Preperitoneal Blockade in the Treatment of Patients with Perforated Gastroduodenal Ulcers and Peritonitis

ORIGINAL ARTICLE
Alexei L. Charyshkin, PhD, ScD; Sergei A. Yakovlev; Vladimir P. Demin

Institute of Medicine, Ecology and Physical Education of Ulyanovsk State University, Ulyanovsk, Russia

Corresponding author: Prof. Alexei L. Charyshkin, PhD, ScD, Head of the Faculty Surgery Department, Institute of Medicine, Ecology and Physical Education, Ulyanovsk State University. Ulyanovsk, the Russian Federation. E-mail: charyshkin@yandex.ru

Published: June 20, 2016.  DOI: 10.21103/Article6(2)_OA4

Abstract: 

The objective of this study was to improve the results of surgical treatment for patients with perforated gastroduodenal ulcers and peritonitis (PGDU-P) by applying the preperitoneal blockade.
Materials and Methods: The study included 102 patients with perforated gastroduodenal ulcers (PGDU) complicated by peritonitis. Patients between 18 and 30 years were predominant. Pain was measured using the Visual Analog Scale (VAS) for Pain. The measurements of intra-abdominal pressure (IAP) by indirect infravesical tensometry were performed daily from the first day after the operation. Surgical interventions (laparotomy, laparoscopic suturing of PGDU, sanitation and drainage of the abdominal cavity) was performed under endotracheal anesthesia in all patients.
Patients were divided into two groups depending on the method of postoperative analgesia. Patients of Group 1 (n=62) were subjected only to systemic opioid analgesia (an intramuscular injection of 1% solution of Promedol 1ml 4 times a day). Patients of Group 2 were subjected to systemic opioid analgesia and catheterization of the preperitoneal space for infusion of 0.5% solution of Novocaine in the postoperative period.
Results: Postoperative analgesia using preperitoneal blockade after laparotomy and suturing of perforated gastroduodenal ulcers reduced the pain intensity by 2 times in comparison with conventional analgesia. The preperitoneal blockade after laparotomy in PGDU-P patients promotes the effective reduction of intra-abdominal hypertension (IAH) for 2 days. The comparative evaluation of the incidence of the early postoperative complications showed that using preperitoneal blockade contributed to significantly reducing the complications in Group 2. Postoperative mortality was 1.6% in Group 1 and 0 in Group 2. The average length of stay was reduced by approximately 3 days in Group 2 compared to traditional anesthesia.

Keywords: 
laparotomy; perforated gastroduodenal ulcers; peritonitis; preperitoneal blockade.
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