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Vol 14, No 4 (2020)

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Editorial

Eponyms in regional anesthesia

Koriachkin V.A.

Abstract

The paper discusses the use of eponymous terminology in regional anesthesia. An eponym is the name of a method or any phenomenon that is used in anesthetic practice. Eponymous terms are an integral part of medical terminologies used in various specialties, as they contribute to a deeper understanding of the doctor’s activities. The paper discussed the difficulties of professional mastering of medical eponymous vocabulary. In conclusion, eponyms are the most important means of professional communication between anesthesiologists.

Regional Anesthesia and Acute Pain Management. 2020;14(4):174-175
pages 174-175 views

Original articles

Medical and psychological support of women with stillbirth in the perinatal period: a national study

Mysovskaya Y.S., Marshalov D.V., Shifman E.M., Shindyapina N.V.

Abstract

In the Russian Federation, the stillbirth rate in 2018 was 5.51 per 1000 live and dead births, which is almost twice the figure in the United States and Europe. This study aimed to conduct a rating analysis separately for each factor that influences the selection of techniques for the management of labor and the postpartum period in women with stillbirth.

Material and methods. A questionnaire was developed, which consisted 23 questions in Russian. A total of 402 Russian-speaking medical workers took part in the survey.

Results. In this study, 49.7% of the respondents seldom encounter patients with stillbirth. Moreover, 59.5% of the respondents find it easy to create a supportive communication with these patients, 70% believed that contact between the mother and her stillborn child has a negative influence on her psychoemotional state both at the time of delivery and in the long term, and only 27.7% found that mothers wanted to spend time with the child. As the optimal method of analgesia, 57.2% of the respondents chose epidural analgesia for stillbirth delivery. Furthermore, 57.7% believed that patients with stillbirth were satisfied with the quality of medical care, and 74.1% gave a positive assessment of the quality of medical care provided to patients with stillbirth in their medical institutions. Moreover, medical professionals (89.3%) consider it necessary to develop clinical recommendations on this problem.

Conclusions. The results indicate that a unified technique of managing the peripartum period with stillbirth is still not established. Clinical guidelines on this problem are necessary.

Regional Anesthesia and Acute Pain Management. 2020;14(4):176-184
pages 176-184 views

Influence of anesthesia methods on the immune system of patients with oncological diseases of the abdominal organs

Neimark M.I., Tanatarov S.Z.

Abstract

Modern anesthesia, based on the use of halogenated hydrocarbons, nitrogen monoxide, or xenon, cannot fully ensure the interruption of nociceptive impulses at the level of the stem and spinal and subcortical formations, which caused vegetative and metabolic signs related to pain. To prevent the negative effects of pain, additional methods are used, including intraoperative analgesia and regional blockades. This study was conducted to assess the effects of various types of anesthesia, including epidural blockade, on the parameters of the immune system in patients with cancer. A total of 438 patients with malignant neoplasms of the abdominal organs were examined. In these patients, levels of cytokines (such as tumor necrosis-alpha and interleukin-6) and T-lymphocytes of various clusters of differentiation in the blood were measured. Impaired cytokine balance in patients with oncological diseases of the abdominal cavity was accompanied by the formation of suppression of cellular immunity in the postoperative period. Measurements revealed immunosuppression that was largely dependent on the type of anesthesia used. Cellular parameters with the greatest relationship with immunity were preserved during combined anesthesia, including epidural blockade.

Regional Anesthesia and Acute Pain Management. 2020;14(4):185-192
pages 185-192 views

Factors and characteristics of chronic pain in survivors of critical conditions

Spasova A.P., Barysheva O.Y., Tikhova G.P., Maltsev V.V., Koriachkin V.A.

Abstract

This study aimed to determine the factors that affect the development of chronic pain in patients who recovered from a critical illness and to explore characteristics of pain.

Material and methods. This study included a total of 112 patients with surgical pathology who stayed in the intensive care unit (ICU) and subsequently discharged from the hospital. Before discharge, patients were assessed using a short pain questionnaire, the PainDetect questionnaire to assess the neuropathic component of pain, and the HADS questionnaire to verify the presence of anxiety and depression. After 6 and 12 months, catanamnestic data were analyzed, and neuro-orthopedic examination and repeat testing were performed. The duration of ventilation and ICU and hospital stays were assessed as risk factors. The APACHE-II scale score and the maximum SOFA scale score were used as severity parameters of critical conditions. The maximum level of C-reactive protein (CRP) was recorded as a marker of inflammation. The Charlson comorbidity index was used to assess baseline comorbidity.

Results. After 6 months, pain syndrome developed in 55.6% of the patients, and after 12 months, the average pain intensity was 4 points on the verbal rating scale in 59% of the patients. Neuropathic pain was diagnosed in 34% of the patients. The most frequent location of pain was the shoulder joint area, and both shoulders were affected by pain in 58.2% of the patients. In the period from 6 months to 1 year after discharge from the ICU, the risk factors for chronic pain were the duration of ventilator use, ICU stay, and CRP level. Age and gender did not affect the development of chronic pain in patients who recovered from critical illness.

Conclusions. Chronic pain is a complication in more than half of the patients with critical illness. A third of patients with chronic pain experienced neuropathic pain, which requires a comprehensive approach to relieve pain.

Regional Anesthesia and Acute Pain Management. 2020;14(4):193-205
pages 193-205 views

Psychological support of patients with chronic pain on multidisciplinary management

Khinovker V.V., Alkina M.V., Chernomurova P.A., Gazenkampf A.A.

