It's no secret that during an operation, an anesthesiologist-resuscitator is able to not only relieve the patient of fear and anxiety, but also provide comfort and freedom from pain. And in order for the patient to be safe, it is not at all necessary to use general anesthesia, putting the patient to sleep. There is another way to protect the patient from surgical exposure and pain - this is local anesthesia.

What are the features of local anesthesia?

Local anesthesia is a type of anesthesia, the essence of which is the introduction of solutions of local anesthetics in close proximity to nerve structures, resulting in a reversible loss of pain (nociceptive) sensitivity.

Please note that local anesthesia is not a local anesthetic. Anesthesia refers only to general anesthesia, in which the patient is artificially put to sleep. There is no such thing as local anesthesia in medicine.

During local anesthesia, drugs will not be administered intravenously or through a mask. The patient will be awake, but at the same time pain will not experience.

Solutions of local anesthetics affect not only the mucous membranes and skin, but also the nerve plexuses and spinal roots. Due to such a variety of effects of local anesthetics, there are methods of performing local anesthesia, and each of them has its own characteristics, indications and contraindications.

Local anesthesia methods

Infiltration anesthesia.
Conduction (trunk) anesthesia.
Plexus anesthesia.
Spinal anesthesia.
Epidural anesthesia.
Combined (spinal + epidural) anesthesia.

Despite the fact that all these methods refer to the same local anesthesia, the methods of administration are different. Let's take a closer look at each of them.

A general contraindication to any method of local anesthesia is intolerance (allergy) to local anesthetics.

Terminal (application) anesthesia.

The essence of the technique is the effect of solutions of local anesthetics on the mucous membranes using aerosols or on individual areas of the skin using a special cream. Application anesthesia is widely used in:

Endoscopic practice.
ENT practice.
Dentistry.
Ophthalmology.
Dermatovenerology.
Gynecology.
Sports medicine.

Aerosols are irrigated (sprayed):

Mucous membranes of the nasal passages during nasogastric intubation (insertion of a tube through the nose into the stomach);
mucous membranes of the oral cavity during dental procedures and minor ENT operations;
mucous membranes of the pharynx and larynx during endoscopic examinations (FGDS, bronchoscopy) and tracheal intubation;
trachea when changing tracheostomy tubes;
mucous membranes of the eye diagnostic studies;
wounds and abrasions;
burns;
aerosols with anesthetic are used for minor gynecological interventions, removal of sutures and removal of superficial structures.

The most common and most effective aerosols used in routine practice are lidocaine solutions 10%. The effect occurs quickly, from 2 to 5 minutes. The duration of action averages from 15 to 30 minutes. After spraying onto the mucous membranes, an aerosol with local anesthetics blocks nerve transmission, as a result of which the patient feels cold and numb, while he does not experience pain during interventions. Side effects or complications develop extremely rarely, since only a small part of the anesthetic can enter the bloodstream.

Another effective method blocking pain sensitivity, mainly in the skin, is a special ESMA cream (a mixture of local anesthetics). It is applied to the skin in a thin layer. Local anesthetics penetrate skin layers up to 5 mm. The action develops after 45-60 minutes and lasts on average from 1.5 to 2 hours. The main use of the cream is percutaneous punctures and catheterization of blood vessels, obtaining skin grafts, circumcisions, etc. Side effects cream are: paleness of the skin, development of erythema or swelling of the skin.

Infiltration anesthesia.

The technique consists of impregnation (infiltration) skin and deeper located anatomical structures. Thanks to this coverage, the technique has become widespread, mainly in minimally invasive surgical practice. At the same time, anesthesia can also be used to relieve pain only on the skin. For example: before spinal anesthesia or epidural anesthesia, first infiltration anesthesia of the skin is performed at the site of the intended puncture, and then direct passage of the spinal or epidural needle.

Infiltration anesthesia is used:

In surgical practice, during small-scale operations, this is the removal of superficial formations, plastic surgery of the skin, taking a skin graft;
when performing operations on the anterior abdominal wall and organs of the lower floor of the abdominal cavity (hernia repair, appendectomy, etc.);
at small urological operations(varicocele, hydrocele, circumcision);
during dental and ENT operations (tooth extraction, tonsillectomy, etc.);
with case blockades.

To carry out infiltration anesthesia, use Novocaine solutions 0.25% and 0.5%; Lidocaine solutions 0.5% and 1.0%. The rate of development of the effect of novocaine is inferior to lidocaine. The average duration of action for novocaine is from 30 to 60 minutes, while for lidocaine it reaches 120 minutes. Side effects are directly related to unintentional puncture of the vessel and the release of local anesthetic solutions into the systemic circulation. Side effects develop quickly: dizziness, pale skin, nausea, decreased blood pressure, decreased heart rate.

