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Vol 17, No 4 (2023)

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Reviews

Perioperative neuropathic and positional problems: literature review

Svirskii D.A., Paromov K.V., Sokolova M.M., Kuzkov V.V., Kirov M.Y.

Abstract

At present, an increasing number of specialists prefer the fast-track surgery concept. One of the significant perioperative complications that can affect the rate and quality of postoperative rehabilitation is the development of neuropathy, which can be the result of improper patient positioning on the operating table, and direct intraoperative damage to the nerve / trunk / plexus. Physical (mechanical compression, stretching, and partial / complete intersection of the nerve with a needle, scalpel, or electrode) and chemical (toxicity of local anesthetics and chemically active liquid effects) mechanisms for neuropathy formation can be described. To prevent the development of a neurological deficit, both the anesthesiologist and surgeon must take all the necessary measures to prevent neuropathies and begin appropriate treatment as soon as possible in the case of its occurrence. This article discusses the anatomy, physiology, and pathophysiology of the peripheral nerve, mechanisms of compression-ischemic neuropathy formation, and perioperative positional problems. Existing recommendations for the treatment of peripheral neuropathic were assessed and proposed for use not only with conservative therapy methods but also with interventional methods for the treatment of established perioperative neurological complications. A summary table of the possible clinical manifestations of postoperative neuropathic is presented.

Regional Anesthesia and Acute Pain Management. 2023;17(4):217-230
pages 217-230 views

Epidural use of glucocorticosteroids for treating radicular pain: narrative review

Fedorov D.A., Khinovker V.V., Koriachkin V.A., Khinovker E.V., Kukharev A.V.

Abstract

This review aimed to examine the history of the epidural use of glucocorticosteroids (GCS), perception of the safety of epidural administration of GCS, and examples of clinical use for the treatment of radiculopathies and radicular pain. The search for publications covered the period from February 2, 2023, to September 1, 2023, in PubMed, Medline, Cochrane Library, and the International Association for the Study of Pain. The search identified 306 studies, of which 243 were excluded because they described the pathophysiology and treatment of chronic pain syndromes other than neuropathic pain and epidural use of GCS. The remaining 63 publications were included in the review. The results of the analysis of the materials and publications revealed that the epidural use of GCS showed high effectiveness both as an independent method of treating radicular pain with neuropathy and as part of complex therapy. In some cases, the epidural use of GCS does not exclude neurosurgical intervention.

Regional Anesthesia and Acute Pain Management. 2023;17(4):231-241
pages 231-241 views

Original study articles

Comparison of the analgesic effect of oral morphine with that of intravenous morphine in pediatric patients: multicenter open-label randomized blinded prospective clinical study

Belousova E.I., Matinyan N.V., Tsintsadze A.A., Kovaleva E.A., Valiev T.T., Gildeeva G.N., Baklykova O.V.

Abstract

BACKGROUND: Certain children with recurrent episodes of acute nociceptive pain experience chronic pain. In accordance with the recommendations of the World Health Organization, short-acting morphine is the main drug used to relieve severe pain and breakthrough pain. In published studies, morphine provided adequate analgesia in the majority (>90%) of the patients; however, no such studies have compared the use of morphine tablets with a control group of pediatric patients.

OBJECTIVE: To evaluate the effectiveness and safety of morphine tablets at a dose of 5 mg and compare them with those of morphine given intravenously at a dose of 10 mg/mL in children with severe pain syndrome in the postoperative period.

MATERIALS AND METHODS: A multicenter open randomized blind prospective clinical study was conducted in parallel groups of 100 patients aged 3–18 years with severe pain syndrome in the postoperative period between September 21, 2020, and December 15, 2022. Cumulative morphine consumption, visual analog scale analgesic efficacy, patient satisfaction scores, and adverse events (AEs) / serious adverse events (SAEs) were assessed.

RESULTS: The comparative analysis of the average values of the total number of doses of an additional analgesic drug administered during treatment with the study drug (group 1)/comparison drug (group 2) in patients of different age groups (cohorts 1, 2, 3) did not reveal significant differences (p=0.05). This finding indicated the equal effectiveness of the used forms of drugs in both groups. Moreover, no significant differences were noted in the development of AEs associated with the study drug (group 1) compared with AEs of the reference drug (group 2) in patients of different age groups (cohorts 1, 2, 3); (p=0.05).

