Vol 10, No 1 (2016)

Articles

Chronic postoperative pain syndrome - «a pitfall» of modern surgery

Ovechkin A.M.

Abstract

The overview is devoted to the problem of chronic postoperative pain. At the moment every fifth patient undergone elective or emergency surgery suffers from chronic postoperative pain. The paper presents current data on epidemiology of chronic pain syndrome following different operations, as well as diagnostic criteria and pathophysiological mechanisms of transformation of acute postoperative pain into chronic pain syndrome. Risk factors responsible of formation of chronic postoperative pain are described in details, among which the most valuable are presence of pain before surgery, trauma of the surgery, intensity of pain in early postoperative period. The article discusses modern methods of prophylaxis of chronic postoperative pain. The most perspective drugs for preventive action include gabapentinoids and ketamine in subanesthetic doses. The main role in prophylaxis belongs to regional anesthesia and analgesia. The role of multimodal approach to perioperative analgesia is presented in the work as well.
Regional Anesthesia and Acute Pain Management. 2016;10(1):5-18
pages 5-18 views

Regional anesthesia in spine and spinal cord surgery

Ezhevskaya A.A.

Abstract

The review is concerned with the summarizing, systematization and analysis of the results of current clinical studies of the use of regional techniques of anesthesia during the spine surgery and spinal cord surgery on the intraoperative stage, as well as regional techniques of postoperative pain management. The current review represents new data concerning description of various regional techniques of anesthesia, the different choice of anesthesia and analgesia, depending on the type of surgery and used drugs. The present overview will focus on possibilities of the use of regional anesthesia at various stages of surgery, including prolonged analgesia in the postoperative period and options combinations of drugs and techniques themselves. We have suggested that there are new opportunities to improve the safety of anesthesia, reduce the number of side effects, as well as finding new solutions for collaborative use of regional anesthesia and neurophysiological monitoring, development of optimal schemes of anesthesia, which should contribute to a better understanding of the issue and expand the possibilities of using the achievements of anesthesiology in medical practice. Although regional techniques are increasingly demonstrating its advantages over general anesthesia, including spine surgery, further research is mandatory in this field of medicine to determine their influence on the surgery outcome of the treatment and the patient's recovery as a whole.
Regional Anesthesia and Acute Pain Management. 2016;10(1):19-29
pages 19-29 views

Estimating the incidence of dpinal epidural hematoma after central neuroaxial blockades: a retrospective review of 38,168 cases in cancer clinic

Garjaev R.V., Gorobets E.S., Feoktistov P.I., Karmanov I.E.

Abstract

Neuraxial blockades provide effective pain relief. There are some benefits of prolonged epidural analgesia versus systemic opioids via PCA. Unfortunately, severe hemorrhagic complications can occur after application of these blockades. Methods: poll of all anesthesiologists working in cancer clinic during 2001-2015, search of data in medical archive. Results: it was revealed 2 cases of spinal hematoma following 30,042 epidural anesthetics and 0 cases among 8,126 spinal techniques. Both of complications were associated with evidence of hemostatic abnormality, there were no neurologic symptoms; patients had a conservative treatment and good outcomes. Conclusions: the incidence of spinal epidural hematoma after prolonged epidural analgesia was 0.67 per 10,000 (95% CI 0.57-0.76per 10,000), after spinal anesthesia - 0 per 8,126.
Regional Anesthesia and Acute Pain Management. 2016;10(1):30-39
pages 30-39 views

Comparative analysis of visual analogue scale and the new scale of efficacy and safety of postoperative analgesia for orediction of pain during the early postoperative period

Zabolotskikh I.B., Durleshter V.M., Musaeva T.S., Trembach N.V., Makarenko V.A., Skraastad E., Dybvik L., Eltaeva A., Konkaev A.K., Kuklin V.N.

Abstract

Modern postoperative analgesia - is an individual selection of optimal doses of analgesics in order to obtain high efficiency of analgesia with minimal side effects. The quality and safety of postoperative pain is largely dependent on the severity of pain immediately after the operation. The aim of the study was to compare the efficacy of visual analogue scale (VAS) and the new scale of efficiency and safety (ESS) of postoperative analgesia in predicting of the severity of pain and postoperative complications. The study was conducted in 209 patients (mean age (66-77) years), in which a major surgery on the abdominal organs were routinely performed. Patients were randomized into two groups, depending on the method of evaluating of the quality of analgesia: in group 1 is controlled via ESS (n = 102), the 2nd group - by VAS (n = 105). Postoperative complications were recorded: nausea and vomiting, respiratory failure (need for noninvasive or invasive ventilation), delirium, cardiac arrhythmias, ileus. ESS and VAS demonstrated good prediction of the effectiveness of pain relief (AUROC 0,973, [0,913-0,996] and 0.976 [0,913-0,997], respectively). ESS showed a good prediction of the complicated postoperative period (AUROC = 0,924, [0,856-0,967]), as opposed to the VAS (AUROC = 0,649, [0,548-0,741]). Baseline ESS and VAS score equally effective in predicting the intensity of pain in the early postoperative period. ESS advantage, compared to VAS, is the ability to predict complicated postoperative period and postoperative complications. ESS score for more than 17 is a risk factor for postoperative complications associated with inadequate analgesia.
Regional Anesthesia and Acute Pain Management. 2016;10(1):40-46
pages 40-46 views

General anesthesia without opioids in surgery for morbid obesity. What for and how?

