REGIONAL ANESTHESIA FOR LOWER LIMBS PERIPHERAL VASCULAR DISEASE RECONSTRUCTIVE SURGERIES

Background: Modern medical literature highlights advanced methods of regional anesthesia that are suitable for patients with high surgical risk undergoing lower limb surgeries. Many studies have been conducted in trauma surgery, but there is a lack of data regarding patients with peripheral artery disease of the lower limbs. Methods and materials: Sixty patients, aged 64.85±7.32 years, classified ASA III-IV, who required reconstructive surgery for peripheral artery disease of the lower limbs, were included in the study. The SA group (30 patients) received hyperbaric 0.5% bupivacaine (3 ml), while the RA group (30 patients) was administered 20 ml of 0.5% bupivacaine hydrochloride solution with 4 mg of dexamethasone and 100 mg of lidocaine to block the femoral and sciatic nerves. Additionally, 5 ml of 0.5% bupivacaine hydrochloride was used for the obturator nerve block, along with infiltration of the skin with lidocaine solution at the site of the genitofemoral nerve branches. The duration of analgesia, the time of onset and regression of sensory and motor block, visual analog scale (VAS) scores, and any adverse effects were recorded. Results: The duration of analgesia was significantly longer in the RA group (1171.63±172.1 minutes) compared to the SA group (238.33±32.27 minutes) (p < 0.0784). The onset of sensory and motor block did not show significant differences between the groups. The VAS score was lower in the RA group at 6 and at 24 hours postoperation (p < 0.00001). In the SA group, there was a higher incidence of postoperative nausea and vomiting, hypotension, while in the RA group, there were more unpleasant sensations at the surgical site. Respiratory depression did not occur. The use of opioids was significantly lower in the RA group. Conclusions: Regional anesthesia significantly reduces the need for opioids, prevents the development of central sensitization, and decreases the risk of chronic postoperative pain. Peripheral nerve blocks of the lower limb provide surgical anesthesia with minimal hemodynamic effects, without reducing regional blood flow to the lower limb. They can serve as an alternative method of anesthetic management for patients at high anesthetic risk.