ОЦЕНКА СТЕПЕНИ НАРУЖНОЙ ДИСЛОКАЦИИ ЭПИДУРАЛЬНОГО КАТЕТЕРА В КЛИНИЧЕСКОЙ ПРАКТИКЕ У ТРАВМАТОЛОГИЧЕСКИХ БОЛЬНЫХ

Abstract

For the purpose of the study, we selected 73 patients who underwent combined two-level spinal-epidural anesthesia with a catheter in the subcutaneous tunnel during operations for lower limbs fractures. All patients underwent postoperative epidural analgesia. We applied a method for assessing the degree of external dislocation of the epidural catheter and an algorithm of actions when a dislocation of the epidural catheter is detected. When changing the fixing aseptic sticker, the degree of epidural catheter dislocation was assessed, and if a pronounced dislocation was detected, additional measures were taken to enhance the fixation of epidural catheter. In 14 cases, we used additional fixation devices “Epi-Fix”, which was associated with the threat of falling out of the epidural catheter with a pronounced degree of dislocation. Additional fixation in this case helped to avoid prolapse and ensure continuation of anesthesia. However, in two cases, the epidural catheter was removed because the dislocation corresponded to the 6th degree of the proposed scale, and its continued use was useless. Thus, the use of the scale we developed enables to monitor and assess the risk of worsening anesthesia and catheter migration or prolapse. Further tactics in relation to prolonged anesthesia depend on an objective assessment of the position of the catheter.