Рain management in emergency limb trauma

Abstract

Background. In Ukraine annually more than 4.5 million people receive injuries of varying severity, in the structure of injuries, 60–65 % of patients suffer damage to the limbs. Victims of limb traumas require effective anesthesia/analgesia at an early stage. An urgent anesthetic should provide sufficient relaxation of the extremity, adequate for operative and postoperative anesthesia, should be safe. Peripheral regional anesthesia meets the set requirements, but there are problem issues: severe identification of gums and nerve trunks, high frequency of complications. The purpose of the work is to carry out an analysis of the effectiveness and safety of the ultrasound-guided nerve block of the extremities in emergency traumatology. Material and methods. The retrospective analyzes of patients with isolated mechanical trauma of the limbs that were on treatment in the trauma department of “City clinical emergency hospital of Zaporizhzhia” in 2019–2020 were conducted. All patients underwent ultrasound-guided nerve block using the ultrasound device Logiq E with standard 12 MHz linear sensor. Anesthesia was performed in 0.5% bupivacaine 15–20 ml. During the study, the duration of the identification of plexus and nerves was evaluated; monitoring of hemodynamics with the help of UM-300 monitor at the research stages; fixed complications. Statistical analysis of data provided for methods of descriptive statistics. In all procedures of statistical analysis, the critical level of significance of p was taken to be 0.05. Data processing was performed using Statistica 6.0. Results. The results of the study indicate that ultrasound-guided nerve block was significantly faster than the non-ultrasound-guided nerve block (2.40 ± 0,03 min and 7.60 ± 0.04 min, respectively). During the study, there were no statistically significant changes in hemodynamic parameters at the study stages. ultrasound-guided nerve block were accompanied by complications in 5 cases (7.5 %), but these complications were diagnosed in a timely manner and did not lead to deterioration of the patient’s condition. Conclusions. Thus we can conclude that in emergency traumatology ultrasound-guided nerve block is statistically significantly faster than non-ultrasound-guided nerve block. Intraoperative analgesia for hemodynamic parameters in patients during the ultrasound-guided nerve block was effective. Ultrasound-guided nerve block were accompanied by complications in 5 cases (7.5 %), but these complications were diagnosed in a timely manner and did not lead to deterioration of the patient’s condition.

Keywords

• ultrasound-guided nerve block
• peripheral regional anesthesia
• emergency traumatology