Our generation has turned a vein into a cesspool, avasha – turns epidural space .
Sad joke of the old anesthesiologist
Over the past two decades, adjectives are often found in articles devoted to regional anesthesia: selective, balanced, polymodal (or multimodal) Soviet fashion of the 1970s for various types of “balanced” anesthesia (see epigraph) led to the appearance of “narcotic borscht” “. In order to avoid a mindless fashion on “borscht” in regional anesthesia, it is necessary to clearly understand what is required of it during and after the operation.
Balanced General Anesthesia
The term “balanced anesthesia” was first used in 1926 by Lundy, implying a combination of regional and superficial general anesthesia. And only after the Second World War, with the advent of muscle relaxants and new opioids, the concept of balanced general anesthesia was born, which we now all use: thiopental or propofol for sleep, fentanyl for analgesia, pipecuronium or atracurium for relaxation.
Balanced regional anesthesia
An important advantage of regional anesthesia is the ability to selectively (selectively) provide only two of the three above-mentioned components, that is, analgesia and relaxation (without loss of consciousness), which is especially valuable after operations without trauma to the gastrointestinal tract. So, after orthopedic operations, analgesia and myorelaxation are necessary (especially after the suturing of the tendons or the fixation of comminuted fractures). Without sedatives and opioids, the patient can eat and drink already in the first hours after the operation. Another effect of postoperative epidural anesthesia — moderate hypotension — will reduce blood flow from bone fragments. But after a few hours after orthopedic surgeries, only selective analgesia is needed (not only without sedation, but also without muscle relaxation).
Epidural anesthesia of vaginal labor (pervias naturales) also requires selective analgesia (without muscle relaxation and without arterial hypotension), so that the woman in labor can not only be strained in the second period, but also walk in the first. Local anesthetics alone make such selectivity difficult to achieve.
In such situations, multicomponent epidural analgesia is possible with the addition of drugs that modulate the transmission of the pain signal on the neurons of the horn through different receptors: opioid, alpha2 adrenergic, cholinergic. Such analgesia is called balanced, multimodal, or multimodal