Treatment of acute postoperative pain in patients undergoing open abdominal aortic repair (current state of the problem)

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


The epidemiology of acute postoperative pain and complications associated with inadequately controlled acute postoperative pain syndrome were considered. The paper presents treatments for acute postoperative pain, the clinical value of multimodal analgesia in enhanced recovery, and reduction of mortality in patients undergoing open abdominal aortic repair. The problem associated with the limitations of the methods in postoperative pain management after open surgical abdominal aortic repair is also considered. The paper also presents alternative methods of multimodal analgesia in patients undergoing other abdominal surgery. The choice of the optimal method in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair is now significantly limited, as a comparative analysis of alternative methods of analgesia and epidural analgesia in vascular surgery was not conducted. Multicenter studies on multimodal analgesia in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair are therefore required when deviating from the standard protocol.

Full Text

Restricted Access

About the authors

Anzhelika V. Kozhanova

National Medical Research Center for Surgery. A.V. Vishnevsky

ORCID iD: 0000-0002-0607-6570
SPIN-code: 3138-6590


Russian Federation, 27, st. Bolshaya Serpukhovskaya, Moscow, 117997

Georgy P. Plotnikov

National Medical Research Center for Surgery. A.V. Vishnevsky

Author for correspondence.
ORCID iD: 0000-0002-4291-3380

MD, Dr. Sci. (Med.)

