Epidural anesthesia

One of the effective methods of pain relief is an epidural anesthesia.
Reducing pain in the wound comes through 4-5 minutes after injection of preparation, and then the pain is completely gone. Patients can breathe freely, to produce mucus and phlegm, move in bed. The duration of one epidural blockade is 2-3 hours. To ensure long-term pain relief in the epidural space insert a thin catheter through which periodically bring an anesthetic - 0.3% solution dikaina or preparations of prolonged action (procaine, prilocaine, lidocaine, etc.). Epidural anesthesia allows to provide full segmental pain relief for up to 10 days. The disadvantage of epidural anesthesia is the complexity of its implementation, in particular the risk of puncture Dura with a subsequent release of drug in the spinal canal and complications specific to spinal anaesthesia, it is a drop in blood pressure, uncontrolled relaxation of the diaphragm and abdominal muscles and breathing problems, therefore, epidural anesthesia should only be performed by a specialist.
Good energeticheskim effect have some inhalant drugs, in particular nitrous oxide. Inhalation mixture of nitrous oxide with oxygen in the ratio of 2 : 1 or 1 : 1 allows to ensure the long controlled analgesia (from several hours to several days). This saves the consciousness of the patient, he can make contact, but his emotional reactions are reduced, breathing remains deep, smooth, hemodynamic parameters also normalized. This method allows to achieve a result when other measures are ineffective, for example with coronary insufficiency and in the postoperative period. The disadvantage of this method of pain relief is the need to use a fairly complex equipment and continuous monitoring of patients by nurses (industry created a special unit for a long anesthesia nitrous oxide - Knapp). Good analgeticakimi properties have trilan and methoxyflurane (inhalan) - liquid drugs. In sovnarkomivska doses they, as well as nitrous oxide, provide pain relief with preserved consciousness, but, unlike nitrous oxide, for their application does not need any expensive anesthesia equipment or control of an anesthesiologist. Anesthesia these drugs can be performed using a portable vaporizers. Thus there is a kind of autoregulated depth of anesthesia: the patient himself holds the evaporator around the mouth and breathe through it. In 1-2 minutes after the start inhalation there comes a loss of pain sensitivity with preserved consciousness. If the vapour concentration is too high, it comes drowsy condition, the patient is involuntarily puts hand and wakes up. With the resumption of the pain he again begins inhalation, etc.
A significant challenge is the choice of anesthesia for children and for the elderly. During the operation the method of choice for children because of their easy irritability, difficulty of establishing contact and lack of criticism of his conduct should be considered anesthesia, and in the postoperative period the combination of non-narcotic analgesics (analgin, amidopyrine) with drugs, soothing mind (barbiturates, tranquilizers),- nerolac-analgesia. Patients senile age is a major risk is easily the coming depression of respiration and circulation. So when the pain in this group of patients need careful use of opiates and drugs, oppressive spontaneous respiration. The best are the most sparing methods: the combination neyroleptanalgezii with local anesthesia by Century A. Vishnevskaya, and in the postoperative period - epidural anesthesia.