OPTIMIZED METHOD OF UNILATERAL SPINAL ANESTHESIA, PRELIMINARY RESULTS
Introduction: Unilateral, or otherwise, monolateral spinal anesthesia (USA /MSA), is one of the methods of spinal anesthesia in one side operations on the lower limbs. However, this kind of anesthesia is not without flaws. One of the main criteria for evaluating this type of anesthesia is the frequency of successful monolateral blocks, which, according to different authors, varies from 13% to 94%. Such a spread is, without any doubts, is not the criterion of a "reliable" method of anesthesia and in many cases is explained by the technique of its implementation. In recent years, by Mamyrov D.U. et al., a new original technique of monolateral spinal anesthesia with the use of electroneurostimulation (MCA + ENS) has been proposed, reg №26023 ((19) KZ(13)A4(11)26023), but its effectiveness and safety have not been studied enough.
The aim of the study: To conduct the comparative evaluation of the efficacy and safety of the methods of conventional monolateral spinal anesthesia (MSA) and monolateral spinal anesthesia using electroneurostimulation (MSA + ENS).
Materials and methods: This work was carried out within the frames of the PhD doctoral education program. On the basis of Pavlodar city hospital №1, in the period from July to September 2018, 18 patients operated on for varicose disease of the lower limbs, deep vein thrombosis of the lower extremities, as well as amputations of one of the extremities were examined. 7 patients underwent MSA + ENS (main group), 11 patients had traditional MSA (comparison group).
The study design is a blind, randomized, clinically-controlled study.
During the processing of statistical data, the following criteria were applied: the Shapiro – Wilk criterion, the Levene criterion, Student's t-test for independent samples, the U-Mann Whitney test with the Moses amendment and the Chi-square test was used to analyze dichotomous variables.
Results: Both study groups were comparable to gender M = 1.56 (SD = 0.5), age M = 50.7 (SD = 8.7), BMI = 25 (SD = 5.2) and ASA status M = 2.4 (SD = 0.5). In both groups there were no statistically significant differences in hemodynamic parameters, so in main group MSAP = 103 (SD = 4.6), t = 1.43 df = 16 p> 0.05; in comparison group MSAP = 99 (SD = 6.6), t = 1.55 df = 15.7 p> 0.05. At the same time, the parameters of the sensor and motor block are different. Thus, the adequacy of anesthesia in the main group was observed in all patients, in the comparison group, 4 (36%) patients required additional administration of analgesics. Bilateral anesthesia was in 2 (18.1%) patients in the comparison group. Also, 2 (18.1%) patients of the comparison group had nausea, without vomiting. In the postoperative period 2 (18.1%) patients of the comparison group there were post-puncture headaches, that had been treated after 2 days, in patients of the main group headaches were not observed
Conclusions: The obtained results, despite the small amount of observations, confirm the expediency of applying the MSA + ENS method, since this technique gives an objective control of the puncture of the dura mater process by obtaining a motor response. The MSA + ENS technique allows to stop pushing the spinal needle into the subarachnoid space, thereby reducing the incidence of injury of the spinal cord roots and cauda equina with a needle, also significantly increases the chance of obtaining an adequate one-sided spinal block. Thus, this method seems to us more effective and safe in comparison with the usual monolateral spinal anesthesia.
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Мамыров Е.Д., Мамыров Д.У., Сыздыкбаев М.К., Йошихиро Носо. Усовершенствованный метод односторонней спинальной анестезии, предварительные результаты // Наука и Здравоохранение. 2019. 2 (Т.21). С. 67-75. Mamyrov Ye.D., Mamyrov D.U., Syzdykbayev M.K., Yoshihiro Noso Optimized method of unilateral spinal anesthesia, preliminary results. Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 2, pp. 67-75. Мамыров Е.Д., Мамыров Д.У., Сыздыкбаев М.К., Йошихиро Носо. Бір жақты жұлын анестезия әдісін жетілдіру, алдын ала нәтижелері // Ғылым және Денсаулық сақтау. 2019. 2 (Т.21). Б. 67-75.Похожие публикации:
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