CONCLUSION: The study demonstrated the effectiveness and safety of the study drug in tablets in comparison with an injection drug in children with severe pain syndrome.

Regional Anesthesia and Acute Pain Management. 2023;17(4):243-254
pages 243-254 views

Intravenous infusion of lidocaine as a component of opioid-free anesthesia in thoracic surgery: prospective randomized single-center observational study

Zimina L.A., Zhikharev V.A., Bushuev A.S., Koriachkin V.A., Malyshev Y.P.

Abstract

BACKGROUND: The possibility of reducing doses of narcotic analgesics during the perioperative period is widely discussed in modern scientific literature. This direction is called opioid-free anesthesia and is used in abdominal surgery, oncology, gynecology, and other areas. Publications on the use of opioid-free anesthesia in thoracic surgery are scarce.

OBJECTIVE: To evaluate the analgesic effectiveness of intravenous lidocaine infusion as a component of anesthesia in thoracic surgery.

MATERIALS AND METHODS: Ninety patients who underwent open lobectomy or pneumonectomy were examined. Depending on the analgesic component, patients were divided into three groups: group 1 (n=30) received intravenous infusion of lidocaine, group 2 (n=30) received epidural block, and group 3 (n=30) had fentanyl infusion. Blood pressure, heart rate, cortisol, and blood serum glycemia levels were measured. The intensity of postoperative pain syndrome and the need for promedol, tramadol, and sanitation fibrobronchoscopy were assessed. Arterial hypotension and frequency of postoperative nausea and vomiting were recorded. The length of stay of the patients in the intensive care unit and hospital was recorded.

RESULTS: Cortisol levels did not differ between groups (p=0.26). The glucose level in the epidural block group was significantly lower than that in other groups (p=0.011). A significant increase in mean blood pressure and heart rate was observed in the opioid analgesia group (p <0.001). The lowest severity of pain 6 h after surgery was observed in the epidural blockade and lidocaine groups (p <0.001). Perioperative hypotension was more common in the epidural analgesia group (p=0.045). The incidence of postoperative nausea and vomiting was higher in the opioid anesthesia group (p=0.004). In the fentanyl infusion group, sanitary fibrobronchoscopy was more often required to eliminate atelectasis (p=0.039). The number of bed days spent in the ICU was significantly higher in the opioid analgesic group (p=0.002); however, no significant differences were noted between the groups regarding the number of days spent in the hospital (p=0.228).

CONCLUSION: Opioid-free anesthesia based on intravenous lidocaine infusion, as a component of anesthetic management in thoracic surgery, provides sufficient perioperative stability of hemodynamic and neuroendocrine status, has a pronounced analgesic effect, with less opioid consumption on the first day after surgery, and helps reduce the length of stay in the intensive care unit and hospital.

Regional Anesthesia and Acute Pain Management. 2023;17(4):255-266
pages 255-266 views

Postoperative pain relief quality after cesarean section using a stress monitor (Neon FSC system): prospective single-center randomized clinical comparative study

Upryamova E.Y., Shifman E.M., Degtyarev P.A., Snezhko V.D., Maksimkina T.A.

Abstract

BACKGROUND: The objective assessment of pain levels during labor, postpartum period, and effectiveness of analgesic response remains difficult. We suppose that the dynamics of the activity of the sympathetic nervous system by measuring the galvanic skin response may become a promising method for solving this problem.

OBJECTIVE: To evaluate the effectiveness of various multimodal analgesia regimens after cesarean section using the NeonFSC stress monitoring system.

MATERIALS AND METHODS: A prospective single-center clinical comparative study was conducted to evaluate the effectiveness of various postoperative multimodal analgesia regimens in 48 postpartum women who underwent elective cesarean section under spinal anesthesia. For postoperative analgesia, group 1 (n=24) underwent a TAP block, and ketorolac and tramadol were prescribed, and group 2 (n=24) received only ketorolac and tramadol. Randomization was made using the envelope method. The visual analog scale (VAS) and NeonFSC system were used to assess the effectiveness of postoperative pain relief. The observation time was 19–22 h.

