peripheral atherosclerosis]. Fundamental research,
, no. 2 (part 1), pp. 117–120. (In Russian)
Downloads
Published
How to Cite
Issue
Section
License
Articles of "Vestnik of Saint Petersburg University. Medicine" are open access distributed under the terms of the License Agreement with Saint Petersburg State University, which permits to the authors unrestricted distribution and self-archiving free of charge.