Современные подходы к применению методов регионарной анестезии в области бариатрической хирургии

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Аннотация

Настоящий обзор литературы посвящён проблеме периоперационной аналгезии у пациентов с морбидным ожирением в области бариатрической хирургии. Традиционная опиоидная аналгезия имеет осложнения в виде высокого риска респираторных осложнений, послеоперационных диспепсических явлений и развития опиоид-индуцированной гипералгезии, особенно у пациентов с морбидным ожирением. В этом контексте стратегии мультимодальной аналгезии, одним из компонентов которых является регионарная анестезия, представляют собой перспективную альтернативу. Проведённый аналитический обзор современных данных литературы свидетельствует о том, что современные методы регионарной анестезии, включающие блокаду поперечной мышцы живота (TAPB), блокаду квадратной мышцы поясницы (QLB) и блокаду мышцы, выпрямляющей позвоночник (ESPB), интегрированные в структуру мультимодальной аналгезии, обеспечивают эффективный контроль послеоперационного болевого синдрома, значительное снижение опиоидной нагрузки и минимизацию связанных с ней побочных эффектов. Ультразвуковое наведение является обязательным при выполнении блокад у пациентов с морбидным ожирением, поскольку позволяет преодолевать технические сложности, обусловленные избыточным развитием подкожно-жировой клетчатки. QLB может превосходить TAPB по продолжительности анальгетического действия и эффективности в отношении висцерального компонента боли, в то время как эпидуральная анестезия, имея высокую эффективность, сопряжена с техническими трудностями при выполнении процедуры у данной категории пациентов. В рамках настоящего обзора представлен детальный сравнительный анализ различных методов регионарной анестезии (TAPB, RSB, QLB, TPVB, эпидуральная анестезия, IIB/IHB) с оценкой их уровня доказательности, технической сложности выполнения, особенностей профиля безопасности и спектра потенциальных рисков. Данный анализ предоставляет клиницистам методологическую основу для обоснованного выбора оптимальной методики с учётом типа планируемого оперативного вмешательства, уровня технической оснащённости лечебного учреждения и индивидуальных анатомо-физиологических особенностей пациента. В работе также рассмотрены основные ограничения, препятствующие широкому внедрению методов регионарной анестезии в клиническую практику.

Об авторах

Дарья Анатольевна Бикташева

Башкирский государственный медицинский университет

Автор, ответственный за переписку.
Email: darya.biktasheva14.07@gmail.com
ORCID iD: 0009-0003-4837-401X
Россия, Уфа

Александр Антонович Люциус

Башкирский государственный медицинский университет

Email: sasha.lyutsius14@gmail.com
ORCID iD: 0009-0001-2931-7656
Россия, Уфа

Раиль Мунирович Габдулхаков

Башкирский государственный медицинский университет

Email: krios.gip.14@gmail.com
SPIN-код: 3379-0166

д-р мед. наук, профессор

Россия, Уфа

Юлия Александровна Скворцова

Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова

Email: julia30.2001@mail.ru
ORCID iD: 0009-0004-1754-7288
Россия, Санкт-Петербург

Айгуль Гинариковна Набиева

Ижевская государственная медицинская академия

Email: nelolita2016@mail.ru
ORCID iD: 0009-0008-9958-8559
Россия, Ижевск

Ильназ Рамисович Сафин

Ижевская государственная медицинская академия

Email: ilnazsafin106@gmail.com
ORCID iD: 0009-0008-3811-8254
Россия, Ижевск

Альбина Ринатовна Ибрагимова

Саратовский государственный медицинский университет имени В.И. Разумовского

Email: albinaibragimova342@gmail.com
ORCID iD: 0009-0001-1126-4963
Россия, Саратов

Алиса Рустамовна Галлямова

Башкирский государственный медицинский университет

Email: gallyamovaalisa@yandex.ru
ORCID iD: 0009-0002-5493-8558
Россия, Уфа

Камилла Данииловна Понамарева

Северо-Западный государственный медицинский университет имени И.И. Мечникова

Email: ponamareva.milla@mail.ru
ORCID iD: 0009-0009-4286-7642
Россия, Санкт-Петербург

Урсула Забиюллаговна Чимагомедова

Северо-Западный государственный медицинский университет имени И.И. Мечникова

Email: ursula_0676@mail.ru
ORCID iD: 0009-0007-1388-2988
Россия, Санкт-Петербург

Наида Магомедовна Алибекова

Саратовский государственный медицинский университет имени В.И. Разумовского

Email: naika03@icloud.com
ORCID iD: 0009-0006-6317-7593
Россия, Саратов

Анастасия Витальевна Рыбакова

Ижевская государственная медицинская академия

Email: anastasija.rybakova@yandex.ru
ORCID iD: 0009-0006-3329-5740
Россия, Ижевск

Евгений Иванович Соболев

Воронежский государственный медицинский университет имени Н.Н. Бурденко

Email: evgeniy.sobolev.2002@mail.ru
ORCID iD: 0009-0001-2645-8410
Россия, Воронеж

Анастасия Владимировна Иванова

Воронежский государственный медицинский университет имени Н.Н. Бурденко

Email: anastasia.iv2002@mail.ru
ORCID iD: 0009-0000-5603-0485
Россия, Воронеж

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