In the review, neurological complications associated with regional anesthesia are discussed: epidural hematoma (frequency 0.0008 to 0.2%), spinal cord or peripheral nerves injury during puncture or catheter placement (frequency from 0.5 to 1%), post-dural puncture headache (frequency from 0.16 to 6% in obstetrics), transient neurologic syndrome (frequency from 0 to 37%, most often after spinal anesthesia with lidocaine), Horner’s syndrome (frequency from 0.13 to 2.5%). Epidemiology, risk factors, preventive measures, and management of neurological complications associated with regional anesthesia are presented.

Rationale. Knee join replacement is accompanied by intensive pain syndrome. Prolonged blocks of branches of sciatic and femoral nerves are the most effective. Apart from sensory block and analgesia some types of blocks cause motor block of lower extremities, particularly quadriceps muscle of thigh which may prevent patients mobilization. In this connection, the choice of anesthesia strategy is significant concerning the use of prolonged blocks of the branches of sciatic and femoral nerves maintaining the motor function of the lower extremities with adequate analgesia. The goal of the study is to select a method of pain relief after knee replacement that provides adequate analgesia while maintaining the motor function of the lower limb muscles. Material and methods. The investigation was carried out in patients undergone knee join replacement according to standard procedure. The operation was performed under combined anaesthesia: spinal anaesthesia plus prolonged block of tibial nerve and femoral nerve or femoral triangle block with perineural space catheterization. The block with the use of local anesthetic in the analgesic concentration for postoperative analgesia during 3 postoperative days. All participants were divided into four groups according to the combinations of the blocks. Results. The combination of block of branches of sciatic and femoral nervessignificantly improves the quality of postoperative analgesia on the first postoperative day. The block in femoral triangle (subsartorial) in comparison with the block of femoral nerve is accompanied by significantly less weakness of quadriceps muscle of thigh at the equal analgesic potency. Conclusions. Maintaining the motor function of quadriceps muscle of thigh with the use of the prolonged block in femoral triangle for analgesia can be of certain advantage for patients mobilization in the early postoperative period (fast track).

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The authors analyzed studies on the issues of perioperative analgesia in hip and hip joint surgery. Based on the analysis, modern recommendations are presented regarding the choice of optimal anesthetic techniques for proximal femoral fractures and hip arthroplasty. Early surgical intervention in older patients contributes to the restoration of the supporting function of the limb, enables rapid rehabilitation, and reduces the risk of life-threatening complications. This requires pain relief for preoperative preparation and high-quality intraoperative and postoperative pain relief, allowing early rehabilitation of the patient. The review included materials from recent congresses, and webinars of the European Society of Regional Anesthesia Pain Treatment. According to many authors, ileofascial blockade is the method of choice for preoperative anesthesia for proximal femoral fractures. Variants of the blockades of the branches of the lumbar and sacral plexuses in various anatomical spaces and plane blocks are considered. In addition, recommendations of the PROSPECT group (Procedure Specific Postoperative Pain Management) on the use of various technologies in the perioperative period are considered based on data from multicenter randomized trials and meta-analyses in relation to a specific procedure. The effectiveness of new approaches to the branches of the lumbar plexus was also considered, for example, suprainguinal ileofascial blockade and blockade of the pericapsular nerves. Anesthesiologists have used relatively new and traditional tools available to reduce pain and speed up postoperative recovery for patients with injuries and undergoing surgery for the proximal femur. Although the effectiveness of not all of them is confirmed by evidence-based medicine, clinical practice shows a positive effect on their use.