Gomon N. Multimodal anesthesia using regional analgesia in the complex of antinociceptive protection іn surgery (clinical and experimental study).

In experiment on 23 animals (dogs) were created models of epidural analgesia, selective blockade of the sciatic nerve and brachial plexus for use as a controlled analgesic component in the multimodal anesthesia. Was proved positive impact of 0.25 % bupivacaine during epidural analgesia in reducing inflammation in the entero-entero anastomosis in animals. Were developed principles for increasing efficiency of brachial plexus blockade by using sharp edges when leading of neurostimulation needle and catheter to the nerve trunks, differentiated blockade of its branches and solutions with different characteristics. Was developed principle for increasing efficiency of blockade of sciatic nerve from the popliteal fossa, as a method of prolonged analgesia with preservation of motor activity in the limbs. In the clinical part (291 patients) were developed schemes of preoperative preparation of patients using long-acting anxiolytic to reduce psychosomatic disorders during regional techniques and multimodal anesthesia. Was developed and implemented in practice individualized (through the use of integrated hemodynamic index) technique of intraoperative and postoperative epidural analgesia, as a major component of antinociceptive protection in multimodal anesthesia by patients with surgical interventions on the digestive tract. Achieved better results in antinociceptive protection and security of surgery interventions during reconstructive surgery interventions on the abdominal aorta and the arteries of the lower extremities due to different reduced spin-epidural anesthesia / analgesia and postoperative analgesia by combination of NSAIDs with epidural analgesia. Achieved the best results of course and safety of multimodal postoperative antinociceptive protection in patients with atherosclerotic ischemia of terminal areas limbs due to prolonged selective blockade of the sciatic nerve with preserving the motor function of limbs. Reached improve safety and reduce the severity of toxic reactions to bone cement during prosthetic repair of hip joint due to reduced spinal/epidural anesthesia/analgesia and controlled hypertension/normotension. Implemented obtained experimentally principles efficiency of brachial plexus blockade by multimodal two-tiered method of blocking sites of plexus by anesthetics with different characteristics, that ensured the safety and efficacy of intraoperative and postoperative analgesia bloc. The analysis of hemodynamics, micro and blood glucose as indicators of perioperative stress, pain when using the above-described methods using multimodal regional analgesia.