Vol 11, No 1 (2017)

Koryachkin V.A.
Regional Anesthesia and Acute Pain Management. 2017;11(1):3-4
The polymorphism of cathechol-O-methyltransferase gene and pain
Spasova A.P., Barysheva O.Y., Tikhova G.P.
The catechol-O-methyltrasferase (COMT) enzyme is involved in metabolism of dopamine, noradrenalin, adrenalin regulating such important physiologic functions as attitude, cognition and response to stress or pain. The gene encoding the COMP has functional polymorphisms that contribute to individual differences of human pain phenotype such as pain threshold, pain sensitivity, chronization of pain and response to analgesics. The review summarizes the results of genetic studies of COMT gene functional polymorphisms and their effect on pain phenomenon. The knowledge about mechanisms of gene COMT polymorphism effects allows to personalize treatment of pain of different genesis.
Regional Anesthesia and Acute Pain Management. 2017;11(1):6-12
Regional anesthesia for removal of chiasmosellar area tumors by endoscopic endonasal transsphenoidal approach
Kurnosov A.B., Shmigelskiy A.V., Lubnin A.Y., Kalinin P.L., Kutin M.A., Fomichev D.V., Sharipov O.I.
Rationale. Currently is being actively developed a method for removal of chiasmosellar area tumors by endoscopic endonasal transsphenoidal resection, which is considered to be less traumatic and is well tolerated by patients, resulting in an expanded possibility to operate the elder patients, and patients with clinically localized somatic pathology. Objective. Considering the aforesaid, the issue of choosing the adequate anesthetic method and the problem of reducing the perioperative pharmacological load on the patient are brought to the forefront. Materials and Methods. In order to improve the anesthetic management results 200 patients divided into two subgroups have undergone certain examinations. These two subgroups included: a subgroup of 125 patients with general anesthesia and a subgroup of 75 patients with general anesthesia together with the regional one. By use of the undertaken study, we were able to improve successfully the technique of anesthesia for this type of operations through a combination of general and regional anesthesia (bilateral anesthesia of a pterygopalatine fossa). Results and Discussion. A significant decrease in pharmacological load on a patient and stress reaction has been obtained on the background of more stable intraoperative hemodynamics. In addition, a problem of postsurgical pain syndrome control has been considered. For this purpose two subgroups of 20 patients have been allocated: subgroup where patients only received general anesthesia, and the subgroup where the patients received general anesthesia together with regional one, for the purpose of analizing the severity of postsurgical pain on a visual analog pain scale during the day as well as the consumption of analgesics on the patient’s request. For this purpose patients have been divided into two subgroups of 20 people each (subgroup where only general anesthesia was performed, and the subgroup where general anesthesia combined with regional anesthesia was performed), where the severity of postsurgical pain syndrome on a visual analog pain scale during the day has been analyzed, as well as the consumption of analgesics on a patient’s request. Conclusion. As a result, the subgroup of patients received the concomitant anesthesia has shown the best results: there was a significant decrease in pain syndrome intensity on a background of lower consumption of Lornoxicam.
Regional Anesthesia and Acute Pain Management. 2017;11(1):13-21
Salivary alpha-amylase as an indicator of stress in pregnant women
Degtyarev E.N., Shifman E.M., Tikhova G.P.
Acute or chronic stress during pregnancy and before spinal anesthesia (SA) for cesarean section (SC) causes poor birth outcomes. So it seems important to find objective and non-invasive measure of stress intensity in order to predict and prevent adverse events during labor. The goal of the study was to develop non-invasive and accessible method for objective estimating of stress presence and intensity. Material and Methods. Prospective observational study was conduced in order to estimate significance and magnitude of changing of salivary a-amylase level (AAC) in pregnant woman before and after SC performed under SA and to study its relationship with stress intensity. The study included 30 women, 20-41 years old, full-term pregnancy, undergoing CS under SA. Saliva sampling was followed by registering of patient's estimate of current stress intensity, from 0 (no stress) to 3 (intensive stress). AAC (ME/l) was defined using automatic biochemical analyzer Labio 200 (Mindray). The saliva sampling and stress intensity estimating was performed 3 times: at baseline (in the ward after admission), on the operating table immediately before performing of SA and during 1st hour after delivery. Data analysis included descriptive statistics, ANOVA and c2 -criteria. Results. The AAC mean values differ significantly among 3 sampling points. The AAC mean after CS was lower than before labour but didn't equal baseline level. The highest mean of patient's estimate of current stress intensity was revealed before CS. The higher AAC value corresponds to the higher grade of patient's stress intensity estimate. The results of our study supposed non-linear relationship between AAC and VAS estimation of postoperative pain. Conclusion. The AAC has relationship with stress intensity and postoperative VAS estimate in pregnant women undergoing CS under SA. This biomarker is simple objective and non-invasive measure of the patient’s stress intensity before delivery and postpartum. Further clinical studies are required to enhance proposed method of objective and non-invasive estimation of stress intensity in before labor and postpartum.
