DOI: https://doi.org/10.22263/2312-4156.2019.3.45
Kanankou V.V.1, Marochkov A.V.2
Combined anesthesia with intrathecal administration of low doses of bupivacain and morphine-spinal in abdominal surgery
1Mogilev Hospital No.1, Mogilev, Republic of Belarus
2Mogilev Regional Hospital, Mogilev, Republic of Belarus
Vestnik VGMU. 2019;18(3):45-51.
Abstract.
Objectives. To compare the effectiveness and safety of combined anesthesia with the use of low dose hyperbaric bupivacain and morphine spinal anesthesia with general anesthesia in patients of ASA grade II and III scheduled for laparatomic operations on the organs of the upper part of the abdominal cavity.
Methods. A nonrandomized prospective trial included 32 patients aged from 50 to 88 years, who were scheduled for operation on the organs of the abdominal cavity. The first group consisted of 16 patients with subarachnoid administration of low dose hyperbaric bupivacain and morphine as the components of combined anesthesia. The second group included 16 patients with general anesthesia.
Results. Statistically significant differences (р<0.001) of the use of the narcotic analgesics due to sensory block in the operation area were revealed. The use of systemic opioids in the postoperative period decreased credibly because of the prolonged analgetic effect of intrathecal morphine. There were minor fluctuations in the mean values of MAP and the heart rate in all periods of observation both in the first and in the second groups. These indicators were significantly lower in the first group at the time of the incision (p<0.01 and 0.02), which can be regarded as a more effective nocioceptive protection.
Conclusions. Combined anesthesia with subarachnoid administration of low doses of bupivacain and morphine allows to better control hemodynamics compared to general anesthesia, to decrease the amount of used systemic opioids and muscle relaxants, to reduce the time between the end of surgery and the extubation of patients, while maintaining a high level of safety. Our technique has shown a qualitative level of postoperative analgesia with significantly less use of systemic opioids.
Key words: hyperbaric bypivacain, intrathecal morphine, low dose spinal anesthesia, abdominal surgery, combined anesthesia.
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Information about authors:
Kanankou V.V. – head of the anesthesiology & resuscitation department, Mogilev Hospital No.1,
ORCID: https://orcid.org/0000-0002-0000-658X
Marochkov A.V. – Doctor of Medical Sciences, professor, anesthesiologist-resuscitator, Mogilev Regional Hospital,
ORCID: http://orcid.org/0000-0001-5092-8315
Correspondence address: Republic of Belarus, 212018, Mogilev, 2 Academician Pavlov str., Mogilev Hospital No.1, the anesthesiology & resuscitation department. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Valery V. Kanankou.
