Efficiency estimation of intrapleural and thoracic paravertebral block in combination with general anesthesia at thoracoscopic interventions

Background. Efficiency of intrapleural and thoracic paravertebral block in combination with general anesthesia in patients performed thoracoscopic interventions due to traumatic injuries of thorax have been studied. Aim of the study. The aim of our investigation is the efficiency estimation of intrapleural (IPA) and thoracic paravertebral analgesia(TPVA) in composition of combined anesthesia in intraand post-operative periods in patients with chest traumatic injuries. Materials and methods. 90 patients admitted to RRCEM in urgent way with chest traumatic injuries have been examined. They have been divided into 2 groups against to the applied method of anesthesia and post-operative pain relief. The above mentioned investigations have been carried out at the following levels: Intra-operative period: 1 – outcome – before the anesthesia; 2 – after block; 3 – traumatic moment of the operation; 4 – the end of operation; Post-operative period: 1 – before the pain relief; 2 – 30 minutes after pain relief; 3 – 3 hours after pain relief; 4 – 6 hours after pain relief. Extubation time in both patients groups, analgetic first needs time have been recorded, calculation of the used phentanil narcotic analgesic intra-operationally and also it has been calculated the use of promedol narcotic analgesic in the post-operative period. Results. The received results shows that the use of the regional way of anesthesia in combination with general anesthesia promotes a smooth course of intra- and post-operative periods with the minimal tension of hemodynamic indexes, less revealed pain syndrome in post-operative period, has the economic effect shown up by the decrease of the use of narcotic analgetics both in intra- and post-operative periods. Conclusion. 1. Both method of the regional anesthesia cut short a pain syndrome sufficiently and safety in patients with chest injuries before an operative intervention. 2. Introduction the component of IPA and TPVB into anesthesia scheme at thoracoscopic operative interventions allows to provide it the additional antinociceptive protection both in intra- and in post-operative period with minimal stress of central and peripheral parameters and promotes the reduction of narcotic analgesic use due to significant analgetic efficiency and neuro-vegetative protection. 3. In spite of good analgetic efficiency of IPA, pain relief duration using this method is lower and it is connected with mixing the local anesthetic introduced into pleural area with serous fluid secreting by pleura and as the result of it a concentration of local anesthetic is reduced and its duration is shortened. Also the presence of drainage tube promotes outflow of the local anesthetic from pleural cavity together with exudates.