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Vol 12, No 4 (2018)

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Editorial

To the authors and readers of the journal

Ovechkin A.M.

Abstract

Here is the 4th issue of our magazine for 2018, a late issue and, alas, the last one. The journal Regionar Anesthesia and Acute Pain Management ceases to exist. Years of life 2007–2018.

Regional Anesthesia and Acute Pain Management. 2018;12(4):210
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Original articles

Comparative evaluation of the use of a single and extended blockade of shoulder splitting at arthroscopic operations on the shoulder

Krylov S.V., Pasechnik I.N., Sotnikov A.V., Timchenko D.О.

Abstract

In the last decade, there has been a steady increase in the number of arthroscopic operations on the shoulder joint. The development and introduction of arthroscopy made it possible to improve the quality of surgical care for injuries of the shoulder joint. However, despite the minimally invasive technique, the issues of postoperative analgesia in this type of surgical interventions have not been fully developed. The article discusses the possibility of using single and prolonged conductive anesthesia in patients with arthroscopic operations on the shoulder joint.

Regional Anesthesia and Acute Pain Management. 2018;12(4):211-216
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The Possibility of blocking the femoral nerve under ultrasound control with the use of the electrical stimulator of the peripheral nerves with small doses of ropivacaine

Piacherski V.G., Marachkou A.V.

Abstract

Goal. The aim of the study is to determine the possibility of using small volumes of ropivacaine for blockade of the femoral nerve performed with the use of an electrostimulator of peripheral nerves under ultrasound.

Materials and methods. 44 blockages of the femoral nerve were performed under ultrasound control with the use of electrical stimulation of the peripheral nerves. In the first group (22 patients), a blockade of the femoral nerve was performed with 10 ml of 0.75% ropivacaine; in the second group (22 patients), 0.75% ropivacaine was used in a volume of 5 ml. Evaluation of the development time of the sensory, motor blocks and the duration of analgesia was carried out from the time the local anesthetic solution was introduced into the fascial sheath of the femoral nerve.

Results. The time of development of the complete sensory block in the 1st and 2nd groups of patients was 21 (20; 24) minutes and 30 (24; 35) minutes (p <0.05). The time of development of the full motor block in the 1st group was 22 (16; 24) minutes; in the second group, 21 (17; 30) minutes (p <0.05). There was no difference in the duration of analgesia in the postoperative period between the groups: 7.75 (7; 8) h and 8 (7.5, 8) h. respectively (p> 0.05).

Conclusion. It has been established that 5 ml of 0.75% solution of ropivacaine is sufficient for effective blockade of the femoral nerve. With a decrease in the effective amount and volume of local anesthetic, there is an increase in the time of development of complete blockade of the femoral nerve without reducing the period of postoperative analgesia.

Regional Anesthesia and Acute Pain Management. 2018;12(4):217-221
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Dexmedetomidine vs clonidine. The best medication of prevention of hemodynamic response during awakening after craniotomy

Arefiev A.M., Lubnin A.Y., Kulikov A.S.

Abstract

The paper is devoted to comparison of two drugs from the group of alpha-adrenoagonist: clonidine and dexmedetomidine, in the context of their impact on the quality of awakening in patients with neurosurgical profile. In the study of two groups of patients, the authors did not reveal a clear advantage or disadvantage of each drug, both of them were appropriate for the successful solution of the tasks.

Regional Anesthesia and Acute Pain Management. 2018;12(4):222-226
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Experience of appllication of the bilateral suprazygomatic maxillary nerve block for cleft palate repair in children

Dubinenkov V.B., Bessonov S.N., Voitsekhovsky I.S., Ganert A.N.

Abstract

The aim of the study was to determine the efficacy and safety of the bilateral suprazygomatic maxillary nerve block for cleft palate repair in children with congenital malformation, cleft palate. The study was carried out on 55 patients with primary cleft palate repair. The average age of the patients was 1 year 8 months±6 months. Patients were divided into 2 groups. In the main group, general anesthesia, local anesthesia and bilateral suprazygomatic maxillary nerve block were performed. In the control group, general anesthesia and local anesthesia were performed. The severity of the pain syndrome in children was assessed according to the FLACC scale. In addition, the dose opioid analgesics (tramadol) was taken into account on the 1st day; satisfaction with anesthesia and analgesia. Results for the main group: FLACC indicators were kept longer at a low level; less consumption of opioid analgesics. No complications were observed on the bilateral suprazygomatic maxillary nerve block. The bilateral suprazygomatic maxillary nerve block for primary cleft palate repair in children provides a better quality of anesthesia, and, especially postoperative analgesia.

Regional Anesthesia and Acute Pain Management. 2018;12(4):227-230
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Spinal analgesia increases the frequency of noradrenalin administration, but does not affect the oxygen status of patients during laparoscopic surgeries for colorectal cancer

Zemskova D.V., Potapov A.L., Derbugov V.N., Poluektova M.V., Tchirkova T.V., Vorobjova O.A., Kostyuk I.P.

Abstract

The objective. To assess the effect of spinal analgesia on the oxygen status and the level of myocardial damage markers in patients with colorectal cancer operated by laparoscopic access.