Conductor (trunk) and plexus (plexus) anesthesia.

The essence of the conduction technique is to apply solutions of local anesthetics to the nerve trunks, and when local anesthetics act on the plexuses of nerves, on their bundles, until they branch into branches, we are talking about plexus anesthesia. As a result of such anesthesia, either a separate area of ​​innervation, for example a finger on the hand, or the entire upper limb. Anesthesia is most widespread and used in traumatology. Surgeries can be performed on the fingers, hand, forearm and shoulder.

If the operation is limited to the hand, then conduction anesthesia is more often performed. It consists of applying local anesthetics to the nerve, resulting in paresthesia (loss of sensation) and the patient does not feel pain.

If the operation affects several areas - hand, forearm, shoulder, then in this case plexus anesthesia is performed. Thus, solutions of local anesthetics are supplied in close proximity to nerve plexus, until it branches into many branches. By acting on the plexus, the nerve impulse is blocked and does not spread to the underlying nerves.

The most commonly used local anesthetics during this anesthesia are: Novocaine solution 1-2%, duration of action from 30 minutes to 1 hour; Lidocaine solution 0.5-1%, duration of action 1-1.5 hours; Marcaine solution 0.25-0.5%, duration of action up to 8 hours; Naropin solution 0.2-0.5%, duration of action up to 6 hours.

Side effects just as in the case of conduction anesthesia, are directly related to unintentional puncture of the vessel and the entry of local anesthetic solutions into the systemic bloodstream. In this case, dizziness, pale skin, nausea, decreased blood pressure, and decreased heart rate develop.

Spinal anesthesia.

The most commonly used regional anesthesia technique in modern anesthesia practice is spinal anesthesia. This technique combines a persistent analgesic effect, a low percentage of complications, and the ability to eliminate postoperative pain, and all this along with technical simplicity.

During spinal anesthesia, pain-conducting nerves in certain areas are temporarily switched off. To do this, pain medication is injected into a specific location in the spine near these nerves. Drugs, local anesthetics, will be injected into the subarachnoid (spinal) space. Pain sensitivity below the injection site of the anesthetic is switched off.

Epidural anesthesia.

Epidural anesthesia (epidural anesthesia) is a method of regional anesthesia, the essence of which is the reversible loss of temperature, pain, tactile and motor sensitivity due to root blockade spinal cord.

In this case, anesthetics will be injected into the epidural space - a rounded gap located along the entire spine, from big hole occipital bone to the tailbone.

Combined spinal-epidural anesthesia.

Based on the name, the essence of this technique immediately becomes clear - it is a combination, a combination of two methods of local anesthesia. The main and most important difference of this technique is long duration effects of anesthesia with the introduction of a smaller amount of local anesthetics. This is achieved by reducing the dose local anesthetic at the time of insertion into the subarachnoid (spinal) space.

The technique is exactly the same as for spinal anesthesia or epidural anesthesia, except that this anesthesia can be performed using a special kit for combined spinal-epidural anesthesia.

The indications for combined anesthesia are the same as for spinal or epidural anesthesia. They will only be supplemented by the fact that some surgical interventions, for example in traumatology, may be longer, which will require the administration of additional doses of anesthetic. This is precisely why prolonged combined spinal-epidural anesthesia exists. When the main effect of local anesthetics injected into the spinal space begins to come to an end, then anesthetics begin to be administered through the epidural catheter, which prolongs the effect of the latter.

Local anesthesia is a huge branch of anesthesiology, combining many techniques and various techniques. Mastery of the art of local anesthesia by an anesthesiologist-resuscitator will give you protection from pain during surgery with minimal effect of the drug on your body.

And don’t forget that the main thing is your health. Be healthy!

Sincerely, anesthesiologist-resuscitator Starostin D.O.

Everyone has heard about local anesthesia and general anesthesia, but not everyone knows the meaning of these words. This is a means of protecting the patient from pain during medical procedures in which painful shock is possible without anesthesia. In medicine, local and general anesthesia is widely used - loss of sensitivity after use special drugs. Let us examine in more detail which anesthesia is best to use and what kind of anesthesia is used.

A special industry is engaged in the development of pain relief methods medical science- anesthesiology. Doctors in this specialty monitor the patient’s condition during anesthesia. Nowadays, there are many drugs used for temporary loss of sensitivity.

