Regional anesthesia — the type of an anesthesiology grant consisting in local interruption of a painful impulsation from the place of intervention by blockade of conduction paths. Regional anesthesia can act as as a basic element of an anesthesiology grant, and to enter composition of the so-called combined anesthesia, that is to be applied as its component. Extent of participation of regional anesthesia in this case is various: she can act as the main analgetic component of a grant, strengthen action of a system analgesia or be applied to postoperative anesthesia.
Regional anesthesia is very attractive in physiological sense as it allows to stop locally a painful impulsation, without allowing system impact of pain on an organism and allowing or to refuse in general system influence of anesthetics, or to considerably reduce extent of such influence. Use of regional anesthesia promotes more effective treatment of a postoperative pain syndrome, prevents forming of chronic pains after operation, has beneficial influence on a trophicity and an angenesis that, eventually, accelerates recovery and rehabilitation of the patient. Early activization of patients after regional anesthesia promotes prevention of tromboembolic episodes in the postoperative period.
Distinguish the following types of regional anesthesia:
The infiltration (terminal) anesthesia — blockade of painful impulses directly in an intervention zone, is most often carried out by the surgeon;
Conduction — blockade of neuroplexes and separate nerves which is carried out already on removal from an operation zone;
Neuroaxial (central) blockade — spinal, epidural and caudal anesthesia and also their combination.
The infiltration anesthesia is the simplest type of local anesthesia. It is carried out directly by the operator by infiltration of the place of expected intervention by anesthetic solution. Infiltration can be limited to leather and hypodermic cellulose, and can affect also deeper layers. Its version is terminal (topikalny) anesthesia when anesthetic is applied on mucous membranes (ophthalmology, otorhinolaryngology, endoscopy, etc.).
Conduction anesthesia represents blockade of neuroplexes and also separate nerves. Was widely adopted at the upper extremity operations (blockade of a brachial plexus and separate nerves). Blockade of a brachial plexus makes high percent of success as at its correct performance there is enough hit of anesthetic in a fascial case of a texture, the block rather qualitative and is sufficient on duration. Contrary to it, blockade of nerves of the lower extremity of such success did not receive as they make lower interest of success and with ease are replaced with spinal or epidural anesthesia. Recently blockade of nerves of an anterior abdominal wall – TAP block and to it similar were widely adopted. Verification of textures or separate nerves when carrying out conduction blockade can be carried out in various ways: on paresthesias, by means of a neurostimulator or by means of ultrasonic navigation. Verification on paresthesias gradually consigns to the past as this method is followed by unpleasant feelings for the patient and high risk of injury of nerves. Verification by means of a neurostimulator remains a classical technique that gives the high frequency of success of blockade, allows to carry out manipulation under sedation and Bol it is safe for the patient. Ultrasonography navigation when carrying out regional blockade actively develops recently. It allows to see directly nervous structures and to reduce amount of the entered local anesthetic. Now most of specialists for verification of nervous structures recommends an ultrasonography navigation combination to use of a neurostimulator.
The central (neuroaxial) blockade are very widespread thanks to their efficiency, a possibility of the prolonged performance and relatively carrying out outage of technology. Spinal anesthesia is widely applied at interventions lower than the level of a navel, Cesarean section, to a labor pain relief. Epidural anesthesia is the gold standard of the prolonged labor pain relief, is widely applied in a postoperative analgesia, to stimulation of motor function of intestines, as a part of multicomponent anesthesiology grants on bodies of a thorax and abdominal cavity. Caudal anesthesia finds application in gynecologic and urological practice. Essential plus of epidural and caudal anesthesia is the possibility of the prolonged anesthesia when the established catheter allows to enter to the patient local anesthetic for a long time.