Fesenko V. Topographo-anatomical and clinical validation of increasing of effectiveness and safety of regional analgesia

The dissertation focuses on increasing of effectiveness and safety of the brachial plexus anaesthesia with three approaches. Anatomical investigations proved the existence of a barrier between supra- and infraclavicular parts of the brachial plexus sheath and validated two original modifications of interscalene and coracoid infraclavicular blockade. Clinical investigations demonstrated the efficacy of infrared thermometry as a predictor of successful blockade, the most rapid onset of sensory, motor, and sympathetic block after supraclavicular blockade and the best trapezius muscle anaesthesia with interscalene blockade. In the meantime, the interscalene blockade showed the most respiratory side effects and the highest plasma levels of lidocaine. The coracoid infraclavicular blockade showed no respiratory side effects. Intra- and postoperative biochemical stress-markers (glycaemia, cortisol and prolactin levels) intra- and postoperatively changed less after plexus blockade, compared with general anaesthesia, but prolactin increased fourfold after plexus blockade in correlation with the patients’ anxiety levels. Postoperatively, pain intensity and the need for opioids were significantly less, duration of analgesia was longer after plexus blockade. An algorithm for the choice of optimal approach for brachial plexus blockade is proposed.