Epidural analgesia with local anaesthetics and promedol as a component of optimisation of management of patients with ischemic pains of the lower limbs in the preoperative period

Abstract

Comparative analysis of two methods of pain relief in critical ischemia of lower limbs in patients with obliterating atherosclerosis of vessels of lower extremities was implemented. In group I, the parenteral infusion of a set of compounds, which included non-narcotic analgesics (non-opioids) and promedol was used, in II group — epidural analgesia with local anaesthetic (ropivacaine or bupivacaine) in combination with promedol. Comprehensive assessment of the pain syndrome in case of critical ischemia of the lower extremities, including qualitative and quantitative evaluation of pain by patients, studies of hemodynamic, neuroendocrine and metabolic parameters was carried out. On the basis of the data obtained, one-way ANOVA was completed, which confirmed the influence of the type of analgesia on the severity of ischemic pain on the dynamics of recorded parameters with a high degree of approximation of the analysis. Convincing data about the greater effectiveness of epidural analgesia with local anaesthetics and promedol compared to parenteral infusion of promedol and other analgesics not only in the treatment of pain and improve quality of life, but also in the correction of adverse reactions of cardiovascular system were received. Prolonged epidural block in the preoperative period contributed to the improvement of neuroendocrine status, metabolism and oxygen transport. Comparison of bupivacaine and ropivacaine used in epidural analgesia revealed the equal efficacy of these drugs. Bupivacaine more often caused a more prolonged motor block. Refs 23. Tables 5.