Anesthesiologic support of patients with complicated diabetes mellitus when they have an amputation below the knee joint

Objective: to evaluate the efficacy of nerve block anesthesia and prolonged post-surgery analgesia for patients who had amputation of the lower limb below the knee because of diabetic foot syndrome. Materials and methods. The amputation of the lower limb at the shin-bone was made for 30 patients with the diabetic foot syndrome (20 of them at the level of the upper third of the shin-bone, and 10 patients - the guillotine amputation at the level of the lower third of the shin-bone). The operations were performed in the presence of nerve block anesthesia of the sciatic and femoral nerves with the catheterization of the perineural spatium of the nerves for post-surgery analgesia (Ropivacaine, properly, 100 and 50 mg, 4-12 mg per hour). Monitoring included a constant ECG, noninvasive blood pressure every 5 minutes, pulse oximetry and plethysmography. The quality of analgesia was evaluated by VAS. Results. All blockings were effective, they were accompanied by a vegetative, sensory and motor block below the level of knee-joint. It was noticed stabile hemodynamics. Post-surgery analgesia was made from 1 to 7 days by bolus dosing of naropin through catheters in the same volumes as in primary blocking for 20 patients (66,7 %). The intensity of pain syndrome with bolus dosing of naropin ranged from 0 to 3 points. 10 patients (33,3 %) were inserted ropivacaine using an elastomeric pump (2 mg per ml, a dose from 4 to 12 mg per h). The intensity of the pain syndrome also ranged from 0 to 3 points. When the pain intensity was 3 points, 12 patients (40,0 %) were injected of 8 mg of lornoxicamum additionally. No patients needed narcotic analgesics. Conclusions. Prolonged blockings of the sciatic and femoral nerves with catheterization of the perineural spatium are the choice-method of anesthesia and post-surgery analgesia for patients with complicated diabetes mellitus when they have amputation below the knee joint.

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