RESUMO
The research is based upon comparative evaluation of methods of analgesia in 107 patients after surgical correction of scoliotic spinal deformities, which were divided into three comparable groups. The quality of analgesia was assessed on the basis of the clinical manifestations, central hemodynamic changes and total score of pain intensity on. With a combination of narcotic and non-narcotic analgesics (group 1), adequate blockade of nociceptive impulses and comfort of the child are not being reached. Postoperative wound irrigation with 0.1 - 0.2% solution of ropivacaine in combination with NSAIDs is more effective (group 2), if the length of the wound does not exceed 20-23 cm. This method reduces vomiting after surgery and is applied if the patient has not received epidural analgesia. The best effect is achieved with the constant introduction of 0.2% solution of ropivacaine into the epidural space (group 3). This method provides adequate analgesia, sympathetic blockade, and a comfortable postoperative period. It allows the earlier feeding, reduces the incidence of vomiting and can be considered the method of choice.
Assuntos
Analgesia/métodos , Dor Pós-Operatória/prevenção & controle , Escoliose/cirurgia , Adolescente , Analgesia/instrumentação , Analgesia Epidural/instrumentação , Analgesia Epidural/métodos , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Cateteres de Demora , Criança , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Medição da Dor , Limiar da Dor , Dor Pós-Operatória/psicologia , Irrigação Terapêutica , Resultado do TratamentoRESUMO
The authors describe specific effects of prolonged epidural blockade in treatment of contractures of the lower extremity joints in children with cerebral palsy. The method was used in 5 patients aged from 11 to 16 years. The prolonged epidural blockade during 4-5 weeks allowed adequate motor rehabilitation and conditions for learning to walk.
Assuntos
Analgesia Epidural/métodos , Paralisia Cerebral/terapia , Contratura/terapia , Articulação do Joelho , Procedimentos Ortopédicos/métodos , Adolescente , Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Criança , Contratura/etiologia , Contratura/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
The impact of spinal anesthesia on cardiac rhythm variability was studied in 36 children aged 13-17 years who had been operated on for urological, orthopedic, and vascular diseases. The findings were compared with the results obtained in 83 children with the same pathology at the age of 7-15 years, who had been operated under general anesthesia. A spectral cardiac sinus rhythm analysis demonstrated a steady state of stress-limiting systems during spinal block. Unlike general anesthesia, spinal anesthesia was ascertained to reduce the likelihood of intraoperative arrhythmias, by producing an adequate analgesic effect.
