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Abstract
Background and Aims Anesthesiology is showin a tendency to reduce use of opioids. This is due to respiratory depression and hypoxia in postoperative period. In addition – opioids does not allow patient to mobilize in early postoperative period, which increases the risk of thromboembolic complications. Rapid progress in development of regional methods of analgesia has significantly reduced the use of opioids and has provided sufficient pain relief. Despite the results achieved, we continue to search for perfect combination of local anesthetic and adjuvants to ensure long-lasting and safe analgesia.
Methods Seventy peripheral nerve blocks were performed in patients undergoing orthopedic surgery. Patients were randomly assigned to 2 groups (G1, G2), depending on the adjuvant: G1 – blockade with solution of bupivacaine 0,375% and dexamethasone 0,02%; Gr2 – blockade with a solution of bupivacaine 0,375% with dexamethasone 0,02% and epinephrine 0,00018%. The duration of the blockade was assessed. Pain intensity was assessed at the 6th, 12th, 24th and 36th h. after blockade. The amount of narcotic anesthetic were also recorded. In addition, patients underwent electromyography of the innervation area of the blocked nerve before the surgery and 24 and 36h after surgery.
Results Duration of blockade in G2 was longer by 10h, intensity of pain was significantly higher after 24h (1.65 ± 1.35 in G2 and 5.3 ± 1.26 in G1). According to electromyography, 24h after blockade conductance in G1 was restored by 95–100%, unlike G2, where conductivity was restored by only 47–59%.
Conclusions Proposed combination of local anesthetics and adjuvants provides both adequate anesthesia during surgery and prolonged post-operative analgesia.