Types of anesthesia and methods of administration

General anesthesia is accompanied by complete loss of consciousness by the patient. Used for long-term heavy operations. Local anesthesia performed with minor interventions.

The difference between them lies both in the methods of drug administration and in the effect they have on the human body. Methods of drug administration:

It is not necessary to use one drug to achieve analgesia. Species Definition general anesthesia depending on the type of operation. Combined anesthesia is often used, when one drug is used to quickly achieve the state of necessary analgesia, and then another drug is used to maintain pain relief.

In addition to the anesthetic agent, other agents are sometimes required. medical supplies. In particular, inhalation endotracheal general anesthesia, which requires relaxation of the respiratory muscles, for which the patient is given medicinal substances from the group of muscle relaxants.

In cases where local anesthesia is used, you can do without additional drugs. The substance used to numb a specific area is injected superficially. The administration does not require special preparation, with the exception of treating the injection site with an antiseptic.

IN Lately anesthetic solutions are produced in the form of an aerosol, which allows them to be widely used in sports medicine. This form of drug release allows you to quickly numb the site of injury.

How does local anesthesia work?

Some procedures use local anesthesia, or topical anesthesia, to numb a small area during medical procedures.

As a rule, it is used during minor operations and is widely used in dentistry.

The essence of the method is to suppress the sensitivity of peripheral nerve fibers. These may be skin pain receptors, then the skin at the site of the procedure is injected with an anesthetic solution.

Conduction anesthesia can be considered as a local anesthesia. In this case, the drug is administered along the course of the major nerve bundle, responsible for sensitivity in this area. This also includes spinal anesthesia, when the drug is injected into the spinal cord, and the patient loses sensation below the injection site. This is commonly used for caesarean sections and is called .

An undoubted advantage over general anesthesia is the ease of implementation. This allows a doctor of any specialty, not necessarily an anesthesiologist, to provide anesthesia. Usually, for minor interventions, the surgeon himself injects the anesthetic in the area he needs. The patient feels pain only at the moment of the injection itself, which is due to the use of a thin needle.

IN modern medicine Increasingly, operations are performed under local anesthesia. This is possible thanks to the development of medical technologies, which make it possible to perform even significant operations through a small access.

Contraindications and side effects local anesthesia cannot compare with those for general anesthesia. But unfortunately, Negative consequences possible. Local anesthetic drugs can have a toxic effect, affecting the nervous and cardiovascular systems.

Sometimes, the expression local anesthesia evokes negative associations in the patient. Doctors have to resort to sedatives to reassure the patient.

Stages of pain relief

General anesthesia makes it possible to put the patient into a state of complete loss of all types of sensitivity. Its use allowed us to open a new chapter in surgery. General anesthesia is a means of protecting the patient from the consequences of trauma, which is any surgical procedure.

How is general anesthesia done?

Oppression of the central nervous system leads to loss of consciousness by the patient. When general anesthesia is used for surgery, the participation of an anesthesiologist is required. It is necessary to maintain a certain stage of anesthesia in order to be able to bring the patient out of this state. There is a concept of depth of anesthesia. This concept reflects the stage in which the patient is currently located. The following stages are distinguished:

• I - stage of analgesia;
• II - stage of excitation;
• III - stage surgical anesthesia:
• IV - agonal stage.

General anesthesia of the third stage, in turn, is divided into the following levels:

• Level 1 (III) - superficial anesthesia;
• Level 2 (III) – easy;
• 3rd level (III) - deep;
• Level 4 (III) - super deep.

The anesthesiologist’s task is to bring the patient to stage III, but to prevent it from progressing to stage IV.

The drugs that can be used for anesthesia differ in the severity of these stages. During the Great Patriotic War used for minor operations intravenous administration ethyl alcohol, which is characterized by a long excitation stage and a short surgical stage.

Currently, combinations of drugs are used, which allows you to quickly bring the patient to the stage of surgical anesthesia and maintain it long time. An example of induction anesthesia is intravenous administration of sodium hydroxybutyrate, followed by intubation and inhalation anesthesia, since the concentration of gaseous substances is easier to control. The noble gases helium and xenon have found application in anesthesiology.

While the patient is in a state of sleep, clear control over his vital signs is necessary: ​​pulse, blood pressure, oxygenation.

The disadvantages of general anesthesia include its severity for the body and excessive oppressive force. After surgery, the patient must be transferred to the department intensive care, where he is under constant observation throughout the day.

