RU-2861581-C1 - METHOD FOR TREATING PATIENTS AFTER ABDOMINAL SURGERY

RU2861581C1RU 2861581 C1RU2861581 C1RU 2861581C1RU-2861581-C1

Abstract

FIELD: medicine; abdominal surgery. SUBSTANCE: invention is intended for the treatment of patients after abdominal surgery. A method for treating patients after abdominal surgery consists in that before the operation, the doctor marks with a marker the points for injecting norapine at the level of the 7th, 9th and 11th intercostal spaces; during the marking, marking a point located at the midpoint of the distance between the angle of the scapula and the vertebral line – the 7th intercostal space, a point on the 9th intercostal space located 1 cm lateral to the point on the 7th intercostal space, and a point on the 11th intercostal space located 1 cm lateral to the point on the 9th intercostal space; after the surgical intervention, on the operating table, placing the patient in a lateral position, finding the point marked on the 7th intercostal space, infiltrating the skin area with 0.25% novocaine solution, making a puncture of the intercostal muscle frame with an injection needle along the lower edge of the overlying rib until the needle gives way, injecting norapine solution at a concentration of 7.5 mg/ml in a volume of 20 ml and removing the injection needle; similarly, performing the injection of norapine into the 9th intercostal space, and then into the 11th intercostal space; turning the patient onto the other side and performing the same manipulations on the other side of the body; the total amount of norapine solution administered is 120.0 ml; in the postoperative period, prescribing conservative therapy to the patient: cefazolin 1.0 ml twice a day intravenously drip in 200 ml of 0.9% NaCl, 5% glucose up to 400 ml intravenously drip twice a day with 4.0 ml of ascorbic acid, drotaverine 2.0 in 200 ml of 5% glucose once a day intravenously drip. EFFECT: reducing pain in patients in the postoperative period, rapid restoration of intestinal peristalsis, improving microcirculation and regeneration of the abdominal wall after surgery by involving a large number of elements innervating the lumbar part of the diaphragm, the thoracic and abdominal walls and forming the sympathetic plexuses of the upper floor of the abdominal cavity into the blockade zone. 1 cl, 1 dwg, 2 ex

Inventors

Koreiba Konstantin Aleksandrovich
Krivoshchekov Evgenii Petrovich
Lysov Nikolai Aleksandrovich
Romanov Vladislav Evgenevich
Khoroshilov Maksim Iurevich
Kompaniets Vladislav Pavlovich
MOLCHANOV MIKHAIL ALEKSANDROVICH

Dates

Publication Date: 20260506
Application Date: 20250908

Claims (1)

A method for treating patients after abdominal surgery, which involves marking the injection points of norapine on the patient with a marker at the level of the 7th, 9th and 11th intercostal spaces before surgery; during the marking process, a point located midway between the angle of the scapula and the vertebral line is marked - the 7th intercostal space, a point on the 9th intercostal space, located 1 cm lateral to the point on the 7th intercostal space and a point on the 11th intercostal space, located 1 cm lateral to the point on the 9th intercostal space; After the surgery, the patient is placed on the operating table in a lateral position, the point marked on the 7th intercostal space is found, the skin area is infiltrated with a 0.25% novocaine solution, the intercostal muscle frame is punctured with an injection needle along the lower edge of the superior rib until the needle fails, a solution of norapine at a concentration of 7.5 mg / ml in a volume of 20 ml is injected and the injection needle is removed; norapine is injected into the 9th intercostal space in a similar manner, and then into the 11th intercostal space; the patient is turned over onto the other side and the same manipulations are performed on the other side of the body; the total amount of norapine solution administered is 120.0 ml; In the postoperative period, the patient is prescribed conservative therapy: cefazolin 1.0 ml twice a day intravenously by drip in 200 ml of 0.9% NaCl, glucose 5% up to 400 ml intravenously by drip twice a day with 4.0 ml of ascorbic acid, drotaverine 2.0 per 200 ml of 5% glucose once a day intravenously by drip.