RESULTS: The patients were comparable in age, gestational age, physical status, method of pain management and delivery. At baseline and during the 2-h postoperative period, the median and distribution of visual analogue scale pain scores did not show a statistically significant difference between groups. During the study period, the highest level of spectral power of skin conductance (SC) was recorded in group 2. Baseline skin conductance variability (SCV) values were comparable between groups (p >0.001). Lower SCV values were noted in patients of group 1, compared to group 2, at night (p=0.003 vs p <0.001). The median values of the level of total spectral power of skin conductivity (DASS) in patients of group 1 were 1.5–2 times lower, starting from the second hour until the end of observation.

CONCLUSION: The NeonFSC system can be a component of an objective assessment of the effectiveness of analgesia after cesarean section.

Regional Anesthesia and Acute Pain Management. 2023;17(4):267-277
pages 267-277 views

Case reports

СVII level сervical ESP-block at the surgical treatment of a neck tumor: clinical case

Krasnov K.S., Zabolotskii D.V., Safin R.R., Koriachkin V.A.

Abstract

BACKGROUND: Еrector spinae plane (ESP) block at the level of СVII under ultrasound navigation control can be technically feasible and successfully used in surgical interventions in the topographic area above the level of the seventh cervical vertebra, which is the upper anatomic boundary for the m. erector spinae. At the same time, the available information on the clinical use of posterior cervical plane blockades, which also includes the ESP block, during surgical interventions in the cervical dorsal region is rather scarce.

CLINICAL CASE DESCRIPTION: We present a clinical case of removal of a large benign tumor localized on the posterior surface of the neck in a patient who had a serious concomitant endocrine and cardiovascular pathology, using bilateral ESP-blockade, which was performed at the level of СVII under the control of ultrasound navigation in combination with local infiltration anesthesia directly in the area of the skin incision. The peculiarities of this case include the absence of ESP-block potentiation with general anesthetics, preservation of the patient’s consciousness during the surgical intervention, stable hemodynamics and good indices of gas metabolism in combination with the absence of any pain sensations, as well as satisfactory condition of the patient and his early activation in the postoperative period.

CONCLUSION: The presented clinical case demonstrates the possibility of using ESP-block at the level of CVII in volumetric surgical intervention on the dorsal surface of the neck as the method of choice.

Regional Anesthesia and Acute Pain Management. 2023;17(4):279-286
pages 279-286 views

Cryoanalgesia of the ankle joint: clinical cases in the practice of a doctor of interventional pain treatment

Ushakov A.A., Antipin E.E., Andriychuk I.V., Konovalova S.G.

Abstract

BACKGROUND: Currently, with the advent of the cryoablation device, much attention is paid to cryoanalgesia of large joints, however, the pathology of smaller structures can also bring discomfort and reduce the patient’s quality of life. The article presents 3 cases of successful treatment of ankle arthrosis at the Multi-Specialty Center for Pain Treatment and Rehabilitation «Anesta» (Arkhangelsk), presenting the author’s method of joint denervation and its detailed description.

CLINICAL CASES DESCRIPTION: Three patients were presented. The first with arthrosis of the knee and ankle joint, the second patient — after an accident with purulent-septic complications and violation of the anatomical integrity of the ankle joint, the third — with extensive concomitant pathology and severe arthrosis. All patients were satisfied with the procedure and its impact on the quality of life in the postoperative period. An anatomical rationale and a detailed description of the relevance of the ankle joint cryoanalgesia method are provided. Cryoanalgesia of the ankle joint was tested on cadaver by introducing liquid silicone into the places where the cryoprobe was installed, which confirmed the interest of the sensory branches going to the joint capsule. Due to the fact that the method is proprietary, and the use of cryoanalgesia is limited on the territory of the Russian Federation, there is very little literature data regarding the procedure for performing cryoanalgesia of the ankle joint, however, as experience is gained, we assume that this procedure will become a good alternative to surgery for arthrosis ankle joint.

CONCLUSION: The presence of pain has an extremely negative impact on the general condition of patients. The presented author’s technique can significantly improve the quality of life of many patients, minimizing pain in both large and small joints.

Regional Anesthesia and Acute Pain Management. 2023;17(4):287-294
pages 287-294 views


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