Efficiency and safety of peripheral regional anesthesia application in urgent traumatology

In Ukraine, more than 4.5 million people sustain injuries of varying severity annually, and damage to extremities constitutes 60–65 % in the structure of traumatism. Patients with traumatic limb injuries require effective anesthesia / analgesia at an early stage. An urgent anesthesia should provide a sufficient relaxation of the extremity, adequate operative and postoperative pain management and should be safe for patients of different age groups. Peripheral regional anesthesia meets the requirements indicated, but there are a number of outstanding issues: difficulties in identifying plexuses and nerves, high rate of complications. Neither a larger injection volume of local anesthetic nor plexuses and nerves identification using a neurostimulator solves the problem completely. At the same time, ultrasound-guided nerve block does not have the weaknesses mentioned and its use is increasingly covered in literature. The purpose of this work is to analyze the effectiveness and safety of the ultrasound-guided nerve block of the extremities in urgent traumatology. Material and methods. Cases of isolated mechanical traumatic injuries of the limbs in patients who were at the clinical base of the Department of Disaster Medicine, Military Medicine, Anesthesiology and Intensive Care of Zaporizhzhia State Medical University from 2016 to 2018 were analyzed. The average age of the trauma patients was 62.5 (47.0; 82.5) years with a body weight of 78.7 (64.3; 94.6) kg. All the patients underwent ultrasound-guided nerve block using an ultrasound device Logiq E with a standard 12 MHz linear array transducer or the “classical” method (anatomical landmark and paraesthesia technique of plexus location). Anesthesia was performed with 0.5 % bupivacaine at a dose of 1–2 mg/kg. Analgesia was performed with a solution of propofol at 1.5–2.0 mg/kg /h with the addition of ketamine at 1–2 mg/kg/h in case of need. The level of analgesia was evaluated on the Ramsay sedation scale. The study analyzed the duration of plexus and nerves location, block onset time, the duration of motor and sensory block; hemodynamics monitoring with the help of UM-300 monitor at the study stages; complications were recorded. Statistical analysis of the data included descriptive statistics methods. When the values did not follow a normal distribution, these data were expressed as a median (lower quartile; higher quartile). Mann-Whitney U test was used to compare variables; the categorical data were analyzed b