Side effects and contraindications

There is no doubt that anesthesia is harmful to the body. The effect of potent drugs on the human nervous system can cause serious complications.

This is due to, namely, the pathology of internal organs in a state of decompensation, violation heart rate, headaches, disorders endocrine system, childhood, alcohol and drug intoxication and many others.

Contraindications are not always absolute. Perform general anesthesia in childhood permissible in case emergency, requiring immediate surgical intervention. The inadmissibility of pain relief in alcohol and drug intoxication is due to the patient’s resistance to anesthesia, which leads to the need to increase the dose of the drug.

Suppression of the nervous system can cause damage to many organs. This is due to a violation of their innervation and functioning. Side effects associated with the respiratory system include the patient’s loss of ability to breathe independently, a reaction to a drug leading to spasm of the airways, changes in gas composition blood.

The cardiovascular system may respond to anesthesia by increasing or decreasing blood pressure. Possible arrhythmias various types, myocardial infarction may be provoked. Putting a patient under anesthesia causes an imbalance in the homeostasis system, which can lead to hormonal imbalances, disturbances in the thermoregulation system.

The consequences of general anesthesia in childhood may be more severe, but there is no clear evidence of the effect of anesthetics in early childhood on the development of the nervous system. Therefore, in all cases of providing surgical care Local anesthesia is recommended for children.

Text: Evgenia Skvortsova

Anesthesia in the dentist's chair or even more so anesthesia on the surgical table can be more frightening than the operations themselves: the injections are painful, and after general anesthesia you may not even come to your senses at all. Which of this is true and which is a myth, we’ll figure it out together with experts: a doctor highest category, anesthesiologist-reanimatologist at the aesthetic medicine clinic “Time of Beauty” Oleg Karmanov, implantologist, network orthopedist dental clinics"NovaDent" Mikhail Popov and anesthesiologist-resuscitator of the "Refformat" clinic Yuri Timonin.

How does anesthesia work?

Any anesthesia, local or general (the latter is also called anesthesia), is a medicinal intervention in the body that helps to avoid pain stress. In response to a pain impulse from the injured area, pain awareness occurs in the cerebral cortex. To prevent this, you need to block the nerve endings. Local anesthesia stops the transmission of pain impulses in a certain area - the medicine passes through the cell membranes and disrupts the reactions in them. As a result, nerve impulses are blocked and the sensation of pain does not occur. Consciousness is preserved during local anesthesia, and the effect lasts on average one to two hours. Anesthesia, or general anesthesia, is an effective method when a large area of ​​the body is subjected to intervention. In this state, the person sleeps soundly and is well relaxed: tension in the muscles and other tissues should not interfere with the surgeon’s work.

Oleg Karmanov notes that it is wrong to be afraid of damage from the anesthetic: enduring pain is much more dangerous. In many cases, the risk of losing your life from painful shock during surgery without anesthesia is very high. According to the doctor, modern anesthetics are well controlled. This means that as soon as the active substance is no longer introduced into the body, it quickly disintegrates - and the patient wakes up. The only absolute contraindication is an allergy to the drugs used, and possible side effects are usually associated with the presence of additional substances: vasoconstrictors ( vasoconstrictors), preservatives and stabilizers.

How to prepare for surgery
under anesthesia and why it feels bad after it

Depending on the type of intervention, you need to undergo prescribed examinations - usually blood tests, ECG, and sometimes, for example, ultrasound lower limbs to exclude the presence of blood clots, and also avoid alcohol and taking certain medications during certain time before surgery. If the test results satisfy the doctor, he will confirm the planned operation. In this situation, drugs with a mild effect are used and recovery from anesthesia is usually painless. It is worth considering that during the operation processes such as changes in blood pressure may occur - but the work of the anesthesiologist does not stop after the patient is put under anesthesia; During the entire operation, the doctor monitors the depth of anesthesia and brain activity. The so-called neuroprotection is also used - protection nerve cells with the help of certain medications.

Karmanov notes that unpleasant consequences after recovery from anesthesia - memory impairment, absent-mindedness, hallucinations - usually occur with emergency operations, when you need to act very quickly, for example after a large loss of blood as a result of a car accident. In these cases, drugs with a hypnotic, that is, hypnotic, effect are used, which can give such side effects. With special care, the doctor should also select drugs for pain relief for those who have cardiovascular diseases, problems with respiratory systems oh, kidney failure, hormonal disorders and diabetes mellitus.

Is it true that you can wake up during anesthesia or not wake up after?

It is theoretically possible to wake up during an operation if the dosage is incorrectly calculated, the anesthetic is selected incorrectly, or the body itself processes the injected drugs too quickly. But in practice this is extremely rare. Usually the doctor monitors the situation well and knows when a “supplement” of the drug is needed so that the patient’s sleep remains restful.

There is also a risk of not waking up after an operation performed under anesthesia, but experts note that the likelihood fatal outcome high only in emergency and neurosurgery. True, in these situations, death more often occurs not because of anesthesia, but because of a serious condition - an acute injury or a life-threatening illness. When planned operations the likelihood of not surviving due to anesthesia is close to zero. In general, if the technique is followed and the necessary control is provided, anesthesia does not pose a threat to health, much less life.

What is sedation
and why is it needed

Sedation is the intravenous administration of non-narcotic sleeping pills, causing shallow sleep. It is used for different types endoscopy, colonoscopy, but most often in the dentist's office. When a person is dozing, light contact with him is possible: vital reflexes and body functions are preserved and the patient responds to the doctor’s requests, for example, to turn his head or “bite a piece of paper.” Sedation is accompanied by local anesthesia to numb the work area itself.

According to anesthesiologist Yuri Timonin, propofol does not cause side effects, and the substance itself has a short-term effect and is quickly eliminated from the body. The big advantage of sedation is that it allows you to increase the treatment time to 3.5–4 hours, without stress for the patient, with easy awakening and no unpleasant consequences after it. Doctors recommend this method for arterial hypertension and angina pectoris, as well as those who are afraid of dentists until they lose consciousness.

Is dental anesthesia safe during pregnancy?

Implantologist Mikhail Popov emphasizes that local anesthesia not only does not threaten the health of the fetus, but is also recommended for dental treatment, especially in the second and early third trimester of pregnancy. The anesthetic is absorbed into the blood in minute quantities and does not penetrate the placenta, so it will not affect the course of pregnancy and the condition of the fetus. Yuri Timonin adds that local anesthesia allows you to “turn off” a fairly large area of ​​the jaw associated with the blocked nerve for 1–1.5 hours. Moreover, the harm from it is always less than from the source of infection in the mouth.

Women should warn the dentist about pregnancy before starting treatment: this information will allow them to make a choice in favor of drugs without adrenaline, which are best suited for expectant mothers. Postponing non-urgent dental problems at 35–40 weeks of pregnancy - but only if necessary urgent treatment, for example, in case of inflammatory processes and ulcers, local anesthesia is given throughout the entire pregnancy. As for sedation, this method is contraindicated in pregnant women: the effect of drugs for it on the fetus has not been fully studied.

Epidural anesthesia: pros and cons

Thanks to epidural anesthesia, when an anesthetic is injected into the space along the spinal canal, contractions become less painful and childbirth is noticeably calmer - while the woman is conscious. With a good dose calculation, sensitivity disappears almost only in the pelvic area, but sensations in the legs and the ability to move them remain. This anesthesia is also called walking epidural, although in fact you won’t be able to walk - your legs will be weak, and sensors or catheters will different parts bodies will not allow you to go far. It is also important psychological aspect: when you know in advance that it won’t hurt, it’s much easier to relax and not worry.

According to Oleg Karmanov, with epidural anesthesia already performed, it is faster and easier to proceed to an emergency caesarean section, if necessary: ​​you will not have to waste time on pain relief. But you can’t always rely on epidural anesthesia; at a certain stage of labor it is already too late to perform it. The method has a number of contraindications, including intervertebral hernia and serious violations blood circulation and coagulation. Dangerous complications Epidural anesthesia is extremely rare.

What to expect from anesthesia in the future

The main feature of modern anesthetics is good controllability. Once the supply of the drug is stopped, it begins to quickly disintegrate. As a result, it is convenient for the doctor to control the time and depth of anesthesia for different conditions: for a patient with heart disease, the anesthesiologist will select one mixture of drugs, for a person with respiratory tract disease - another. In both cases, it will be anesthesia with minimal drug load on the body. At the same time, various devices for anesthesia, like modern intravenous catheters, increase safety and comfort during surgery. Careful monitoring of the patient's condition (measurement of pulse, blood pressure, amount of oxygen in the blood automatically) is another bonus of general anesthesia in modern conditions.

New generation local anesthetics have much fewer side effects and contraindications compared to drugs even ten years ago, and the waiting time for an effect has been reduced to five minutes. Doctors agree: over time, the percentage allergic reactions and will become completely zero, and the injection itself will be completely painless. The controllability of the process during anesthesia will also increase: it will become possible to introduce and remove a person from the state even faster deep sleep, and also bring him back to his senses at any appropriate moment. Oleg Karmanov does not rule out that in the near future, instead of intravenous anesthesia a remedy will appear in the form of a tablet: I ate the pill and fell asleep.