Epshtein S.L., Azarova T.M., Storozhev V.Y., Vdovin V.V., Sablin I.A., Romanov B.V., Martynov A.N.

Abstract

The paper presents the experience of applying the technique of general opioid-free anesthesia and postoperative analgesia in bariatric laparoscopic surgery that was developed by Belgian specialists. Thirty patients with body mass index of 48±5,3 kg/M2 were operated using this technique. All of the patients underwent laparoscopic longitudinal gastrectomy. Anesthesia was induced using propofol 230±25 mg and maintained by sevoflurane in concentration of 0,7-0,9 MAC combined with 50%-65% nitrous oxide as well as multimodal analgesic infusion (0,9% NaCl 1000,0 + lidocain 600 mg + ketamine 50 mg + dexmedetomidine 100μg + MgSO4 25%-5 g) with administration rate of 1,0-1,3 ml/кгLBM/hour, where LBM - lean body mass equaled to ideal body mass (IBM). Miorelaxation was achieved using esmeron in dose of 0,6 mg/kg IBM. Reversal of neuromuscular block was performed in 10 patients using sugammadex. The infusion of analgesic solution was continued for 8-10 hours after the operation. All the patients got up and walked within a ward 4-5 hours after the surgery. The activation accompanied with increasing of pain in the operation zone and tangible discomfort in 20 patients who required the enhance of analgesia using opioids. The proposed technique facilitates the early postoperative activation that is very important for the patients suffered from morbid obesity.
Regional Anesthesia and Acute Pain Management. 2016;10(1):47-54
pages 47-54 views

Advantages of regional anesthesia for carotid endarterectomy

Shmelyov V.V., Neimark M.I.

Abstract

At 190 patients with carotid endarterectomy the relative assessment of total intravenous anaesthesia with use propofol, penetrating blockage of a cervical plexus and inhalation sevofluran is made. Cerebral circulation parametres, markers of cerebral damage, a state of the highest mental functions were investigated. It is shown that for each kind of anaesthesia specific changes of parametres of the cerebral blood-groove, defining level neuronal damages that affects on a state of number and character of postoperative complications are characteristic.
Regional Anesthesia and Acute Pain Management. 2016;10(1):55-59
pages 55-59 views

Successful use pulsed radiofrequency spinal ganglions in patient with chronic stump pain. Case report

Genov P.G., Smirnova O.V., Timerbaev V.H.

Abstract

About 50-85% of patients suffer from stump and phantom pain after amputations. These chronic pain conditions are often debilitating and result in disability, sleep and psychosocial disorders, impairment of day-work and the substantial decline in the quality of life. In some patients pharmaceutical therapy may fail to bring satisfactory pain relief or follows severe adverse events. Operations such as rhizotomy, cordotomy and stump revision are often unsuccessful in treating post-amputation chronic pain. The solitary case reports about the using of minimally invasive technique of pulsed radiofrequency (PRF) for treatment of chronic stump and phantom pain have been published only. Our current clinical observation is about successful using of the PRF spinal ganglions in patient with chronic pharmaceutical-resistant post-amputation stump pain.
Regional Anesthesia and Acute Pain Management. 2016;10(1):60-64
pages 60-64 views

What are the best ways to develop the Federation of anesthesiologists-reanimatologists? From questionnaire to action programme

Abazova I.S., Abdulaev R.B., Akulov M.S., Aslanukova A.N., Afonchikov V.S., Bayalieva A.Z., Belkin A.A., Butrov A.V., Gel'fand B.R., Gorbachev V.I., Gorobets E.S., Grigoriev E.V., Gritsan A.I., Dashevskiy S.P., Doroginin S.V., Dunts P.V., Egin A.I., Zhenilo V.M., Zabolotskikh I.B., Zaitsev A.V., Zalesny A.S., Zilber A.P., Kaminskiy M.Y., Karelov A.E., Kirov M.Y., Kitiashvili I.Z., Koryachkin V.A., Kokhno V.N., Kudryashov K.A., Kuz'kov V.V., Kulikov A.V., Kurapeev I.S., Lavrentiev A.A., Lazarev V.V., Lebedinskiy K.M., Levshankov A.I., Leiderman I.N., Lekmanov A.U., Lubnin A.Y., Lyuboshevskiy P.A., Mazurok V.A., Makarevich A.N., Malyshev Y.P., Markov O.V., Martynov D.V., Merenkov V.G., Mironov P.I., Molchanov I.V., Nedashkovskiy E.V., Nikolaenko E.M., Nikolenko A.V., Ovechkin A.M., Ovsyannikov A.N., Ovchinnikov S.G., Oskanova M.Y., Popov A.S., Protsenko D.N., Pjataev N.A., Rechkalov V.A., Saltanov A.I., Sviridov S.V., Sitkin S.I., Slepushkin V.D., Smirnov G.A., Stadler V.V., Stepanenko S.M., Sumin S.A., Sukhotin S.K., Tolkach A.B., Fisher V.V., Tsypin L.E., Shapovalov K.G., Shevchenko V.P., Shen' N.P., Shifman E.M., Shumatov V.B., Shchegolev A.V., Yaroshetskiy A.I.

Abstract

The article is devoted to summing up the work of the Federation of anesthesiologists and reanimatologists of Russia and proposing the prospects of its development.
Regional Anesthesia and Acute Pain Management. 2016;10(1):65-74
pages 65-74 views

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