Topographic-Anatomic and Pharmacology Justification of the Choice of the Method of Hand Anesthesia

The need to study anatomical and functional features of the hand is determined by the tendency to increase the number of hand injuries both among military personnel and among civilians who suff ered from hostilities in Ukraine.The study aimed to justify the choice of the method of analgesia in the hand region, taking into account topographic- anatomical and pharmacological features.Material and methods. A study of topographical anatomical and pharmacological justifi cation of the choice of the method of anesthesia of the hand has been carried out through the comparison of the data of the existing practice guidelines for hand analgesia, considering the modern conditions of providing medical care in Ukraine.The results. In everyday practice, sensitivity disorders of the skin of fi ngers and hands are recognized during examination based on the territorial distribution of nerves. Conductor blockade at the level of the wrist allows for painless surgery on any part of the hand: anesthesia occurs after 10-15 minutes, so it is recommended to add infi ltration anesthesia to the intervention area. Recently, the method of introducing a local anesthetic with adrenaline for regional anesthesia under ultrasound control (ropivacaine or lidocaine, etc.) has become widespread, which provides longer anesthesia in smaller doses. At the same time, ultrasound imaging is recommended for any regional blockades, except for blockades on the fi ngers.In long-term and traumatic operations on the hand, traumatologists use high conduction, perineural anesthesia, choosing supraclavicular subclavian or axillary parts of the shoulder plexus. Regional anesthesia is a useful technique that can signifi cantly reduce or relieve extremity pain without the risk of opioid side eff ects or benzodiazepines, such as respiratory depression, sedation, and hypotension. However, with this technique, there is a risk of severe side eff ects, as well as lethality with proximal injections or anesthetic administration directly into the vessel. With this in mind, an attempt has been made in the instructions to fi nd a balance between the overall risks and potential benefi ts of this method, recommending the optimal execution technique (for example, the use of ultrasound), a limited number of areas of the blockade, and the safest combination of drugs and their doses.Conclusions. It is necessary to know the topographical and anatomical relationship of nerves and arteries of the hand, as well as the pharmacokinetics of painkillers and sedatives to solve important theoretical problems related to hand surgery.