РОЛЬ МЕСТНОЙ АНЕСТЕЗИИ ЛАПАРОТОМНОЙ РАНЫ В ПРОФИЛАКТИКЕ ПОСЛЕОПЕРАЦИОННЫХ ОСЛОЖНЕНИЙ

Abstract

Introduction. Wound pain and postoperative complications are a leading problem for patients operated on abdominal organs. In most cases, these two issues are interrelated; that is why their management requires a comprehensive modern approach. Aim. The aim of the study is to evaluate the literature data to identify a causal relationship between wound pain and some complications after abdominal surgeries and to determine the advantages of local anaesthesia of a laparotomic wound, taking into account its additional favourable features. Material and methods. Based on the analysis of Russian and foreign articles, the review presents the structure of the main wound, intra- and extra-abdominal complications after laparotomy, and their producing factors. Moreover, the role of pain during the postoperative period with its multiorgan effect is clearly demonstrated. We considered characteristics of local anaesthetics with their non- standard effects, as well as a comparison of publications regarding the advantages of local anaesthesia in the wound with the systemic administration of parenteral (narcotic and non-narcotic) analgesics, where side effects were also analyzed. Results and discussion. Wound, intra- and extra-abdominal complications after laparotomy are very common today. Pain in the wound area is important in developing each of the complications: it provokes hypodynamia in the postoperative period, develops intestinal paresis, reduces the chest excursion and, as a result, worsens the life quality. All this provokes an increase in intra-abdominal pressure, impaired blood circulation of abdominal organs, wound ischemia in the suture area, lung congestion, which worsens hemodynamics and leads to the systemic consequences. Local anaesthetics are devoid of the well-known side effects of narcotic analgesics and non-steroidal anti-inflammatory drugs. However, they have additional positive local effects. Conclusion. Scientific data analysis has shown that continuous infusion of local anaesthetics into the preperitoneal space of a median laparotomic wound is a promising method for relieving wound pain and preventing postoperative intra- and extra-abdominal complications.