| Abstrakt: |
The regional methods of analgesia are the "golden standard" of choice during trauma surgeries. The supraclavicular block of the bracheal plexus is the method of choice during the cubital joint surgeries. The purpose of the study is to improve the effectiveness of anesthesia and postoperative analgesia for surgical interventions on the cubital joint in children by developing and implementing the clinical practice of peripheral blockade of the brachial plexus by the supraclavicular access. The study included 40 children aged 5 to 12 years. The children rated as ASA I, came to the clinic on an emergency basis with cubital joint bones injuries. All the children were had surgeries on the cubital joint (closed and open repositions with osteosynthesis) with balanced regional anesthesia, the main analgesic component of which was supraclavicular brachial plexus block (by Kulenkampf-Fursaev technique). The supraclavicular block was performed in conditions of psychological comfort of the child. For the means of premedication age appropriate doses of seduxen or midazolam were intravenously administered. Intraoperative sedation was conducted by the re-introduction of benzodiazepines, and ketamine (up to 1 mg/kg/h). During the study period, the effective intraoperative analgesia, provided by supraclavicular blockade of peripheral nerves, was observed in 31 children. In 9 patients the blockade could be found to be incomplete at the second stage of the surgery (reposition). For this reason, it took the additional administration of tramal in a dose of 2 mg/kg and deepening of sedation with ketamine up to the dose of 2 mg/kg/h. The duration of effective postoperative analgesia due to long-acting local anesthetic (0.5% solution of naropin) was 8-9 hours. There were no complications registered as a result of supraclavicular. Thus, this study proves that the supraclavicular brachial plexus block provides effective intra and postoperative analgesia in trauma operations on the cubital joint in children. |