Abstract

Background. Although pain has been studied extensively, its treatment remains an urgent problem. Pain can be caused by various factors, both at the physiological and psychological levels. Patients with chronic pain develop specific psychological problems. Viewing pain through the prism of a psychosocial approach involves the use and development of new psychotechnologies.

Objective. This study aimed to explore the possibilities of improving the emotional state and reducing pain intensity in patients with chronic back pain using mindfulness and cognitive behavioral therapy techniques.

Materials and methods. The study sample consisted of 30 patients with chronic back pain (20 women, 10 men) who were on outpatient treatment at a pain management center.

Results and discussion. Based on the results of the analysis and generalization of literature sources, we prepared a psychological support program, including cognitive behavioral and “mindfulness” techniques. The program consisted of three blocks: diagnostics, exercises, and repeat diagnostics. Experimental data have shown the possibility and confirmed the effectiveness of reducing levels of depression, anxiety, and pain.

Conclusions. Patients with chronic pain often present with varying levels of depression and anxiety symptoms and a reduced quality of life.

A medical and psychological support program using mindfulness techniques and cognitive behavioral therapy positively influenced the level of anxiety, depression, and pain intensity.

A medical and psychological support program helped patients learned methods of self-regulation and self-relaxation.

Regional Anesthesia and Acute Pain Management. 2020;14(4):206-216
pages 206-216 views

Application of bispectral index and analgesia nociception index monitoring during laparoscopic cholecystectomy

Mashyn A.M., Kobelyatskiy Y.Y.

Abstract

The study provides a theoretical generalization and substantive solution to the scientific and practical problem of increasing the efficiency of anesthesia for surgical interventions, such as laparoscopic cholecystectomy, under individualized anesthetic support. This study also presents the peculiar courses of various anesthetic methods during the perioperative period in 120 patients with cholelithiasis who underwent laparoscopic cholecystectomy. Anesthesia types included total intravenous anesthesia using propofol and inhalation anesthesia with sevoflurane. Monitoring the bispectral index and analgesia and nociception index has been widely performed to assess the adequacy of various anesthetic options. These indices were also monitored to assess hemodynamic and autonomic regulation parameters in real time and to predict changes in these parameters intraoperatively. The results suggested the broad possibilities of monitoring, controlling, and minimizing the effect anesthesia on the cardiovascular system in conditions associated with a transient increase in the intra-abdominal pressure.

Regional Anesthesia and Acute Pain Management. 2020;14(4):217-223
pages 217-223 views

Case report

Epidural blockade in thoracic surgery: a case report

Zhikharev V.A., Bushuev A.S., Larin V.F., Koryachkin V.A.

Abstract

This report presents a clinical case of the treatment of pain syndrome in isolated chest trauma following an accident of a patient with liver cirrhosis and hypocoagulation syndrome who sustained bilateral fracture of the ribs (II, III, IV, V, and VI ribs on the right and II, III, IV, V, and VI ribs on the left), fracture of the sternum body in the middle third, bilateral hemopneumothorax, and contusion of both lungs. From the initial hours, fentanyl, which was administered intravenously in a complex of multimodal analgesia, was used for anesthesia. However, adequate pain control was not achieved. Against the background of pain syndrome, the patient developed impaired consciousness and respiratory failure. Epidural puncture and catheterization with an epidural injection of ropivacaine were performed, which relieved the pain syndrome and helped prevent pulmonary complications. The present case highlights the need for an individual assessment of the risk–benefit ratio of the use of epidural catheterization in patients with coagulopathy.

Conclusion: The use of epidural analgesia for chest trauma in patients with moderate coagulopathy made it possible to initiate effective analgesia and reduce the risk of respiratory complications, which ultimately ensured a favorable outcome of severe trauma.

Regional Anesthesia and Acute Pain Management. 2020;14(4):224-227
pages 224-227 views

History

Surgeon-innovator and physician-humanist ahead of his time (to the 145th anniversary of the birth of academician A.V. Vishnevsky)

Morgoshiia T.S., Syroezhin N.A.

Abstract

The main scientific and practical activities of A.V. Vishnevsky took place in Kazan and Moscow. This paper presents little-known facts from the creative life of A.V. Vishnevsky, with a focus on his contribution to the development of local anesthesia and novocaine blockade in our country. Vishnevsky graduated from the Astrakhan gymnasium in 1894 and from the Kazan University in 1899. From 1899 to 1912, he was an assistant dissector at the departments of normal anatomy, topographic anatomy, and operative surgery of Kazan University. During the First World War, he mostly performed surgery to wounded individuals with gunshot injuries that involved peripheral nerves, producing neurolysis or suturing of the nerves. To treat brain abscesses, he used oil-balsamic drainage, which gave better results than other therapeutic methods. From 1914 to 1934, he managed first the hospital and then the faculty surgical clinics in Kazan. With the emerging problems in surgery, he paid much attention to neurosurgery, local analgesia, suppurative processes, nervous tropism, and gunshot wounds. His original theoretical works were devoted to neural trophy. His proposed methods of nerve block, in particular, pericardial novocainic and vago-sympathetic blockages, were widely accepted. As regards his contribution to the field of military surgery, he promoted proper surgical treatment of wounds, justified secondary treatment of wounds, and suggested methods to combat traumatic shock, secondary bleeding, etc. In 1947, A.V. Vishnevsky was appointed as the Director of the Institute of Surgery of the USSR Academy of Medical Sciences in Moscow. He was the founder of the great national school of surgeons.

Regional Anesthesia and Acute Pain Management. 2020;14(4):228-237
pages 228-237 views

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