Vol 11, No 3 (2017)

Articles

LABOUR PAIN RELIEF. THE MODERN APPROACH

Neimark M.I., Ivanova O.S.

Abstract

Women have an intense pain in the labor. Amount of pain varies greatly and it depends on the emotional, mental, physical status of women and environmental factors. The pain is caused by various physiological factors and triggers a cascade of biochemical reactions in the woman’s body. Intense pain brings suffering to women and can do damage to the fetus. Effective and safe anesthesia delivery is extremely important task for modern medicine. The article describes the essence of the most popular methods of pain relief during labor, discussed their positive and negative properties. Search literature for the review of various special medical and general Internet search engines. There are medication and non-medication methods of pain relief in labor. Non-medication method is non-invasive and healthier for a maternity patient and a child but their effectiveness is disputable. Medication methods of pain relief are presented injection of opioid analgesics and non-opioid analgesics, inhalation and neuroaxial anesthesia methods. Every method has advantages and disadvantages. Opioid analgesics reduce the pain for a few hours however cause a large number of undesirable effects such as nauseaand sleepiness of maternity patient, respiratory distress and depression of consciousness of newborn. Study of non-opioid analgesics showed a high analgesic activity but it was not study enough to use for pain relief in labor. Today the most common method is neuroaxial analgesia. It relieves the pain effectively and has no effect on the fetus but it has some disadvantages.The question of the influence of the neuroaxial methods of anesthesia on the duration of the labor is controversial. Promising is the use of inhaled anesthetics in particular xenon. But these methods are not study enough. All currently used labor pain relief methods are not ideal as far as each method has its own characteristics and bad effects. In each particular case the method of labor pain relief must be selected individually, it’s necessary to take into consideration the psychological and physical condition of the woman and obstetric situation.
Regional Anesthesia and Acute Pain Management. 2017;11(3):150-156
pages 150-156 views

REGIONAL ANESTHESIA FOR CHILDREN WITH THE DISEASES OF LOWER LIMBS

Manokhina Y.A., Ulrikh G.E.

Abstract

The article presents an analysis of the publications devoted to the problems of anesthesia to surgical procedures at the diseases of the lower limbs in children. The article reviews the questions of anesthesia safety and the role of regional blockades in the structure of intra- and postoperative analgesia.
Regional Anesthesia and Acute Pain Management. 2017;11(3):157-163
pages 157-163 views

MANAGEMENT OF HEADACHE IN PATIENTS WITH NON-TRAUMATIC SUBARACHNOID HEMORRHAGE

Ganeeva I.R.

Abstract

This review of the literature is devoted to the current state of the problem of management of headache in patients with non-traumatic subarachnoid hemorrhage (NSAH). This pathology is associated with severe and prolonged headache. Despite the huge amount of references on subarachnoid hemorrhage, a little attention is paid to headache in this pathology, so it remains largely unexplored. The article presents data on the epidemiology of the syndrome, possible mechanisms of occurrence, diagnostic methods. Details of the advantages and disadvantages of drugs for anesthesia, available in the arsenal of the clinician at the moment. The results of many previously published studies are diametrically opposed, which does not facilitate the choice of tactics for effective treatment and prevention of complications. The article also identifies the problems, the solution of which, possibly, will lead to an improvement in the results of treatment of SAH and further the quality of life of the patients. The lack of evidance data on the subject suggests that the research is relevant.
Regional Anesthesia and Acute Pain Management. 2017;11(3):164-169
pages 164-169 views

EPIDURAL MORPHINE IN PEDIATRIC ONCOLOGIC SURGERY

Matinyan N.V., Letyagin I.A., Martynov L.A., Sotnikov A.V., Kazantsev A.P., Rybakova D.V.

Abstract

Epidural administration of opioids effectively prevents the sensitization of nociceptive neurons of the posterior horn of the spinal cord, induced by surgical trauma, without the development of motor and autonomic blockade. Study includes 52 patients aged 1 month to 18 years with malignant tumors who underwent surgical treatment at the Pediatric Oncology and Hematology Research Institute, during 2009-2016 years. Surgeries were combined (thoraco-laparotomy). The method of epidural use of morphine in pediatric oncosurgery is presented.
Regional Anesthesia and Acute Pain Management. 2017;11(3):170-181
pages 170-181 views

EPIDURAL ANALGESIA DURING VAGINAL DELIVERY AT THE WOMEN WITH THE UTERINE SCAR. IS IT RISKY? POSSIBLE? NECESSARY?

Bozhenkov K.A., Gustovarova T.A., Ivanyan A.N., Vinogradov V.L., Shifman E.M.

Abstract

This paper will be concerned with the results of a prospective controlled longitudinal study which has involved 132 secundiparae (among them 69 patients are with the uterine scar after cesarean section). The parturient women have been divided into 3 groups. Group “A” includes 38 women with the uterine scar after cesarean section, in this group epidural analgesia was administered during vaginal delivery. Group “B” includes 32 secundiparae without uterine scar, in this group epidural analgesia was administered during vaginal delivery. Group “C” - 31 women with the uterine scar, no epidural analgesia was administered during vaginal delivery. Based on a comparative assessment of the pain syndrome intensity in labor according to the visual analogue scale, the research has proved that delivery at the women with the uterine scar is accompanied by statistically more significant pain than at the women without uterine scar. The necessity of analgesia during vaginal delivery at the women with the uterine scar has been proved. The effectiveness and safety of epidural analgesia at patients with the uterine scar have been analyzed. It has been proved that epidural analgesia provides anesthesia during vaginal delivery at the women with the uterine scar, while it does not affect the total duration and course of labor, maternal and perinatal outcomes, and does not mask the clinical picture of the uterine rupture threat.
Regional Anesthesia and Acute Pain Management. 2017;11(3):182-188
pages 182-188 views

CENTRAL ACTIVITY ANALGETIC NEFOPAM AS A COMPONENT OF ANALGOSEDATION IN OPHTHALMOSURGERY

Myasnikova V.V., Bityukov U.V., Dereza S.V., Kuznetcov I.V., Poryadina O.V., Fedorenko S.S., Cherkasova I.V., Chuprin S.V.