True, anesthesiologists will still not be left idle: the patient’s condition is very important to constantly monitor and correct correctly. But whether it will be possible to replace anesthesia with hypnosis is a big question. In 2006, British television showed an operation to remove a stomach tumor under hypnosis, without the use of anesthesia, and in 2008, in one of the Iranian clinics, a hypnotized woman was successfully C-section without pain relief. However, Mikhail Popov notes that, despite emerging information about such cases, scientific research no on this topic yet.

Local anesthesia

Local anesthesia (local anesthesia) is a reversible and intentionally induced loss of pain sensitivity in a certain part of the body while maintaining full consciousness. At the same time, other types of sensitivity (tactile, proprioceptive, cold) are reduced, but preserved. Local anesthesia is used for surgical procedures and minor operations, as well as for the treatment of pain syndromes.

The advantages of local anesthesia are preservation of consciousness, i.e. possibility of contact with the patient; lack of special preoperative preparation; simplicity and accessibility of implementation; lack of expensive equipment for implementation.

Disadvantages of local anesthesia include possible allergic reactions; psycho-emotional stress of the patient during long operations; impossibility of use during extensive and traumatic operations, when complete muscle relaxation (relaxation) is required, and in patients with impaired vital function important organs when mechanical ventilation and other methods of protection from surgical trauma are required.

No special preparation is required for local anesthesia. However, in emotionally labile people, premedication is prescribed 30-40 minutes before surgery to prevent psychological stress. To do this, drugs with a sedative (calming) effect are administered - seduxen, relanium, neuroleptics (hypnotics) - droperidol, narcotic analgesic- for example, promedol. To prevent allergic complications, administer antihistamines(diphenhydramine, suprastin, tavegil).

The mechanism of action of local anesthetics is based on their ability to penetrate cell membranes, cause reversible “denaturation” of cell protein, disrupt redox reactions in the cell and, as a result, block the conduction of nerve impulse into the central nervous system.

Kinds local anesthesia. Depending on the location of the anesthetic, superficial and deep local anesthesia are distinguished.

Superficial or terminal anesthesia. This anesthesia develops when the anesthetic comes into direct contact with nerve endings, penetrating the skin or mucous membranes. Sometimes a cooling method is used to achieve terminal anesthesia due to the rapid evaporation of volatile liquids (chlorethyl) from the skin surface.

Deep anesthesia. There are two types of deep anesthesia.

Infiltration anesthesia occurs by tight infiltration (impregnation) of tissues strictly layer by layer with an anesthetic solution and filling it with the natural “cases” of the body - interfascial, intermuscular spaces, mesentery and peritoneum. The method is known throughout the world as the “creeping infiltration” method, developed by the Russian surgeon A.V. Vishnevsky in 1928. With infiltration anesthesia, the skin and underlying nerve endings are blocked.

Conduction anesthesia develops as a result of blockade by an anesthetic of conducting nerve trunks, plexuses or roots of the spinal cord. This method is called conduction or regional anesthesia. With conduction anesthesia, pain sensitivity is lost in the zone (region) of innervation of the nervous system pathways. For example, when surgical interventions anesthesia according to Oberst-Lukashevich is performed on the fingers, when an anesthetic solution is injected subcutaneously into the projections of the nerve trunks along internal surfaces finger on both sides (Fig. 5.1).

Rice. 5.1. Conduction anesthesia according to Oberst-Lukashevich

The types of conduction anesthesia are spinal and epidural anesthesia (color insert, Fig. 11). With spinal anesthesia, the anesthetic is injected into the subarachnoid space, and with epidural (epidural) - into the epidural space (Fig. 5.2). The anesthetic acts on the sensory and motor roots and causes anesthesia and relaxation (relaxation) of the entire innervated area. This type anesthesia is used for operations on the pelvic organs and lower extremities and is performed only by a doctor.

Clinical characteristics local anesthetics. Cocaine. As an anesthetic, cocaine is used to anesthetize the mucous membranes of the mouth, nose, larynx (lubrication or irrigation with a 2-5% solution) or the conjunctiva and cornea (1-3% solution).

Novocaine (procaine). Novocaine is mainly used for infiltration (0.25 and 0.50% solution) and conduction anesthesia (1 and 2% solution). For many years it was the standard local anesthetic. Novocaine is characterized by a pronounced local anesthetic effect and relatively low toxicity. To prolong the effect of the solution, add a 0.1% solution of adrenaline hydrochloride to novocaine, one drop per 10 ml of novocaine solution.

