METHOD FOR SUPRAEPINEURAL BLOCKADE OF TIBIAL NERVE DURING AMPUTATION OF LOWER LIMB AT LEVEL OF UPPER THIRD OF LEG IN PATIENTS WITH CONTRAINDICATIONS TO USE OF REGIONAL ANESTHESIA BEFORE SURGERY

摘要

FIELD: medicine. ;SUBSTANCE: invention relates to medicine and namely to surgery and anesthesiology and can be used for supraepineural blockade of the tibial nerve during amputation of the lower limb at the level of the upper third of the leg in patients with contraindications to the use of regional anesthesia before surgery. During amputation of the lower limb at the level of the upper third of the leg, a local anesthetic is administered through a catheter installed supraepineurally. During the operation, the tibial nerve is isolated, 5 ml of a 2% solution of lidocaine is injected subepineurally above the expected level of transection of the nerve and the nerve is transected. Without pulling the end of the nerve, in the cranial direction along the course parallel to the nerve with a 22G needle for intramuscular injections, the adventitia of the nerve is infiltrated with 5 ml of 2% lidocaine solution. Under visual control, a 20G epidural catheter is inserted in the adventitia parallel to the nerve in the cranial direction supraepineurally in the adventitia until the perforated catheter holes disappear in the tissues. The opposite end of the catheter is brought out onto the skin of the lower leg using a Tuohy needle inserted into the wound through a separate puncture in the skin on the lateral surface of the lower leg. After connecting the port for the injection of the anesthetic to the catheter, it is fixed on the skin of the thigh and a bolus of 10 ml of 0.5% ropivacaine solution is injected.;EFFECT: method provides adequate anesthesia both during the operation and for a long time in the postoperative period, helps to avoid an increase in intraneural pressure and ischemia of the nervous tissue as well as additional tissue injury during catheterization both due to visual control and due to the implementation of supraepineural catheterization of the tibial nerve performed taking into account the successive preparatory stages and separation of tissues due to infiltration of the adventitia of the nerve. ;1 cl, 5 dwg