EPIDURAL ANAESTHESIA AS A COMPONENT OF ANESTHETIC PROTECTION IN LUMBAR SPINE SURGERY

Abstract

Study objective. To increase the efficiency of anesthetic protection by combined use of general and epidural anaesthesia (EА) and prolonged epidural analgesia (PEA).

Material and methods. The combined general anesthesia (EA with naropin, sedation with propofol, and myoplegia with trakrium) followed by PEA with 0,2% naropin has been applied in 45 patients (Group I) out of total 104 patients. An anesthetic aid to another 59 patient (Group II) included standard multicomponent total intravenous anesthesia with calypsol, fentanil, relanium as a base, and myoplegia with arduan, in combination with artificial lung ventilation.

Results. The combined general anesthesia provided stability of hemodynamic parameters with authentic decrease in initial values of systolic, diastolic, and mean blood pressure levels at all stages of surgery. Cortizol concentration in patients of Group I was relatively stable at all surgery stages. The postoperative period was characterized by fast awakening, absence of pain syndrome and adequate pain relief by PEA with 0,2 % naropin. In Group I an average pain severity score was 2,4 ± 0,3 as compared with 5,4 ± 0,14 in Group II.

Conclusions. The suggested variant of anesthetic management provides the high level of neurovegetative protection and endocrine-metabolic stability with significant decrease in pharmacological load on a patient. The prolonged epidural analgesia is the optimum anesthetic technique, which essentially decreases the effect of a surgical stress and excludes a necessity for narcotic analgesics.