Sydiuk O. Postoperative analgesia for patients with malignant deseases of esophagus.

Performing surgical interventions on the organs of the chest and abdominal cavity is always accompanied by significant postoperative pain. This is especially true when using thoraco-abdominal access in the surgical treatment of the esophagus and stomach. The purpose of the dissertation is to improve the results of anesthetic providing in the surgical treatment of patients with malignant diseases of the esophagus by developing and applying a method of rational postoperative anesthesia. The study included 80 patients with malignant tumors of the esophagus which were operated in Shalimovs National institute of surgery and transplantology, and for which were performed radical surgery combined thoraco-abdominal access (Lewis or Osawa-Garlock operation): control group - 40 patients who used ostoperative thoracic epidural analgesia; study group - 40 patients who used combined postoperative analgesia (thoracic epidural analgesia + thoracic paravertebral block). On the basis of the prospective study of the course of anesthesia, the analysis of quantitative and qualitative indicators of evaluation of pain relief methods, complications and consequences of surgical interventions in patients with cancer of the esophagus using different methods of anesthetic support, new scientific data were obtained, namely: simultaneously a comprehensive study of the combined use of PBB and TEM on indicators of peripheral hemodynamics, function of external respiration, hormonal- metabolic status in patients after the operation of Lewis and Osawa-Garlock. It has been proved that the methods of the combined paravertebral and epidural block provide adequate anesthesia after Lewis and Osawa-Garloc operations than traditional post- operative analgesia techniques. For the first time it was established that the use of the paravertebral and epidural blocks is characterized by stable indicators of hemodynamics and function of external respiration than with prolonged epidural anesthesia. It has been confirmed that the traditional epidural blockade does not provide a sufficient level of postoperative pain control in rest and is not sufficient for full activation of patients after Lewis and Osawa-Garloc operations. The positive and negative effects of the combined paravertebral and epidural block were revealed and the methods of treatment of possible side effects were suggested. Extended theoretical knowledge on the peculiarities of the influence of the combined paravertebral and epidural block on the intensity of postoperative pain of operated patients, as well as the effect of such combination on the function of external respiration, hemodynamics and cardiac performance, intensity and dynamics of the stress response of the organism against the background of the various methods of postoperative analgesia.