Russian Federation, 27, st. Bolshaya Serpukhovskaya, Moscow, 117997


  1. Carino D, Sarac TP, Ziganshin BA, Elefteriades JA. Abdominal Aortic Aneurysm: Evolving Controversies and Uncertainties. Int J Angiol. 2018;27(2):58–80. doi: 10.1055/s-0038-1657771
  2. Brustia P, Renghi A, Aronici M, et al. Fast-track in abdominal aortic surgery: experience in over 1,000 patients. Ann Vasc Surg. 2015;29(6):1151–1159. doi: 10.1016/j.avsg.2015.02.012
  3. Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Collection: Reports funded by National Institutes of Health. Washington (DC); 2011.
  4. Small C, Laycock H. Acute postoperative pain management. Br J Surg. 2020;107(2):e70–e80. doi: 10.1002/bjs.11477
  5. Andres J, Pogatzki-Zahn E, Huygen F, et al. Controlling acute pain to improve the quality of postoperative pain management: an update from the European Society of Regional Anesthesia meeting held in Maastricht (September 2016). Pain Manag. 2017;7(6):513–522. doi: 10.2217/pmt-2017-0026
  6. Yang MMH, Hartley RL, Leung AA, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019;9(4):e025091. doi: 10.1136/bmjopen-2018-025091
  7. Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet. 2019;393(10180):1537–1546. doi: 10.1016/S0140-6736(19)30352-6
  8. Turan A, Leung S, Bajracharya GR, et al. Acute Postoperative Pain Is Associated With Myocardial Injury After Noncardiac Surgery. Anesth Analg. 2020;131(3):822–829. doi: 10.1213/ANE.0000000000005033
  9. Sacco M, Meschi M, Regolisti G, et al. The relationship between blood pressure and pain. J Clin Hypertens (Greenwich). 2013;15(8):600–605. doi: 10.1111/jch.12145
  10. Dayoub EJ, Jena AB. Does Pain Lead to Tachycardia? Revisiting the Association Between Self-reported Pain and Heart Rate in a National Sample of Urgent Emergency Department Visits. Mayo Clin Proc. 2015;90(8):1165–1166. doi: 10.1016/j.mayocp.2015.06.007
  11. Whibley D, AlKandari N, Kristensen K, et al. Sleep and Pain: A Systematic Review of Studies of Mediation. Clin J Pain. 2019;35(6):544–558. doi: 10.1097/AJP.0000000000000697
  12. Gilam G, Gross JJ, Wager TD, et al. What Is the Relationship between Pain and Emotion? Bridging Constructs and Communities. Neuron. 2020;107(1):17–21. doi: 10.1016/j.neuron.2020.05.024
  13. Mackey S, Kao MC. Managing twin crises in chronic pain and prescription opioids. BMJ. 2019;364:l917. doi: 10.1136/bmj.l917
  14. Leung JM, Sands LP, Lim E, et al. Does preoperative risk for delirium moderate the effects of postoperative pain and opiate use on postoperative delirium? Am J Geriatr Psychiatry. 2013;21(10):946–956. doi: 10.1016/j.jagp.2013.01.069
  15. Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth. 2020;125(4):492–504. doi: 10.1016/j.bja.2020.06.063
  16. Ovechkin AM, Bayalieva AZ, Ezhevskaya AA, et al. Postoperative analgesia. Annals of critical care. 2019(4):9–33. doi: 10.21320/1818-474x-2019-4-9-33
  17. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–157. doi: 10.1016/j.jpain.2015.12.008
  18. Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014;112(6):991–1004. doi: 10.1093/bja/aeu137
  19. Strakhov MA, Zagorodniy NV, Yeghiazaryan KA, et al. Postoperative pain: prevention or treatment of consequences? RMJ. 2019;2:3–7. (In Russ).
  20. Jessula S, Atkinson L, Casey P, et al. Surgically positioned paravertebral catheters and postoperative analgesia after open abdominal aortic aneurysm repair. J Vasc Surg. 2019;70(5):1479–1487. doi: 10.1016/j.jvs.2019.02.037
  21. Prezidium Obshcherossiiskoi obshchestvennoi organizatsii «Federatsiya anesteziologov i reanimatologov». Posleoperatsionnoe obezbolivanie. Metodicheskie rekomendatsii. 2019.
  22. Ball L, Pellerano G, Corsi L, et al. Continuous epidural versus wound infusion plus single morphine bolus as postoperative analgesia in open abdominal aortic aneurysm repair: a randomized non-inferiority trial. Minerva Anestesiol. 2016;82(12):1296–1305.
  23. McNicol ED, Tzortzopoulou A, Cepeda MS, et al. Single-dose intravenous paracetamol or propacetamol for prevention or treatment of postoperative pain: a systematic review and meta-analysis. Br J Anaesth. 2011;106(6):764–775. doi: 10.1093/bja/aer107
  24. Xuan C, Yan W, Wang D, et al. Effect of Preemptive Acetaminophen on Opioid Consumption: A Meta-Analysis. Pain Physician. 2021;24(2):E153-E160.
  25. Kazennov VV, Shishkin MN, Amerov DB. Systemic multimodality postoperative analgesia in vascular surgery. Angiology and vascular surgery. 2011;17(4):108–14.
  26. Hayward KL, Powell EE, Irvine KM, Martin JH. Can paracetamol (acetaminophen) be administered to patients with liver impairment? Br J Clin Pharmacol. 2016;81(2):210–222. doi: 10.1111/bcp.12802
