Panov V. The perioperative analgesia in patients with critical limb ischemia

The comperative analysis of methods of perioperative analgesia and anesthesia was provided in 120 patients with critical limb ischemia due to atherosclerotic occlusion. The prevalence of prolonged epidural analgesia was concluded and the improvement of the method in accordance with pain intensity and hemodynamic parameters proposed. The author found the negative correlation between pain intensity and skin temperature in patients with critical limb ischemia. The dynamics of stress-markers were analysed in relation to the method of analgesia. The algorithm for choosing the prevalent method of perioperative analgesia for the patients with critical limb ischemia was grounded. The new approach for sympathetic blockade near the bifurcation of abdominal aorta is based on calculations on 30 spiral computed tomograms of lumbar and sacral vertebral region. The method was developed experimentally in 20 unembalmed cadavers with the investigation of injected dye spread. The proposed approach allows avoiding such complications of lumbar sympathetic blocks as puncture of kidney, intestine and big vessels (aorta, vena cava inferior). The method was evaluated clinically in 20 patients with lower limb ischemia and demonstrated decreased pain intensity, increased skin temperature and stable hemodynamic parameters.