TO THE ISSUE OF ANALGESIA OF THE NEAREST POSTOPERATIVE PERIOD IN SURGERY OF ESOPHAGUS
L.A. NAZIROVA, A.S. ARIFJANOV
Republican Specialized Centre of Surgery after academician V. Vahidov, Tashkent, UZBEKISTAN
The aim: To evaluate the effectiveness of ketorolac in combination with lidocaine epidural analgesia as an option for postoperative analgesia in patients after extended operations on esophagus.
Material and Methods: Postoperative analgesia by means of continuous intravenous infusion of ketorolac in combination with prolonged epidural analgesia was conducted in 24 patients after reconstructive operations on esophagus. From the operational guide: in 9 patients was performed one-stage shunting retrosternal esophagokoloplasty from the parts of transverse colon and the descending part of large intestine. 15 patients underwent extirpation of esophagus with thoracoabdominal access with esophagogastroplasty. Assessment of the effectiveness of analgesia was performed with the aid of digital rating scale (Numerical Rating Scale, NRS), where 0 is no pain, 10 - max pain.
Results: Tracing the dynamics of the intensity of pain reaction, we noted that at the 3 stage of anesthesia (after extubation of a patient) the intensity of pain perception in almost all patients has made 6,2 ± 0,4 points, which corresponded to the upper limit of the zone of moderate intensity of pain perception. In subsequent phases of anesthesia was observed the decrease of the intensity of pain perception to 2,3 ± 0,4, which corresponded to a weaker perception of pain sensitivity.
The effectiveness of the proposed variant of postoperative analgesia was reflected in the indicators of hemodynamics. Provision of maximal reduction in pain sensitivity has contributed to more rapid stabilization of heart rate, average A / P and to a lesser extent changes of intracardiac hemodynamics. Tracing the dynamics of gas exchange and oxygen status on the stages of early postoperative period has shown the best indicators of the stability of SaO2, RaO2, RaO2/FiO2, RaSO2 and pH and dynamic changes of sLac in the combined use of ketorolac infusion and epidural analgesia. The combination of continuous infusion of ketorolac and epidural analgesia significantly reduced the number of respiratory complications in the immediate postoperative period after surgical interventions on esophagus.
Mortality rate in this group of patients has made 4.2% (1 patient), due to insufficient anastomosis.
Conclusion: Combined epidural analgesia with lidocain and continuous infusion of ketorolac provides more effective postoperative analgesia and more reduction of the intensity of pain perception, promotes the stabilization of hemodynamic parameters with the optimization of gas exchange, helps to early activation of patients with a decrease in respiratory complications and in timing of staying of patients in a department of resuscitation and intensive care.
Date: 2014-12-28; view: 296