  27. Almeida C, Assuncao JP. Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case. Braz J Anesthesiol. 2018;68(6):657–660. doi: 10.1016/j.bjan.2018.05.003
  28. Muehling BM, Halter G, Lang G, et al. Prospective randomized controlled trial to evaluate "fast-track" elective open infrarenal aneurysm repair. Langenbecks Arch Surg. 2008;393(3):281–287. doi: 10.1007/s00423-008-0284-8
  29. Malik K, Poletto G, Musto L, et al. Implementation of a perioperative protocol to enhance open aortic repair. J Vasc Surg. 2021;74(2):434–441 e432. doi: 10.1016/j.jvs.2020.12.102
  30. Nejim B, Weaver ML, Locham S, et al. Intravenous ketorolac is associated with reduced mortality and morbidity after open abdominal aortic aneurysm repair. Vascular. 2021;29(1):15–26. doi: 10.1177/1708538120914454
  31. Hearn L, Derry S, Moore RA. Single dose dipyrone (metamizole) for acute postoperative pain in adults. Cochrane Database Syst Rev. 2016;4:CD011421. doi: 10.1002/14651858.CD011421.pub2
  32. Gómez-Duarte OG. Is it time to restrict the clinical use of dipyrone? Colombian J Anesth. 2019;47(2):81–83. doi: 10.1097/cj9.0000000000000111
  33. Onodera Y, Yamagishi A, Kunisawa T, et al. Postoperative analgesia of continuous intravenous fentanyl or dexmedetomidine for patients receiving anticoagulant therapy. Masui. 2011;60(8):936–940.
  34. Chen Z, Tang R, Zhang R, et al. Effects of dexmedetomidine administered for postoperative analgesia on sleep quality in patients undergoing abdominal hysterectomy. J Clin Anesth. 2017;36:118–122. doi: 10.1016/j.jclinane.2016.10.022
  35. Zhao W, Hu Y, Chen H, et al. The Effect and Optimal Dosage of Dexmedetomidine Plus Sufentanil for Postoperative Analgesia in Elderly Patients With Postoperative Delirium and Early Postoperative Cognitive Dysfunction: A Single-Center, Prospective, Randomized, Double-Blind, Controlled Trial. Front Neurosci. 2020;14:549516. doi: 10.3389/fnins.2020.549516
  36. Sui X, Duan Q, Liu K, Li C. Postoperative delirium after long-term general anesthesia in elderly patients, how to reduce it?: Protocol of a double-blinded, randomized, placebo-controlled trial. Medicine (Baltimore). 2021;100(22):e25885. doi: 10.1097/MD.0000000000025885
  37. Monaco F, Pieri M, Barucco G, et al. Epidural Analgesia in Open Thoraco-abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg. 2019;57(3):360–367. doi: 10.1016/j.ejvs.2018.09.027
  38. Guay J, Kopp S. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. 2016(1):CD005059. doi: 10.1002/14651858.CD005059.pub4
  39. Bukarev АE, Subbotin VV, Ilyin SА, et al. Anaesthesiologic Aspects of Enhanced Recovery Protocol in Abdominal Aortic Surgery. Messenger of anesthesiology and resuscitation. 2018;15(3):5–13. (In Russ). doi: 10.21292/2078-5658-2018-15-3-5-13
  40. Bardia A, Sood A, Mahmood F, et al. Combined Epidural-General Anesthesia vs General Anesthesia Alone for Elective Abdominal Aortic Aneurysm Repair. JAMA Surg. 2016;151(12):1116–1123. doi: 10.1001/jamasurg.2016.2733
  41. Greco KJ, Brovman EY, Nguyen LL, Urman RD. The Impact of Epidural Analgesia on Perioperative Morbidity or Mortality after Open Abdominal Aortic Aneurysm Repair. Ann Vasc Surg. 2020;66:44–53. doi: 10.1016/j.avsg.2019.10.054
  42. Claroni C, Marcelli ME, Sofra MC, et al. Preperitoneal Continuous Infusion of Local Anesthetics: What Is the Impact on Surgical Wound Infections in Humans? Pain Med. 2016;17(3):582–589. doi: 10.1111/pme.12872
  43. Abdallah FW, Adham AM, Chan VW, Kanazi GE. Analgesic benefits of preincisional transversus abdominis plane block for abdominal aortic aneurysm repair. J Cardiothorac Vasc Anesth. 2013;27(3):536–538. doi: 10.1053/j.jvca.2012.01.027
  44. Chenet J, Dupont E, Salomon du Mont L, et al. Clinical effectiveness of ultrasound-guided dual transversus abdominis plane block for postoperative analgesia in open abdominal aortic surgery patients: The randomised, double-blind ETAP trial. Eur J Anaesthesiol. 2020;37(9):821–823. doi: 10.1097/EJA.0000000000001240
  45. Minami E, Kawashima S, Kato T, et al. Analgesic efficacy of transversus abdominis plane block after open abdominal aortic aneurysm surgery. Masui. 2014;63(10):1089–1092.
  46. Yamamoto G, Watanabe T, Fujiwara T, et al. Efficacy of repeated subcostal transversus abdominis plane blocks with 0.2% lidocaine via 18-gauge intravenous catheters for patients undergoing abdominal aortic aneurism surgery. Masui. 2014;63(8):866–871.