Dicaine (pantocaine). Dicaine is 15 times stronger, but almost as many times more toxic than novocaine. It is used for anesthesia of mucous membranes in the form of 0.25; 0.5; 1 or 2% solution.

Trimecaine (mesocaine). Trimecaine is 1.5 times more toxic and 3 times stronger than novocaine. For infiltration anesthesia, use 0.25 and 0.5% solutions of 800 and 400 ml, respectively, for conduction anesthesia - 1 (100 ml) or 2% (no more than 20 ml due to sharp potentiation!) solutions. In the form of a 3% solution, trimecaine in an amount of 7-10 ml is used for epidural anesthesia, and for spinal anesthesia, 2-3 ml of a 5% solution is sufficient.

Bupivacaine (Marcaine). For infiltration anesthesia, a 0.25% solution is used, for epidural anesthesia - a 0.5% solution. The duration of action of the drug during infiltration anesthesia is 7 - 14 hours; spinal and epidural - from 3 to 5 hours.

Novocaine blockades. A blockade is a local administration of raster novocaine of different concentrations and quantities, sometimes in combination with other substances to obtain a therapeutic effect. Blockades are used for certain diseases and injuries to reduce pain, prevent shock and improve the patient's condition.

Novocaine blockades must be carried out with strict adherence to the rules of asepsis in a patient position convenient for performing the blockade. After the blockade, the patient must remain in bed for 2 hours.

Blocking the fracture site- one of the simplest and most effective methods of pain relief for bone fractures. This ensures blockade of nerve receptors directly at the site of damage.

Circular (case) novocaine blockade cross section of a limb carried out in case of significant damage to the tissues of the limb, as well as before removing a tourniquet that has been on the limb for a long time in order to prevent “tourniquet” shock and prolonged compression syndrome (Fig. 5.3). Above the area of ​​injury to the limb (location of the tourniquet) circularly from different points to soft fabrics* up to 250 - 300 ml of 0.25% novocaine solution is injected to the entire depth to the bone.

Intrapelvic blockade according to Shkolnikov - Selivanov indicated for pelvic fractures. With the patient in the supine position, the needle is inserted into the soft tissues abdominal wall to a point located at a distance of 1 cm medially from the anterior superior iliac spine. For bilateral intrapelvic blockade, 200 ml of a 0.25% novocaine solution is injected on each side.

Cervical vagosympathetic blockade performed for chest injuries with damage to the organs of the thoracic cavity. The novocaine solution is administered through a point located along the posterior edge of the middle of the sternocleidomastoid (sternocleidomastoid) muscle (Fig. 5.4).

Perinephric block indicated for certain diseases of the abdominal organs ( acute pancreatitis, intestinal paresis), trauma to the abdomen and retroperitoneum, long-term compartment syndrome. The patient should lie on the side opposite the blockade zone on a cushion located between the XII rib and the wing ilium. Index finger the doctor determines the intersection of the XII rib with the outer edge of the long back muscle and inserts a needle into it, the end of which gradually moves towards the perinephric space, while injecting novocaine (Fig. 5.5).

Short blockade performed to treat the inflammatory process. A solution of novocaine in concentration is injected near the source of inflammation within healthy tissues under the base of the inflammatory infiltrate.

Complications of local anesthesia. Complications of local anesthesia most often occur when there is individual intolerance to the drug, exceeding the permissible dose, accidental injection into a blood vessel, or errors in the anesthesia technique.

There are local and general complications of anesthesia.

Local complications. Local complications are wounds blood vessel, injury to nerves and plexuses, as well as nearby organs, air embolism, infections due to neglect of the rules of asepsis and antiseptics.

Convulsions, loss of consciousness may occur, and a coma with breathing and cardiac problems may develop.

Prevention of complications. To prevent complications, it is necessary to carefully collect allergy history, asking, first of all, whether local anesthetics were previously administered to the patient, and whether and what reactions there were to their administration.

If the patient has not previously received local anesthesia, then it is necessary to use a skin test for sensitivity to novocaine. To do this, a gauze ball moistened with a 1% novocaine solution is applied to the lower third inside forearms, covered with a moisture-proof cloth and bandaged for 10-12 hours. The appearance of hyperemia or skin dermatitis after the specified time indicates hypersensitivity to novocaine.

