ANALYSIS OF THE EFFECTIVENESS OF SCIATIC NERVE BLOCK IN MILITARY PERSONNEL

Abstract

The article considers the current issues of choosing the optimal method of anesthesia in the surgical treatment of military personnel with gunshot and shrapnel wounds of the lower extremities. Particular attention is paid to the comparative analysis of neuraxial methods of anesthesia (spinal and epidural) and modern conductive methods, in particular ultrasound- guided regional anesthesia of the sciatic nerve. It is substantiated that in conditions of combat trauma, traditional neuraxial methods often lose their safety and predictability due to the high probability of hypovolemia, unstable hemodynamics, coagulopathy and the lack of reliable data on the somatic condition of patients. It is shown that spinal and epidural anesthesia can cause pronounced sympathetic blockade with the development of arterial hypotension, depression of consciousness and respiration, which significantly increases the risk of aspiration complications and hemodynamic decompensation in the wounded. In addition, the presence of contaminated wounds and the threat of infectious complications limit the use of epidural catheters in military practice. In this case, regional conductive anesthesia is considered a safer and more controlled alternative that allows achieving effective analgesia with minimal impact on systemic hemodynamics. The aim of the study was to evaluate the effectiveness of different techniques for administering local anesthetics during ultrasound-guided sciatic nerve blockade in patients with combat trauma of the lower limb and to determine their effect on the speed of onset of sensory blockade, duration of analgesia and depth of motor block. The study included 50 wounded, who were divided into four groups depending on the technique of performing the blockade: interbranchial, superficial paraneural, combined paraneural and proximal paraneural. The results showed that the fastest onset of sensory blockade and the longest duration of analgesia is provided by the interbranchial technique of administering the anesthetic in the area of the sciatic nerve bifurcation. At the same time, paraneural techniques were characterized by a somewhat slower onset of action and shorter duration of anesthesia, but maintained a favorable safety profile and moderate depth of motor block. In all cases, radial spread of the anesthetic around the nervous structures with the formation of a circular coating was noted. The results obtained indicate that ultrasound-guided conduction anesthesia is an effective, safe and appropriate method of anesthesia in military patients with lower limb injuries. The use of optimal techniques for administering local anesthetics allows to improve the quality of sensory blockade, reduce the need for systemic opioids and reduce the risk of potential complications. This makes conduction anesthesia an important component of modern military medical protocols and a promising direction for further clinical research.