Subjects and methods. 60 patients with colorectal cancer operated under general anesthesia with laparoscopic access were divided into two groups. In group 1 (n=30) intraoperative analgesia was performed with fentanyl. In Group 2 (n=30) before the induction of general anesthesia was performed an intrathecal administration of 10.0-12.5 mg of bupivacaine and 200 mcg of morphine. In case of decreasing an MAP <65 mm Hg.V. a continue infusion of noradrenaline was began. The frequency of administration and the average dose of noradrenalin were estimated, as well as the levels of lactate, pH, BE, ScvO2, highly specific cardiac troponin I (hs-cTnI ) and NT-proBNP in the central venous blood.

Results. The frequency of noradrenalin administration in group 2 was significantly higher compared to group 1 – 56.7% versus 26.7% (HR=2.1; 95% CI 0.86-4.16; p=0.036). Noradrenalin dose, the levels of lactate, pH, BE, ScvO2, hs-cTnI and NT-proBNP levels did not differ significantly in both groups at all stages of research.

Conclusion. Spinal analgesia increases the frequency of noradrenalin administration but does not affect the oxygen status and the level of myocardial damage markers in patients with colorectal cancer operated by laparoscopic access.

Regional Anesthesia and Acute Pain Management. 2018;12(4):231-236
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The effectiveness of the prevention of the bone cement implantation syndrome during hip arthroplasty

Sokolov S.V., Zabolotsky D.V., Koriachkin V.A.

Abstract

Objective. Evaluation of the effectiveness of drug prevention of bone cement implantation syndrome in hip joint arthroplasty.

Material and methods. A retrospective analysis of 400 medical records of patients who underwent hip arthroplasty was performed. In the main group (n = 200), the prevention of bone cement implantation syndrome was carried out using popular drugs (mafusol, reamberin, antihistamines, glucocorticoids). In the control group (n = 200), these drugs were not used. Blood pressure, heart rate, blood saturation were evaluated intraoperatively. In the postoperative period, fixed complications associated with anesthesia and surgery.

Results. The volume of intraoperative blood loss, mean arterial pressure, heart rate and blood saturation in the main and control groups did not have significant differences. At the stage of cementing the bone canal, hypotension developed in 95% and 95.5% of cases, respectively. 2 patients (1.0%) of the first group developed a stress-related ulcer bleeding on the 3rd day of the postoperative period, one patient (0.5%) had an Ischemic stroke on the 5th day after the operation, in three patients (1.5%) – atrial fibrillation paroxysm during the week after surgery. Three (1.5%) patients developed a skin allergic reaction to reamberin. In the second group, there were two cases (1.0%) of Ischemic stroke within a week after surgery and one cases (0.5%) of acute myocardial infarction on the 5th day after surgical treatment.

Conclusion. There is no need for intraoperative drug prevention of bone cement implantation syndrome. Additional pharmacological load increases the risk of side effects and complications.

Regional Anesthesia and Acute Pain Management. 2018;12(4):237-241
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Comparative evaluation of regional blockades during arthroscopic shoulder surgery

Trukhin K.S., Zabolotskii D.V., Koriachkin V.A., Kuleshov O.V., Cherednichenko A.A., Kulikov A.Y., Zakharov K.I.

Abstract

Objective: To evaluate the effectiveness of interscalene brachial plexus block versus combined suprascapular and axillary nerves block for shoulder arthroscopy. Methods: In this prospective study 174 patients were operated on the shoulder joint by the arthroscopic method under combined anesthesia. In the 1st group (n=96), for the purpose of analgesia, patients got interscalene brachial plexus block; in the 2nd group (n=78), patients received suprascapular and axillary nerves block. Ultrasound visualization and neurostimulation were used in both groups. Recorded the time from the start of blockade to the start of the operation, as well as the duration of the sensory and motor blockade. The intensity of postoperative pain was assessed with a 10-point Numeric rating scale, the need for additional analgesia, the quality of night sleep, and patient comfort. Neurological complications were also recorded.

Results: There were no differences in the time from the admit patients to the operating room and before the start surgery. The analgesic effect in the early postoperative period in the 1st group was higher, but by the end of the first day there was no statistical difference between the groups in the intensity of the pain syndrome. Intake of non-narcotic and narcotic analgesics was higher in the 2nd group. Complications were noted only for the 1st group: diaphragm paresis in 6 (6.25%) patients, in 2 (2.08%) – recurrent laryngeal nerve blockade. Satisfaction with postoperative analgesia was 100% in patients of the 2nd group. The choice of regional anesthesia for arthroscopic interventions on the shoulder did not affect the length of hospitalization.

Conclusion: Selective anesthesia of the suprascapular and axillary nerves during shoulder arthroscopic surgery is an alternative of interscalene brachial plexus block; it is not associated by respiratory and neurological complications; does not violate movements in the distal upper limb, reduces psychological discomfort and anxiety of patients.

Regional Anesthesia and Acute Pain Management. 2018;12(4):242-249
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Comparison of hemodynamic parameters in patients during transcuretral resection of the urinary bubble during spinal anesthesia using levobupivakaina and popivacaine

Tsygankov K.A., Korepanov A.H., Lakhin R.E., Shchegolev A.V., Khalikov A.D., Matich A.I.