To prevent complications, it is necessary to follow certain rules:

· use desensitizing agents as premedication - diphenhydramine, suprastin, pipolfen, tavegil;

Closely monitor the patient's condition during local anesthesia and in early postoperative period;

· do not exceed the maximum permissible doses of anesthetic;

· use an anesthetic solution to which a vasoconstrictor (adrenaline) is added, which slows down absorption;

· before injecting the anesthetic solution, check the position of the needle by moving the syringe piston backwards (aspiration test): if the needle is in the lumen of the vessel, blood will appear.

If a complication occurs, the paramedic must quickly and competently help the doctor remove the patient from a serious condition. He must know all possible life-threatening changes in the functioning of organs and systems, and prepare in advance the medications and medical equipment necessary for their correction.

Local anesthetics are potent drugs that can cause side effects and complications. One of the causes of severe complications is the use of increased concentrations of local anesthetic solution. The paramedic must clearly know what concentration of anesthetic corresponds to the chosen method of anesthesia

The role of the paramedic in local anesthesia. Preparation for local anesthesia begins with identifying the patient's priority problems and addressing them. These may be physical problems related to the patient's pain or helplessness. The paramedic must help him cope with this condition, promptly carry out the pain relief prescribed by the doctor, calmly and kindly carry out all the necessary measures for the care and personal hygiene of the patient.

Potential social problem The patient may be afraid of losing his job or remaining disabled, and in this case the paramedic must convince the patient of his need for society, family, and support the patient in difficult times of decision-making.

It is important to provide the patient with moral and mental peace, take care of proper rest and night sleep, and timely perform evening premedication with the use of sleeping pills.

The paramedic must carefully and conscientiously prepare the patient for the upcoming operation - sanitization, changing linen, processing the surgical site and other procedures.

The paramedic prepares the necessary medications, instruments and equipment for local anesthesia. The main set includes: syringes with a volume of 5, 10, 20 ml; injection or special needles (for epidural or spinal anesthesia) of different lengths and diameters; novocaine or other anesthetic in the required concentration; sterile container for novocaine; adrenaline solution in ampoules - add two to five drops of 0.1% solution per 100 ml of novocaine for infiltration anesthesia and one drop per 1 ml of novocaine or dicaine for terminal (superficial) anesthesia.

Additionally, the paramedic prepares amyl nitrite in ampoules, drugs that stabilize hemodynamics (polyglucin), hormonal drugs (prednisolone, adrenaline), desensitizing drugs (diphenhydramine, tavegil), anticonvulsants (seduxen, relanium) drugs, equipment for providing mechanical ventilation (air ducts, manual breathing apparatus, face mask for oxygen supply). The paramedic must check the presence of oxygen in the system.

The actions of the paramedic consist in supplying the necessary instruments and medications during anesthesia, creating correct position the patient on the operating table, carefully monitoring him during manipulations with recording the main parameters of the cardiac and respiratory systems. The paramedic must immediately inform the doctor performing the operation under local anesthesia about any slightest deviation in the patient’s condition.

In the postoperative period, it is necessary to ensure patient compliance bed rest for the prevention of orthostatic (when changing body position) collapse. During this period, the paramedic monitors not only the parameters general condition patient, but also for signs of late complications of local anesthesia - headaches, dysfunction of the lower extremities after spinal or epidural anesthesia, signs of pneumothorax (increasing shortness of breath, cyanosis, pain in chest) after anesthesia of the brachial plexus and after early manifestations other possible complications.

Local anesthesia is a temporary loss of pain in a specific area of ​​the body. With this type of anesthesia, the patient is conscious but does not feel any pain. Local anesthesia is used for simple and short-term operations, as well as in the presence of contraindications to the procedure.

Local anesthesia: types

Local anesthesia: contraindications

1. Allergy to drugs used for local anesthesia.
2. Availability purulent formations at the puncture site.
3. State of shock.
4. Hypotension.
5. In some cases, obesity and spinal deformities.

Local anesthesia: complications

1. Damage to the human nervous system, which is accompanied by drowsiness, ringing in the ears and dizziness. Sometimes convulsions may occur.
2. Allergic reactions in the form of rashes on the patient’s body, accompanied by itching. IN difficult situations anaphylactic shock is possible.
3. Low blood pressure, which can lead to cardiovascular collapse.
4. The appearance of bradycardia, which can lead to cardiac arrest.

Note: one of the most popular types of general anesthesia is endotracheal anesthesia, which is performed by applying narcotic substance and oxygen through a tube inserted directly into the trachea without involving the nasal cavity and mouth in this process.