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 Almost every patient who is to undergo an operation, even a small one, always asks the doctor the same question: will it hurt, under what anesthesia the operation will be performed?
Fear of pain and fear of surgery make many patients refrain from surgical treatment. This often leads to complications, worsens the patient's condition.
This, in our days, undoubtedly excessive, fear of surgical intervention has its own, so to speak, historical roots.
In the distant past, operations were performed without any anesthesia. This terrified and fearful not only the patient and others, but also the surgeon. It was necessary to have great willpower to decide on an operation. Of course, in such conditions, surgery could not develop and operations were a rare occurrence.
In an effort to alleviate the suffering of patients and to provide themselves, figuratively speaking, a greater operational space, doctors in every possible way sought to find some effective methods of pain relief.
Initially, during operations, they began to use mechanical compression of the nerve trunks, apply snow and ice, artificially cause loss of consciousness, making the patient bloodletting, squeezing the blood vessels in his neck, etc.
They also used narcotic drugs - dope, Indian hemp, belladonna extracts, alcohol, opium, etc. These substances were injected inside in the form of infusions and decoctions, used for rubbing into the skin, wetting anesthetic sponges.
Although all these remedies suppressed pain, they generally had a bad effect on the body, weakened it, reduced resistance to disease, and made the treatment ineffective. Therefore, scientists around the world continued to actively work on the development of new means and methods of pain relief.
In the middle of the 19th century, American doctors Morton and Simpson tested the effects of chloroform and ether. At the same time, the famous Russian surgeon N.I. Pirogov was the first to use these volatile substances on a large scale for anesthesia. The drugs made it possible to calmly carry out complex surgical operations, provided relatively good treatment results. Initially, volatile preparations of ether and chloroform were used with anesthetic masks. Later, surgeons began to use rectal and intravenous methods of pain relief. This is how a new branch of medicine gradually developed and formed - the science of pain relief.
 Anesthesia with the introduction of an anesthetic substance into the spinal canal contributed to the expansion of the volume of surgical activity. But that was not enough. Researchers sought to find more advanced means and methods of pain relief, not only highly effective, but also harmless and safe for the life of patients. One of these techniques was the method of so-called local infiltration anesthesia, in which anesthesia is performed by introducing a weak solution of novocaine into the area to be operated on. The basis for local anesthesia with a weak solution of novocaine was the doctrine of the nervousism of the outstanding Russian scientists I.P. Pavlov, I.M.Sechenov, A.A.Ukhtomsky and N.V. Vvedensky. This method, proposed by the most prominent Soviet surgeons - father and son Vishnevsky, is being used with great success today.
Local anesthesia with a weak solution of novocaine not only eliminates pain, but also has a beneficial effect on the course of the postoperative period, on wound healing, and restoration of the patient's strength. This is because the introduction of a sufficiently large amount of fluid during the operation improves metabolic processes in the body.And besides, a weak solution of novocaine has a beneficial effect on the central nervous system.
Local anesthesia with novocaine found very widespread use later. It belongs to the most harmless and safe methods of pain relief, giving the lowest percentage of complications. In the middle of the last century, 75% of all operations were performed under local novocaine anesthesia. This technique has proven itself especially well in the surgical treatment of elderly patients.
At present, devices have been manufactured that allow the use of a solution of novocaine without resorting to needles. The drug is injected into the tissue using an electric current. This increased the popularity of novocaine anesthesia.
In connection with the further development of science and technology, even more advanced methods of anesthesia began to be introduced, which allow not only painlessly performing the operation, but also make it possible to control the body, regulate respiration and the activity of the cardiovascular system, remove carbon dioxide from the blood, replacing it with oxygen. At the same time, a number of drugs are used that regulate the work of the cardiovascular system, relax the muscles, which is necessary for a successful operation. A great help is provided in this by the equipment, which makes accurate records of the processes occurring in the cardiovascular system, brain, lungs.
In connection with the emergence of sophisticated equipment and complex drugs that allow you to control the body, drugs that seem to be fighting for a successful outcome of the operation together with the surgeon, it became necessary to train anesthesiologists - specialists in the use of various methods of anesthesia.
Currently, all hospitals with large surgical departments have such specialists who, on the basis of a thorough examination of the patient, develop individual recommendations for the use of a particular method of anesthesia, carry out anesthesia during the operation and monitor the patient after the anesthesia has stopped. All this greatly improves the patient's condition, relieves him of anxiety, fear of the operation, and also eases the position of surgeons, simplifies their work. Usually, the operation proceeds calmly, without any pain, and the patient wakes up soon.
The emergence of new drugs - nitrous oxide, cyclopropane, fluethane and others - makes it possible to use superficial, fast-acting anesthesia not only in the operating room, but also in the postoperative ward, in the dressing room, in the clinic and even in the emergency car. In the postoperative period, such anesthesia is used to prevent and alleviate possible complications.
The ease of use of these topical anesthetics has a very positive effect on the treatment of many diseases.
Indeed, for the patient it is not at all indifferent whether they will warn him that a difficult and painful operation is ahead, or they will say: "Breathe through this mask for a few minutes and everything will be done."... A person devoid of fear of pain willingly agrees to an operation exactly when it is needed. And this is often critical.
Take, for example, such a common disease as purulent inflammation of the fingers - felon, in which oneration is most often carried out in a polyclinic. If you start to treat such a disease in time and perform an operation, the patient will quickly recover. A neglected disease can lead to serious consequences, cause the need for deep incisions and even removal of a finger, since the purulent process captures not only soft, but also bone tissues.
Short-term superficial anesthesia has another positive side - it can be used at almost all stages of treatment of patients.
It is known that the so-called acute surgical diseases are accompanied by severe pain. The use of conventional painkillers: morphine, pantapon, promedol, etc. soothes pain, but sometimes obscures the picture of the disease, prevents a quick and correct diagnosis. In these cases, superficial anesthesia with nitrous oxide is extremely useful. This method quickly relieves pain without changing the signs of the disease.
 Many emergency vehicles have special devices that allow you to give short-term anesthesia during the transport of a patient with an acute surgical disease or a patient who has received a serious injury.
The possibilities of using modern types of pain relief are extensive. With their appearance, the field of activity of the surgeon has significantly expanded, the results of treatment have improved.
Previously impossible operations on organs of the gastrointestinal tract, chest, lungs, heart, brain became feasible only with the advent of modern methods of anesthesia.
Currently, in operations on the heart and large vessels, anesthesia is widely used with the help of general and local cooling of tissues and organs. General cooling is achieved by placing the patient in a cold bath or using a so-called cold blanket, the use of which allows the patient's body to be cooled to 28-30 °. At the same time, in addition to complete anesthesia, the activity of metabolic processes in the body decreases, it becomes possible to perform a difficult operation with a lower risk to the patient's life. Usually, these methods of anesthesia are used for congenital heart defects.
Currently, in cardiac surgery, the general cooling method is supplemented by the introduction of cooled blood directly into the vessels supplying the heart. The vessels that flow into and out of the heart are preliminarily turned off, and temporary tourniquets are placed on them. This greatly facilitates the operation.
Many departments of hospitals and clinics are now equipped with special devices and other means to remove patients from a state of deep shock or clinical death. The sooner the patient is taken out of this difficult condition, the greater the opportunity to save his life.
To remove the patient from the state of clinical death (the phase in which the breakdown of brain cells has not yet begun), oxygen is administered to the lungs, intra-arterial blood transfusion, massage and defibrillation (restoration of the normal rhythm of contractions) of the heart. With the help of these techniques, it is possible to achieve positive results.
And we can say with confidence that they could not have been achieved if the most advanced methods of anesthesia had not been put into service with doctors.
So, the use of various methods of anesthesia relieves a person of severe pain, prevents severe postoperative complications, and contributes to the success of surgical treatment. The role of pain relief is great, its use is extensive and fruitful.
Kukin N.N. - Ways of surgery
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