Authors
Shikhmetov A.N.1, Vandanov B.K.2, Lebedev N.N.1, Zadikyan A.M.2
1 Institute for advanced training of physicians FGBI «NMSC named N. I. Pirogov» Ministry of Health of Russi, Moscow
2 MCHU Branch clinical and diagnostic center of PJSC Gazprom, Moscow
Abstract
Presents the results of anesthesia in patients with stage 2–3 chronic hemorrhoids, who underwent departuredate hemorrhoids on an outpatient basis.
Materials and methods. All patients were divided into three study groups depending on the chosen method of anesthesia. In the first group, spinal anesthesia was performed. Patients of the second group underwent selective spinal anesthesia (saddle block), and patients of the third group – combined anesthesia: selective spinal anesthesia (saddle block) with prolonged epidural postoperative analgesia.
Results and discussion. The comparison of clinically significant indicators of spinal anesthesia. According to the time of onset of the sensory block, duration of anesthesia, the length of the latent period, the number of blocked segments, the depth of the motor block on the Bromage scale, at the beginning of activation of patients, the effectiveness of anesthesia after surgery. The introduction of low-volume doses of hyperbaric solution Of marcain hevy reduces the number of blocked segments without causing blockade of motor efferent innervation of the lower extremities. Almost no effect on indices of systemic arterial pressure, non-bradiaritmii. The use of extended epidural postoperative analgesia with a solution naropin, effectively relieves the pain and allows you to completely abandon narcotic analgesics.
Conclusion. This study confirmed that selective spinal anesthesia (saddle block) is an effective method of intraoperative analgesia in patients with chronic hemorrhoids and is most justified in an outpatient setting.
Keywords: ambulatory anesthesia; spinal anesthesia; selective spinal anaesthesia; epidural analgesia; chronic hemorrhoids; departuredate hemorrhoids.
References
1. Zaharchenko AA Vinnik YUS, Kirichenko AK. Endovaskulyarnaya dezarterizaciya vnutrennih gemorroidal’nyh uzlov (emborrhoid technique)// Koloproktologiya. – 2016; Pril. 2: 24-26. (In Russ).
2. Ovechkin AM. Spinal’naya i epidural’naya anesteziya v hirurgii: klinicheskoe znachenie i vliyanie na iskhod. Regionarnaya anesteziya i lechenie ostroj boli. – 2006; 1 (0): 16-25. (In Russ).
3. Ramfell DR, Nil DD, Viskoumi KM. Regionarnaya anesteziya// Moscow: Medpress-inform. – 2008. (In Russ).
4. SHurov AV, Ilyukevich GV, Prushan AV. Vliyanie razlichnyh metodov anestezii na endokrinnometabolicheskij zveno hirurgicheskogo stress otveta. Regionarnaya anesteziya i lechenie ostroj boli. – 2008; 2(1): 21-27. (In Russ).
5. Auroy Y, Narchi P, Messiah A. Serious complication related to regional anesthesia. Anesthesiology. –1997; 7: 469-472.
6. Critchley LAH, Stuart JC, Short TG, Gin T. Haemodynamic effects of subarachnoid block in elderly patients. Br. J. Anaesth. –1994; 73: 464-470.
7. Filingeri V, Buonomo O, Sforza D. Use of Flavonoids for the treatment of symptoms after hemorrhoidectomy with radiofrequency scalpel. Europ. Rev. Med. Fharmacol. Sci. – 2014; 18(5): 612-616.
8. Liu S, Block B, Wu C. Effect of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery // Anesthesiology. –2004; 101: 153-161.
9. Matot I, Oppenheim E, Ratrot R. Preoperative cardiac events in elderly patient with hip fracture randomized to epidural or conventional analgesia// Anesthesiology. – 2003; 98: 156-163.
10. Muravchick S. Cucchiara RF, Miller ED, Reves JG. Anesthesia for the elderly // Anesthesia - 5-th Ed. Philadelphia. –2000; 2140-2156.
11. Navalon G, Morales M. Spinal anesthesia: a protective factor in thromboembolic disease. Rev. Esp. Anstesiol. Reanim. – 2001; 48: 113-116.
12. Parker M, Sanchez M, Casas M. Thoracic apidural analgesia in coronary artery bypass graft surgery: Seven years experience // J. Cardiothorac. Vasc. Anesth. – 2003; 17: 154-159.
13. Pescatori M, Aigner F. Stapled transanal rectal mucosectomy ten years after // Tech. Coloproctol. – 2007; 11(1): 1–6.
14. who.int [интернет].Scheyer M, Antonietti E, Rollinger G. Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): Retrospective analysis of 408 patients in a single center // Tech. Coloproctol. –2014. DOI 10.1007/s10151-014-1246-5. 2014.
15. Sheinin H, Virtanen T, Kentala E. Epidural infusion of bupivacaine and fentanyl reduces perioperative myocardial ischemia in elderly patients with hip fracture // Acta Aneasth. Scand. – 2000; 44: 1061-1070.
16. Tanasichuk MA, Schultz EA, Matthews JH, Van Bergen FH. Spinal hemianalgesia: an evaluation of a method, its applicability, and influence on the incidence of hypotension // Anesthesiology. – 1961; 22: 74-85.
