Regionalna anestezija u torakalnoj i abdominalnoj kirurgiji
| Autor: | Jasmina Markovič-Božič, Vesna Novak-Jankovic |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
030213 general clinical medicine
0209 industrial biotechnology medicine.medical_specialty Analgesic Regional anaesthesia 02 engineering and technology regionalna anestezija torakalna kirurgija abdominalna kirurgija 03 medical and health sciences 020901 industrial engineering & automation 0302 clinical medicine Anesthesia Conduction Transversus Abdominis Plane Block Professional Papers regional anaesthesia Abdomen medicine Humans Pain Management Paravertebral Block Abdominal Muscles Pain Postoperative business.industry Hemodynamics Nerve Block Multimodal therapy General Medicine Perioperative Length of Stay Thoracic Surgical Procedures thoracic surgery abdominal surgery Analgesia Epidural Cardiothoracic surgery Anesthesia business Abdominal surgery |
| Zdroj: | Acta clinica Croatica Volume 58. Issue Supplement 1 Acta Clinica Croatica |
| ISSN: | 0353-9466 1333-9451 |
| DOI: | 10.20471/acc.2019.58.s1.14 |
| Popis: | Surgical procedure causes tissue damage which activates systemic inflammatory response and leads to changes in endocrine and metabolic system. Anaesthesia and pain can further disrupt immune performance. Regional anaesthesia causes afferent nerve blockade and in this way mediates immune protection. Thoracic epidural analgesia is the cornerstone of pain relief in thoracic and abdominal surgery. Alternatively thoracic paravertebral block can be used with less side effects and good analgesic properties. Drugs that interfere with blood coagulation obstruct the use of central regional blocks. Surgery has also changed recently from open to minimally invasive. Also pain treatment for this procedures has changed to less aggressive, systemic or locoregional techniques. It was shown that transversus abdominis plane block and epidural analgesia have the same effect on postoperative pain, but transversus abdominis plane block was better regarding hemodynamic stability and hospital stay. Multimodal approach combining regional and systemic analgesia is currently the most appropriate perioperative pain management strategy. More studies should be done to give recommendations. Kirurški zahvat uzrokuje tkivno oštećenje koje aktivira sistemski upalni odgovor i dovodi do promijena u endokrinom i metaboličkom sustavu pacijenta. Anestezija i bolovi mogu još dodatno utjecati na imunološki sustav. Regionalna anestezija uzrokuje aferentnu blokadu živaca i time dovodi do zaštite imunološkoga sustava. Torakalna epiduralna analgezija je zlatni standard za liječenje bolova u torakoabdominalnoj kirurgiji. Alternativna tehnika je torakalni paravertebralni blok koji ima manje nuspojava i dobar analgetski učinak. Antikoagulantni lijekovi ograničavaju upotrebu centralnih živčanih blokova. Kirurške se tehnike mijenjaju u smjeru minimalno invazivnih kirurških tehnika. Isto tako tehnike liječenja bolova se mijenjaju prema upotrebi manje agresivnih sistemskih i lokoregionalnih tehnika. Studije su pokazale da su “transversus abdominis block” (TAP) i epiduralna analgezija jednako učinkoviti u liječenju postoperativnih bolova, s tim da se kod TAP blokova puno rjeđe pojavljuje pad krvnoga tlaka i da je vrijeme hospitalizacije kraće. Multimodalni pristup s kombinacijom regionalne i sistemske analgezije je trenutno najbolja tehnika za liječenje perioperativnih bolova. Potrebna su dodatna istraživanja da bi se izradile smjernice. |
| Databáze: | OpenAIRE |
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