Description

The invention relates to the field of medicine, namely to abdominal surgery, and is intended for the treatment of patients after operations on abdominal organs. Standard pain relief using opioid narcotic analgesics is known. However, in the early postoperative period, the administration of narcotic analgesics is undesirable due to side effects: nausea, vomiting, dynamic gastrointestinal paresis, respiratory depression, tolerance, and physical dependence (Alyautdinov, R.N., Pharmacology. Moscow: Medicine, 2004, 197 p.). A method known for performing spinal anesthesia is (Handbook of Anesthesiology and Resuscitation, Yu. S. Polushin, St. Petersburg, 2004, 429 pages). This method of pain relief involves injecting a local anesthetic into the subarachnoid space of the spinal canal, blocking the transmission of nerve impulses and providing pain relief in the lower body. The disadvantage of this method is the lack of improvement in intestinal peristalsis, as well as the possibility of only anesthetizing the lower part of the abdominal wall and cavity. A method for relieving pain and improving intestinal peristalsis through electrical stimulation of the anterior abdominal wall is known (RU Patent No. 2173567, A61N1/36, September 20, 2001). A disadvantage of this method is the lack of analgesic effect. There is a known method in which patients undergo paravertebral blockade in the postoperative period using a standard technique (Surgical manipulations: A doctor’s pocket handbook, Romanov E.I., N. Novgorod: NGMA Publishing House, 1999, 27 pp.). The disadvantage of this method is its low efficiency, due to the short-term action of novocaine, as well as due to the involvement in the blockade zone of a small number of elements innervating the lumbar diaphragm, chest and abdominal walls and forming the sympathetic plexuses of the upper abdominal cavity. A known method of preperitoneal blockade in the postoperative period involves creating tunnels on the left and right sides of the laparotomy wound, 1.5-2 cm from its edges, into which catheters with multiple openings are inserted. Local anesthetic is injected into the preperitoneal space through the inserted catheters every 3 hours for 3 days (RU Patent No. 2400259, A61M19/00, September 27, 2010). However, this method also has its drawbacks. It does not ensure uniform distribution of the anesthetic, as a single bolus injection of fluid through an open system, which does not take into account the diameter of the perforations or the diameter of the catheter itself, does not provide uniform irrigation and allows fluid to exit only through the nearest (first) or largest hole in the tube. An open system increases the risk of postoperative wound infection, and uncontrolled injection of local anesthetics into the preperitoneal space can lead to overdose and unwanted side effects. The objective of the invention is to improve the effectiveness of postoperative treatment of patients after surgery on abdominal organs. The technical result achieved by the invention is a significant reduction in pain in patients in the postoperative period, rapid restoration of intestinal peristalsis, improved microcirculation and regeneration of the abdominal wall after surgery. The specified technical result is achieved by the fact that before the operation the points of norapine injection are marked on the patient with a marker, and in the postoperative period a paravertebral block is performed at the marked points at the level of the 7th, 9th and 11th intercostal spaces along the paravertebral line; after the surgical intervention, the patient is placed on the operating table in a lateral position, the middle of the distance between the angle of the scapula and the vertebral line is found - the 7th intercostal space, the skin area is infiltrated with a 0.25% novocaine solution, then 20 ml of norapine solution is used at a concentration of 7.5 mg / ml; an injection needle is fixed on a syringe, a puncture is made in the intercostal muscular frame along the lower edge of the superior rib until a small gap is felt, 20.0 ml of anesthetic solution is injected, the needle is removed; The same is done in the 9th intercostal space, only the needle puncture is located 1 cm laterally from the previous injection point, the same is done in the 11th intercostal space, with the injection point another 1 cm laterally; the same manipulation is performed on the other side, after turning the patient over; the total amount of the injected anesthetic solution is 120.0 ml, and in the postoperative period, the patient is prescribed conservative therapy: Cefazolin 1.0 ml twice a day intravenously by drip in 200.0 ml of 0.9% NaCl, 5% glucose up to 400 ml intravenously by drip twice a day with 4.0 ml of ascorbic acid, Drotaverine 2.0 in 200.0 ml of 5% glucose once a day intravenously by drip. Fig. 1 shows a diagram of the location of the injection points for norapine, where A is the angle of the scapula, B is the vertebra