CHOICE OF ANESTHESIA METHOD IN RECONSTRUCTIVE SURGERY IN PATIENTS WITH CHRONIC LOWER LIMB ISCHEMIA

Abstract

Summary: Obliterating atherosclerosis of the lower extremity vessels is one of the most common diseases worldwide, leading to critical ischemia, high rates of disability, and mortality. Patients requiring surgical restoration of blood flow (revascularization) usually present with progressive systemic involvement of the vascular bed (including coronary, cerebral, and renal arteries). Due to high cardiovascular and perioperative risks, administering anesthesia to such patients poses a serious challenge for the anesthesiology team. Selecting the optimal pain management method in surgical practice is a critical factor for ensuring hemodynamic stability, minimizing surgical stress, and controlling postoperative pain. Materials and methods: A comprehensive study was conducted involving surgical patients assigned to subgroups: subgroup 1.1 (local anesthesia), subgroup 1.2 (US-guided regional anesthesia / nerve block), subgroup 2.1 (spinal anesthesia – SA), and subgroup 2.2 (US-guided regional anesthesia). Systolic (SAP) and diastolic blood pressure (DAP), serum cortisol level (as a surgical stress marker), and VAS pain scores were evaluated across 7 stages: 1 – start of surgery, 2 – 15 min, 3 – 45 min, 4 – 1 hour, 5 – 1.5 hours, 6 – end of surgery, 7 – 1 hour postoperatively. Statistical processing was performed using M ± SE, Mann-Whitney U test, and ANOVA (p ≤ 0.05). Results: Analysis of SAP dynamics demonstrated significantly higher values in the local anesthesia group compared to US-guided regional anesthesia at all stages (p ≤ 0.05, Mann-Whitney U / ANOVA). Specifically, at stage 1, SAP was 163.0 ± 3.2 mmHg vs 153.5 ± 2.8 mmHg; stage 2: 153.0 ± 2.5 vs 141.0 ± 2.1 mmHg; stage 3: 147.5 ± 2.3 vs 137.0 ± 2.4 mmHg; stage 4: 147.5 ± 2.2 vs 137.0 ± 2.5 mmHg; stage 5: 156.5 ± 3.1 vs 144.0 ± 4.8 mmHg; stage 6: 146.5 ± 1.8 vs 136.8 ± 1.9 mmHg; stage 7: 149.0 ± 2.0 vs 137.8 ± 2.2 mmHg. Local anesthesia showed a trend toward arterial hypertension, whereas US-guided regional anesthesia maintained high hemodynamic stability. SA (subgroup 2.1) induced marked transient hypotension peaking at 15 minutes (stage 2), whereas US-guided regional anesthesia (2.2) provided significantly superior stability. Concurrently, US-guided regional anesthesia demonstrated effective surgical stress suppression with significantly lower cortisol response and lower VAS pain scores (p < 0.05). Conlusions: US-guided regional anesthesia provides superior hemodynamic stability, avoiding both SA-induced hypotension and local anesthesia-induced hypertensive spikes. Pain control (VAS) and stress suppression (cortisol) further support its clinical efficacy.