Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain ManagementРегионарная анестезия и лечение острой боли1993-65082687-1394Eco-Vector10796310.17816/RA107963Original study articlesОригинальные исследованияResearch ArticleEpidural blockade during liver transplantationЭпидуральная блокада при трансплантации печениhttps://orcid.org/0000-0001-5147-56377406-7687ZhikharevVasiliy A.ЖихаревВасилий Александрович
Russian Federation

MD, Dr. Sci. (Med.)

д.м.н.

Vasilii290873@mail.ruhttps://orcid.org/0000-0002-1427-40323640-7080BushuevAlexander S.БушуевАлександр Сергеевич
Russian Federation
Vasilii290873@mail.ruhttps://orcid.org/0000-0002-3558-4283KhasanovMovsar U.ХасановМовсар Умарович
Russian Federation
Vasilii290873@mail.ruhttps://orcid.org/0000-0002-3400-89896101-0578KoriachkinVictor A.КорячкинВиктор Анатольевич
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

vakoryachkin@mail.ruhttps://orcid.org/0000-0003-0572-13952446-5933PorkhanovVladimir A.ПорхановВладимир Алексеевич
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

Vasilii290873@mail.ruScientific Research Institution, Ochapovsky Regional Clinic Hospital N1Научно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С. В. ОчаповскогоSt. Petersburg State Pediatric Medical UniversityСанкт-Петербургский государственный педиатрический медицинский университетKuban state medical universityКубанский государственный медицинский университет150920211542452561605202201062022Copyright ©; 2021, Eco-VectorCopyright ©; 2021, ООО "Эко-Вектор"2021Eco-VectorООО "Эко-Вектор"https://rjraap.com/1993-6508/article/view/107963

AIM: This study aimed to evaluate the efficacy and safety of epidural analgesia as a component of pain relief on orthotopic liver transplantation.

MATERIALS AND METHODS: Forty-five patients who underwent orthotopic liver transplantation were examined. Epidural and opioid analgesics were used as a component of pain relief in groups 1 (n=24) and 2 (n=21), respectively. The following parameters were evaluated: intensity of postoperative pain, time of patient activation, incidence of postoperative nausea and vomiting, time of onset of enteral nutrition, restoration of bowel function, incidence of postoperative acute respiratory failure, need for opioid analgesics, and length of stay in the intensive care unit (ICU).

RESULTS: Pain intensity and total postoperative need for tramadol and promedol were significantly lower in group 1 than in group 2. During the postoperative period, group 1 showed a decrease in postoperative nausea and vomiting, incidence of postoperative respiratory failure, and time spent in the ICU. No complications with the insertion and removal of the epidural catheter were observed.

CONCLUSION: The use of epidural blockade for liver transplantation significantly reduces the severity of pain syndrome, accelerates the recovery of bowel function, and shortens the length of ICU stay. The use of EA reduces the risk of PONV during the use of opioid analgesics and causes an early start of enteral nutrition. Therefore, epidural analgesics can be used as a component of pain relief in patients undergoing orthotopic liver transplantation.

Цель. Оценить эффективность и безопасность эпидуральной анальгезии как компонента обезболивания при ортотопической трансплантации печени.

Материалы и методы. Обследовано 45 пациентов, которым была выполнена ортотопическая трансплантация печени. В 1-й группе (n=24) как компонент обезболивания использовалась эпидуральная анальгезия (ЭА), во 2-й группе (n=21) – опиоидные анальгетики. Проводилась оценка интенсивности послеоперационной боли, времени активизации пациента, частоты развития послеоперационной тошноты и рвоты, времени начала энтерального питания, восстановления функции кишечника, частоты развития послеоперационной острой дыхательной недостаточности, потребности в назначении опиоидных анальгетиков, продолжительности пребывания пациентов в отделении интенсивной терапии.

Результаты. Интенсивность боли, а также общая послеоперационная потребность в трамадоле и промедоле была значительно ниже в 1-й группе. В послеоперационном периоде у пациентов 1-й группы отмечался более низкий уровень послеоперационной тошноты и рвоты, частоты развития послеоперационной дыхательной недостаточности и времени пребывания в отделении интенсивной терапии. Не было зафиксировано осложнений при установке и удалении эпидурального катетера.

Заключение. Применение эпидуральной блокады при трансплантации печени значимо снижает степень выраженности болевого синдрома, ускоряет восстановление работы кишечника и снижает сроки нахождения пациента в ОИТ. Применение ЭА уменьшает риски возникновения ПОТР вследствие использования опиоидных анальгетиков и обусловливает раннее начало энтерального питания. ЭА может быть использована как компонент обезболивания у пациентов при проведении ортотопической трансплантации печени.

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