DYNAMICS OF STRESS LABORATORY FINDINGS AND THEIR RELATION TO PSYCHOEMOTIONAL STATE DURING REGIONAL ANESTHESIA IN PATIENTS WITH LOWER LIMBS INJURIES
Abstract
The choice of an adequate method of anesthesia for surgical treatment of lower limbs injuries remains a critical task today. Each method applied in this treatment has its advantages and disadvantages. In recent years, regional anesthesia has been the preferential method.
The aim of the study. To study the stress laboratory findings and their relation to the patients’ psychoemotional state in perioperative period while performing regional and combined anesthesia.
Material and methods. It was studied 60 patients aged 18-59 years, who underwent metal osteosynthesis operations due to lower limbs injuries. Surgical treatment was performed under regional anesthesia and regional anesthesia followed by sedation. The patients of both groups were conducted heamodynamics monitoring and determined the intensity of pain in accordance with visual analogue scale and stress indicators with a laboratory method. The psychoemotional state was assessed with the Spielberger-Hanin anxiety scale.
Results. According to the study it was determined, that in patients, who were planned to have surgery, significant psychoemotional stress and stress concentration of hormones in the blood and their interrelation was discovered. Patients about before surgery had a relationship between situational anxiety and cortisol r=0.7; p=0.00006 in group I; r=0.6; p=0.002 in the second group. The relationship between VAS and cortisol r=0.5; p=0.04 in groups I and II. After surgery, the connection was in group I patients between situational anxiety and cortisol r=0.4; p=0.02; the relationship between insulin and the HOMA index r=0.5; p=0.01.
Conclusions. Before the operation, all patients revealed significant psychoemotional stress and stressful changes in the concentration of hormones in the blood. Reliably pronounced dynamics of the indicators was with the use of combined conduction anaesthesia. Thus, the performed study allows to recommend combined regional anesthesia as the method of anesthesia choice, particularly in patients with high anxiety.
Downloads
References
Tobin, J. M., Barras, W. P., Bree, S., Williams, N., McFarland, C., Park, C. et. al. (2018). Anesthesia for Trauma Patients. Military Medicine, 183(suppl_2), 32–35. doi: http://doi.org/10.1093/milmed/usy062
Bohuslavska, N. M., Heorhiiants, M. A. (2015). Choice of the method of anesthesia management of traumatological surgeries in young patients. ScienceRise, 7 (4 (12)), 28–35. doi: http://doi.org/10.15587/2313-8416.2015.47374
Gadsden, J., Warlick, A. (2015). Regional anesthesia for the trauma patient: improving patient outcomes. Local and Regional Anesthesia, 8, 45–55. doi: http://doi.org/10.2147/lra.s55322
Shapovalov, A. A. (2017). Klinicheskaya effektivnost sposoba blokady sedalishnogo nerva lateralnym dostupom pri metallosteosinteze perelomov kostei goleni i stopy. Saint Petersburg, 95.
Logvinenko, V V., Shen, N. P. (2015). Sravnitelnaia kharakteristika riskov razvitiia nezhelatelnykh sobytii i kriticheskikh incidentov pri obschei i regionarnoi anestezii. Analiz 6 let klinicheskoi praktiki. Regionarnaya anesteziya i lechenie ostroi boli, IX (2), 22–28.
Voysekhovskiy, D. V., Averyanov, D. A., Schegolev, A. V., Svistov, D. V. (2018). Effect of deep anesthesia on development of post-operative cognitive dysfunction. Messenger of Anesthesiology and Resuscitation, 15 (1), 5–9. doi: http://doi.org/10.21292/2078-5658-2018-15-1-5-9
Huo, T., Sun, L., Min, S., Li, W., Heng, X., Tang, L. et. al. (2016). Major complications of regional anesthesia in 11 teaching hospitals of China: a prospective survey of 106,569 cases. Journal of Clinical Anesthesia, 31, 154–161. doi: http://doi.org/10.1016/j.jclinane.2016.01.022
McIntyre, J. W. R., Finucane, B. T. (2017). Regional Anesthesia Safety. Complications of Regional Anesthesia, 15–40. doi: http://doi.org/10.1007/978-3-319-49386-2_2
Tarabrin, O. A., Suslov, V. V., Fesenko, V. S., Maruhnyak, L. I., Sherbakov, S. S. (2013). Oslozhneniya perefericheskih nevralnyh blokad. Klinichna anesteziologiya ta intensivna terapiya, 1, 106–119.
Allegri, M., Bugada, D., Grossi, P., Manassero, A., Pinciroli, R., Zadra, N. et. al. (2016). Italian registry of complications associated with regional anesthesia (RICALOR). an incidence analysis from a prospective clinical survey. Minerva Anestesiologica, 82 (4), 392–402.
Ovechkin, A. M., Politov, M. E. (2018). Problemy bezopasnosti regionarnoi anestezii na sovremenom etape. Anesteziologiya i reanimatologiya, 63 (1), 9–16.
Steadman, J., Catalani, B., Sharp, C., Cooper, L. (2017). Life-threatening perioperative anesthetic complications: major issues surrounding perioperative morbidity and mortality. Trauma Surgery & Acute Care Open, 2 (1), e000113. doi: http://doi.org/10.1136/tsaco-2017-000113
Merry, A. F., Mitchell, S. J. (2018). Complications of anaesthesia. Anaesthesia, 73, 7–11. doi: http://doi.org/10.1111/anae.14135
Bradshaw, P., Hariharan, S., Chen, D. (2016). Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean. British Journal of Pain, 10 (2), 108–115. doi: http://doi.org/10.1177/2049463716635680
Pinto, A., Faiz, O., Davis, R., Almoudaris, A., Vincent, C. (2016). Surgical complications and their impact on patients’ psychosocial well-being: a systematic review and meta-analysis. BMJ Open, 6 (2), e007224. doi: http://doi.org/10.1136/bmjopen-2014-007224
Powell, R., Scott, N. W., Manyande, A., Bruce, J., Vögele, C., Byrne-Davis, L. M. et.al. (2016). Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database of Systematic Reviews. doi: http://doi.org/10.1002/14651858.cd008646.pub2
Stark, P. A., Myles, P. S., Burke, J. A. (2013). Development and Psychometric Evaluation of a Postoperative Quality of Recovery Score. Anesthesiology, 118 (6), 1332–1340. doi: http://doi.org/10.1097/aln.0b013e318289b84b
Zagurovskii, V. M. (2014). Stress i ego posledstviya (dogospitalnyj i rannii gospitalnyi etapy). Medicina neotlozhnyh sostoyanii, 7 (62), 11–23.
Strashnov, V. I., Zabrodin, O. N., Mamedov. A. D. et. al. (2015). Preduprezhdenie intraoperacionnogo stressa i ego posledstvii. Saint Petersburg: ELBI-SPb, 160.
Syusyuka, V. G. (2015). Ocenka balansa kortizol/insulin u beremennyh s razlichnym urovnem trevozhnosti. Suchasni medichni tehnologiyi, 1, 65–70.
Kolomachenko, V. I., Krivobok, V. I., Fesenko, V. S. (2010). Predoperaciina ta pislyaoperaciina trivozhnist v ortopedichnih paciyentiv: korelyaciya z biohimichnimi stres-markerami. Ukrainskii visnik psihonevrologiyi, 18 (2 (63)), 52–56.
Copyright (c) 2020 Elina Korobko
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our journal abides by the Creative Commons CC BY copyright rights and permissions for open access journals.
Authors, who are published in this journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the journal under the terms of a Creative Commons CC BY, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form in which it has been published by the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.