Abstract

Summary. The aim of the study was to compare hemodynamic changes when using ropivacaine and levobupivacaine in patients during spinal anesthesia. Materials and methods: The study included 48 patients who were randomized into two groups, depending on the anesthetic used: group P – ropivacaine, group L – levobupivacaine. Changes in mean arterial pressure and heart rate were evaluated. Results: patients in group L showed stable hemodynamic parameters. On the contrary, in the group P for 12 min, arterial hypotension was registered in 45.8% of the subjects, for 15 min it was detected in 37.5% of cases. At 18 min, a decrease in mean arterial pressure was observed in 41.6% of patients, while in 12.5% of cases it was necessary to connect vasopressor support for norepinephrine in a dosage of 0.07–0.15 μg/kg/min. When analyzing the heart rate of less than 60 beats/min in group L was not identified. At the same time, in group P, sinus bradycardia was registered at all stages of control of the heart rate, and in some cases atropine correction was required. Conclusions: the course of anesthesia in the group using levobupivacaine was characterized by stable mean arterial pressure and heart rate. Patients in the ropivacaine group showed a decrease in mean arterial pressure of less than 70 mm Hg. in a controlled period of time from 12.5% to 48.5% for the purpose of correction of which, use of vasopressor support was required by 12.5%. Bradycardia in this group was registered in 12.5% -54.1% of cases, while atropine was used in 12.5%.

Regional Anesthesia and Acute Pain Management. 2018;12(4):250-256
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The use of epidural morphine in patients with severe traumatic injury

Sholin I.Y., Ezugbaia B.S., Avetisyan V.A., Koriachkin V.A., Zhikharev V.A.

Abstract

Objective. Assessment of the efficacy and safety of epidural morphine in patients with severe concomitant injury.

Material and methods. 70 patients with severe combined injury (17–45 points for ISS) were divided into two groups: in group 1 (n = 37), 2 mg of morphine was administered epidurally followed by morphine infusion 0.4 mg / h, in the 2nd group (n = 33), intravenous administration of fentanyl was used at a rate of 50–100 μg / h. The level of pain syndrome was assessed by a 10-point visual analogue scale (VAS). The mean arterial pressure (MAP) and heart rate (HR) at rest and with activation were recorded, the gas composition of the blood (pH, SaO2, PaCO2) was measured, and the vital capacity (VC) was measured. The evaluation of delirium was carried out according to the RASS and CAM-ICU scales. In addition, they recorded the frequency of itching.

Results. The intensity of a pain syndrome at rest was more expressed at patients of the 2nd group (p < 0.05). Against the background of activation of 10,8% of patients of the 1st group and 36,4% of patients of the 2nd group experienced a pain syndrome intensity of 4–7 points on VAS. In patients of the 2nd group, with activation, there was an increase (p < 0.05) in the indices of MAP and HR. VC in patients of the 1st group was 45.4 ± 5.8%, in the 2nd – 41.3 ± 4.7% (p < 0.005). Patients of the 1st group had a lower level of PaCO2 (p < 0.05) compared with the 2nd group. Postoperative delirium developed in the 1st group in 16.2%, in the 2nd – in 30.3% of patients (p < 0.05). Pruritus occurred in the 1st group at 21.6% and was absent in the group with systemic administration of opioids. Opioid-induced ileus, nausea and vomiting in the 1st group were not recorded, in the 2nd group were noted in 18.2% and in 9.1% of cases (p < 0.05), respectively.

Conclusion. The use of epidural morphine in patients with severe traumatic injury effective pain relief was observed, not accompanied by of the respiratory depression and changes in blood gas composition. Epidural administration of morphine in patients undergoing massive blood loss and hemorrhagic shock was not accompanied by arterial hypotension. Effective anesthesia contributed to reducing the incidence of postoperative complications.

Regional Anesthesia and Acute Pain Management. 2018;12(4):257-264
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Case report

Epidural anesthesia for correction of heavy deformation of the spine

Leonov A.A., Koriachkin V.A.

Abstract

The description of the anesthesia in the operation in a patient with severe spinal deformity is presented. Epidural anesthesia was used as a component of anesthesia.Epidural anesthesia during spinal fusion provides stress protection, minimal pharmacological load, has a blood-saving effect, analgesic effect, and postoperative enhanced recovery after operation.

Regional Anesthesia and Acute Pain Management. 2018;12(4):265-268
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Articles

Information about the 17th Congress of the All-Russian Public Organization "Federation of Anesthesiologists and Resuscitators" (FAR) and the Congress of Anesthesiologists and Resuscitators of Russia "Topical Issues of Improving Anesthesiology and Resuscitation Care in the Russian Federation"

- -.

Abstract

From 28 to 30 September 2018 in St. Petersburg under the motto "Anesthesiology-resuscitation in the focus of perioperative medicine" was held the regular, XVII Congress of the All-Russian public organization "Federation of Anesthesiologists and Resuscitators" (FAR).

Regional Anesthesia and Acute Pain Management. 2018;12(4):269
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