Regional Anesthesia and Acute Pain Management. 2017;11(1):22-28
Evaluation of superficial cervical plexus block combined with total intravenous anesthesia for reconstructive operations on carotid arteries
Osipenko D.V., Marochkov A.V.
Objective. The main purpose of the prospective, randomized study was to evaluate the efficiency of the superficial cervical plexus block combined with total intravenous anesthesia by propofol and fentanyl during surgical procedures on carotid arteries. Material and methods. 86 patients were divided in 2 groups depending on the method of anesthesia. There was held a comparative analysis of clinical, instrumental, laboratory parameters, the intensity of pain and the number of perioperative complications. Results and conclusion. It turned out that this option allows you to reduce the dose of anesthetic propofol and fentanyl, to decrease the duration of mechanical ventilation, as well as to provide better antinociceptive protection of patients during surgical procedures on carotid arteries.
Regional Anesthesia and Acute Pain Management. 2017;11(1):29-35
The blockade of the sciatic nerve of a pharmaceutical composition of lidocaine and ropivacaine (2:1) with a short block of peripheral nerve and prolonged postoperative analgesia
Piacherski V.G., Marochkov A.V.
The goal of this study is to optimize the intra- and postoperative analgesia by a pharmaceutical composition of ropivacaine and lidocaine in a ratio of 2:1, which has shorter time of sciatic nerve blockade and prolonged analgesic effect. Materials and methods. Achieved 40 blockades of the sciatic nerve under ultrasound guidance with the use of electrical stimulation of peripheral nerves. In the study, patients with the upcoming surgery in the knee joint were included, shin, ankle and foot. In the first group of the sciatic nerve blockade was performed with 5 ml 0.75% naropina combined with 5 ml 1% lidocaine; in the second group used a combination of 1% lidocaine and 0.75% ropivacaine (2:1) in a volume of 10 ml. In addition, the femoral nerve blockade was performed. Evaluation time of sensory, motor blocks and duration of analgesia were performed since the beginning of the administration of local anesthetic solution into the fascial sheath of the sciatic nerve. Results. In all cases the pain relief was effective. Time of onset of complete sensory block in the 1st and 2nd groups was 13 (12.5; 14) and 14 minutes (13; 15.5) min (p> 0.05), respectively. Time of onset of complete motor block was 14 (12; 17.5) minutes; Group 2 - 16 (14; 17.5) min (p> 0.05). The duration of postoperative analgesia in group 1 was 8 (7, 8), in group 2 - 7.5 (6.75; 8) hours (p> 0.05). Conclusion. Use of a pharmaceutical composition of ropivacaine and lidocaine in a ratio of 2:1 in a volume of 10 ml for sciatic nerve blockade causes complete nerve blockade by 16 (14; 17.5) minutes without sacrificing analgesia.
Regional Anesthesia and Acute Pain Management. 2017;11(1):36-40
The effectiveness of prewarming for patients under spinal anaesthesia in oncogynecological surgery
Pasheev A.V., Sayetgaraev A.K., Muftahutdinova G.S.
Inadvertent perioperative hypothermia (IPH) occurs in many patients, undergoing oncogynecological operations, due to the influence of the spinal anesthesia and sedation. The conventional intraoperative using of forced-air warming is insufficient to counteract thermal redistribution resulting from the peripheral vasodilatation, associated with spinal anesthesia. The objective of the study was to test the efficiency of the preoperative forced-air warming device (Bair Hugger) in combination with intravenous injection of tramadol in preventing IPH. Material and Methods. Eighty adult patients undergoing oncogynecological surgery under spinal anesthesia (SA) were randomized to receive either normal care or prewarming for 30 min, at 43°C, using the Bair Hugger, in combination with the injection of tramadol preoperatively. Results. Forty patients were prewarmed and received tramadol (0,5 mg/kg) and 40 patients were in the control group. There was smaller decrease in mean core temperature in the prewarmed group at 15, 30, 75, 90 min post-induction (p < 0,05). By the end of the operation all patients from the control group remained hypothermic, whereas only 28 patients (70%) remained hypothermic in prewarmed group (P < 0,05). 26 (65%) patients from the control group and 10 (25%) patients in prewarmed group suffered from muscle shivering (P < 0,05). There were no significant differences in vomiting and nausea between the groups. Conclusions. Preoperative warming using the Bair Hugger, combined with preoperative injection of tramadol results in smaller decreases in core temperature intraoperatively and less IPH in patients undergoing oncogynecological surgery under SA.
Regional Anesthesia and Acute Pain Management. 2017;11(1):41-45
Errors occurring while performing neuroaxial blockades. The analysis of clinical cases
Krasnov V.G.
The paper presents three clinical cases demonstrated causal relationships between errors of clinic staff actions, concealment of the errors and consequences for patients and clinic.
Regional Anesthesia and Acute Pain Management. 2017;11(1):46-48

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