  47. Hotta A, Yagi Y, Hakata S, et al. Case of Leriche's syndrome treated with safe and effective analgesia after laparotomy by transversus abdominis plane block, rectus sheath block, and continuous wound infusion with ropivacaine. Masui. 2013;62(12):1461–1465.
  48. Teshome D, Hunie M, Essa K, et al. Rectus sheath block and emergency midline laparotomy at a hospital in Ethiopia: A prospective observational study. Ann Med Surg (Lond). 2021;68:102572. doi: 10.1016/j.amsu.2021.102572
  49. Karaarslan E, Topal A, Avci O, Tuncer Uzun S. Research on the efficacy of the rectus sheath block method. Agri. 2018;30(4):183–188. doi: 10.5505/agri.2018.86619
  50. Makharin OA, Zhenilo VM, Skoblo ML. Variants of the Transverse Plane Block and Quadratus Lumborum Block (Review). General Reanimatology. 2019;15(3):102–113. (In Russ). doi: 10.15360/1813-9779-2019-3-102-113
  51. Kuosmanen V, Ruottinen M, Rahkola D, et al. Brief Pain Inventory (BPI) Health Survey After Midline Laparotomy With the Rectus Sheath Block (RSB) Analgesia: A Randomised Trial of Patients With Cancer and Benign Disease. Anticancer Res. 2019;39(12):6751–6757. doi: 10.21873/anticanres.13890
  52. Gupta N, Kumar A, Harish RK, et al. Comparison of postoperative analgesia and opioid requirement with thoracic epidural vs. continuous rectus sheath infusion in midline incision laparotomies under general anaesthesia – A prospective randomised controlled study. Indian J Anaesth. 2020;64(9):750–755. doi: 10.4103/ija.IJA_976_19
  53. Howle R, Ng SC, Wong HY, et al. Comparison of analgesic modalities for patients undergoing midline laparotomy: a systematic review and network meta-analysis. Can J Anaesth. 2022;69(1):140–176. doi: 10.1007/s12630-021-02128-6
  54. Patel R, Sweeting MJ, Powell JT, et al. Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366–2374. doi: 10.1016/S0140-6736(16)31135-7
  55. McGinigle KL, Eldrup-Jorgensen J, McCall R, et al. A systematic review of enhanced recovery after surgery for vascular operations. J Vasc Surg. 2019;70(2):629–640 e621. doi: 10.1016/j.jvs.2019.01.050
  56. Rosero EB, Joshi GP. Nationwide incidence of serious complications of epidural analgesia in the United States. Acta Anaesthesiol Scand. 2016;60(6):810–820. doi: 10.1111/aas.12702
  57. Bos EME, Hollmann MW, Lirk P. Safety and efficacy of epidural analgesia. Curr Opin Anaesthesiol. 2017;30(6):736–742. doi: 10.1097/ACO.0000000000000516
  58. Zang K, Chen B, Wang M, et al. The effect of early mobilization in critically ill patients: A meta-analysis. Nurs Crit Care. 2020;25(6):360–367. doi: 10.1111/nicc.12455
  59. Weibel S, Jelting Y, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev. 2018;6:CD009642. doi: 10.1002/14651858.CD009642.pub3
  60. Kranke P, Jokinen J, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Database Syst Rev. 2015(7):CD009642. doi: 10.1002/14651858.CD009642.pub2
  61. Dunn LK, Durieux ME. Perioperative Use of Intravenous Lidocaine. Anesthesiology. 2017;126(4):729–737. doi: 10.1097/ALN.0000000000001527
  62. Daykin H. The efficacy and safety of intravenous lidocaine for analgesia in the older adult: a literature review. Br J Pain. 2017;11(1):23–31. doi: 10.1177/2049463716676205
  63. Hung KC, Chu CC, Hsing CH, et al. Association between perioperative intravenous lidocaine and subjective quality of recovery: A meta-analysis of randomized controlled trials. J Clin Anesth. 2021;75:110521. doi: 10.1016/j.jclinane.2021.110521
  64. Dai Y, Jiang R, Su W, et al. Impact of perioperative intravenous lidocaine infusion on postoperative pain and rapid recovery of patients undergoing gastrointestinal tumor surgery: a randomized, double-blind trial. J Gastrointest Oncol. 2020;11(6):1274–1282. doi: 10.21037/jgo-20-505
  65. Cooke C, Kennedy ED, Foo I, et al. Meta-analysis of the effect of perioperative intravenous lidocaine on return of gastrointestinal function after colorectal surgery. Tech Coloproctol. 2019;23(1):15–24. doi: 10.1007/s10151-019-1927-1
  66. Sridhar P, Sistla SC, Ali SM, et al. Effect of intravenous lignocaine on perioperative stress response and post-surgical ileus in elective open abdominal surgeries: a double-blind randomized controlled trial. ANZ J Surg. 2015;85(6):425–429. doi: 10.1111/ans.12783
  67. Ovechkin AM. Intravenous lidocaine infusion: should we stop or continue? Regional Anesthesia and Acute Pain Management. 2021;15(1):5–8. (In Russ). doi: 10.17816/1993-6508-2021-15-1-5-8
  68. Ovechkin AM, Becker AA. Intravenous Lidocaine Infusion as a Perspective Component of Multimodal Analgesia, Which Affects on Early Postoperative Outcome. Regional Anesthesia and Acute Pain Management. 2017;11(2):73–83. (In Russ). doi: 10.18821/1993-6508-2017-11-2-73-83