Abstract

Prospective research was made to evaluate the efficiency of nefopam in anasthesiology manual- analgosedation with preserved consciousness- during anticataractal and antiglaucoma operations. The research involved 2 groups of patients: with nefopam analgesia and tramadol analgesia. Data of research includes evaluation of the dynamics of hemodynamic information and oxygenation, rate of intraoperation critical incidents (oculocardiac syndrome, other arrhythmias, hypertension and hypotension). By verbal pain assessment scale we have compared the level of intraoperation analgesia. We get the following results: combination of nefopam and droperidol provides analgosedation which is more hemodynamic stable and has significantly lower intraoperation critical incidents then analgosedation of tramadol. Nefopam has undesirable side effects like temperate increase in heart rate and pain during injection along the vein in combination with ketorolac. Sufficient dose for analgesia at old-aged patients in ophthalmosurgical practice is 10 mg of nefopam.
Regional Anesthesia and Acute Pain Management. 2017;11(3):189-194
pages 189-194 views

DOES ANEMIA AFFECT PERIOPERATIVE PAIN INTENSITY IN AGED PATIENTS WITH DIABETIC FOOT SYNDROME?

Sheina M.A., Sokologorskiy S.V., Zvyagin A.A., Orudzheva S.A.

Abstract

Background: As diabetes takes on pandemic proportions more than 500000 aged (over 50 years) patients undergo pedis amputation yearly. Anemia is very often accompanied diabetes mostly in aged patients. Anemia may influence somehow the pain severity in postoperative period. Objective: To investigate the possible anemia influence on severity of post surgery pain in aged diabetes patients with anemia. Design: A retrospective medical documentation analysis. Setting: Federal scientific centre. Patients: 58 diabetes patients aged from 50 to 75 with and without anemia after elective pedis surgery. Intervention. Patients were allocated to one of four groups: - 16 patients with anemia who received naropin combined with lidocaine for peripheral nerve blockades (I group), 14 patients with anemia who received only naropin (II group), 11 patients without anemia who received naropin combined with lidocaine (III group) and 17 11 patients without anemia who received only naropin. Main outcome measures: Levels of mean arterial pressure, oxygen delivery index, glycaemia and VAS scores were evaluated on four time points: 24 hours before surgery, in operating room, 12 and 24 hours after surgery respectively. Results. VAS scores and levels of mean pressure was higher in anemia groups postoperativly - 3,3±1,50 vs 0,6±0,82 and 101,7±7,81 mm Hg vs 87,9±12,08 mm Hg respectively. Glycaemia levels had no statistically significant differences neither in time points nor in groups. Oxygen delivery index levels also had no differences in time points but levels were significantly different between groups. Conclusion: Taking in account the results of the analysis it is obvious that anemia contributes to the severity of pain in postoperative period in aged diabetes patients somehow. More clinical investigations must be done to evaluate exact portion of anemia contribution.
Regional Anesthesia and Acute Pain Management. 2017;11(3):195-201
pages 195-201 views

BLOCKADE OF THE PTERYGOPALATINE GANGLION AS A COMPONENT OF COMBINED ANESTHESIA DURING SURGERY FOR CONGENITAL CATARACT

Oleshchenko I.G., Yuryeva T.N., Zabolotskii D.V., Gorbachev V.I.

Abstract

The purpose of combined anesthesia in surgical treatment for congenital cataracts in children is, in addition to providing adequate analgesia of the intra- and postoperative period, to decrease adverse reactions and functional-anatomical changes in eye structure. Objective: The goal of the study is to assess the effectiveness of blockade of the pterygopalatine fossa as a component of combined anesthesia in surgical treatment for congenital cataracts in children. Material and Methods: The study included 52 children operated for congenital cataracts. The patients were divided into 2 groups. In the first group (n=26) anesthesia was carried out on the base of sevoflurane in combination with a pterygopalatine blockade as a regional component, the distinctive feature of the second group (n=28) was the implementation of retrobulbar blockade. The effectiveness of the methods was evaluated by a comparative analysis of hemodynamic parameters, the index of the tension of the vegetative system, the level of cortisol in the blood plasma, the assessment of the intensity of pain on the verbal rating scale, as well as the surgeon’s definition of the degree of comfort of the operative intervention. Results and conclusion: The data received show that the use of blockade of the vascular nodule as a component of combined anesthesia in the surgery for congenital cataracts in children allows to provide adequate anesthesia, to reduce the sympathetic activity during the operation, to create prolonged anesthesia in the postoperative period and create favorable conditions for the surgeon’s work.
Regional Anesthesia and Acute Pain Management. 2017;11(3):202-207
pages 202-207 views

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