  69. Sholin IY, Avetisyan VA, Ezugbaia BS, et al. The Use of Lidocaine Infusion for Analgesia and Prevention of Ileus after Major Abdominal Surgeries. Regional Anesthesia and Acute Pain Management. 2018;12(2): 107–112. (In Russ). doi: 10.18821/1993-6508-2018-12-2-107-112
  70. Xu SQ, Li YH, Wang SB, et al. Effects of intravenous lidocaine, dexmedetomidine and their combination on postoperative pain and bowel function recovery after abdominal hysterectomy. Minerva Anestesiol. 2017;83(7):685–694. doi: 10.23736/S0375-9393.16.11472-5
  71. Foo I, Macfarlane AJR, Srivastava D, et al. The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety. Anaesthesia. 2021;76(2):238–250. doi: 10.1111/anae.15270
  72. Ho MLJ, Kerr SJ, Stevens J. Intravenous lidocaine infusions for 48 hours in open colorectal surgery: a prospective, randomized, double-blinded, placebo-controlled trial. Korean J Anesthesiol. 2018;71(1):57–65. doi: 10.4097/kjae.2018.71.1.57
  73. Ovechkin AM, Efremenko IV, Krasnoselsky MYa. Postoperative analgesia based on the complex use of non-opioid analgesics and drugs affecting NMDA receptors. Russian journal of pain. 2015;40 (3–4):34–40. (In Russ).
  74. Arikan M, Aslan B, Arikan O, et al. Comparison of the effects of magnesium and ketamine on postoperative pain and morphine consumption. A double-blind randomized controlled clinical study. Acta Cir Bras. 2016;31(1):67–73. doi: 10.1590/S0102-865020160010000010
  75. Bartoli F, Riboldi I, Crocamo C, et al. Ketamine as a rapid-acting agent for suicidal ideation: A meta-analysis. Neurosci Biobehav Rev. 2017;77:232–236. doi: 10.1016/j.neubiorev.2017.03.010
  76. Radvansky BM, Shah K, Parikh A, et al. Role of ketamine in acute postoperative pain management: a narrative review. Biomed Res Int. 2015;2015:749837. doi: 10.1155/2015/749837
  77. Brinck EC, Tiippana E, Heesen M, et al. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018;12:CD012033. doi: 10.1002/14651858.CD012033.pub4
  78. Moon TS, Smith KM. Ketamine Use in the Surgical Patient: a Literature Review. Curr Pain Headache Rep. 2021;25(3):17. doi: 10.1007/s11916-020-00930-3
  79. Zhu M, Li Y, Wan Z, et al. Effects of small-dose lidocaine combined with ketamine on early postoperative cognitive function in elderly patients undergoing gastrointestinal tumor surgery. Nan Fang Yi Ke Da Xue Xue Bao. 2015;35(7):1076–1078, 1071 p following 1078.
  80. Natoli S. The multiple faces of ketamine in anaesthesia and analgesia. Drugs Context. 2021;10. doi: 10.7573/dic.2020-12-8
  81. Karlow N, Schlaepfer CH, Stoll CRT, et al. A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department. Acad Emerg Med. 2018;25(10):1086–1097. doi: 10.1111/acem.13502
  82. Fabritius ML, Geisler A, Petersen PL, et al. Gabapentin for post-operative pain management - a systematic review with meta-analyses and trial sequential analyses. Acta Anaesthesiol Scand. 2016;60(9):1188–1208. doi: 10.1111/aas.12766
  83. Rajput K, Shergill S, Chow RM, et al. Enhanced Recovery After Surgery: Opioid Sparing Strategies After Discharge: A Review. Curr Pain Headache Rep. 2022;26(2):93–102. doi: 10.1007/s11916-022-01009-x
  84. Park CY, Park SH, Lim DG, Choi EK. Effect of preoperative pregabalin on postoperative pain after gastrectomy. Yeungnam Univ J Med. 2018;35(1):40–44. doi: 10.12701/yujm.2018.35.1.40
  85. Hu J, Huang D, Li M, et al. Effects of a single dose of preoperative pregabalin and gabapentin for acute postoperative pain: a network meta-analysis of randomized controlled trials. J Pain Res. 2018;11:2633–2643. doi: 10.2147/JPR.S170810
  86. Grant MC, Lee H, Page AJ, et al. The Effect of Preoperative Gabapentin on Postoperative Nausea and Vomiting: A Meta-Analysis. Anesth Analg. 2016;122(4):976–985. doi: 10.1213/ANE.0000000000001120
  87. Wanhainen A, Verzini F, Van Herzeele I, et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8–93. doi: 10.1016/j.ejvs.2018.09.020
  88. NICE Guideline Updates Team (UK). Anaesthesia and analgesia for people having surgical repair of an abdominal aortic aneurysm: Abdominal aortic aneurysm: diagnosis and management: Evidence review. London: National Institute for Health and Care Excellence (UK); 2020.
  89. National Guidelines for the management of patients with abdominal aortic aneurysms. Moscow; 2013.

Supplementary files

There are no supplementary files to display.

Copyright (c) 2022 Eco-Vector

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ ФС 77 - 55827 от 30.10.2013 г
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ЭЛ № ФС 77 - 80651 от 15.03.2021 г

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies