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Vol 15, No 3 (2021)

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Which way to choose next?

Zabolotskiy D.V.


An increased interest in regional anesthesia in the pediatric practice was noted; however, the frequency of using regional blockages in children is much lower than in adults. This is facilitated by the insufficient awareness of anesthesiologists about the peculiarities of children’s physiology, fear of the child, fear of side effect development, and simply, unwillingness to use regional methods. This situation can be corrected at the stages of training young specialists.

Promoting regional anesthesia is required in the pediatric practice for residency training by improving theoretical knowledge and manual skills. This requires interest, knowledge, practical skills, and equipment.

Regional Anesthesia and Acute Pain Management. 2021;15(3):175-178
pages 175-178 views


Monolateral spinal anesthesia

Neimark M.I., Burenkin A.A.


Spinal anesthesia is a simple and affordable method of anesthesia that provides a sufficient level of intraoperative and postoperative analgesia, muscle relaxation, and early activation of patients. Like all other techniques, it has advantages and disadvantages. The most common side effect of anesthesia is the central hemodynamic disturbance, such as hypotension, which is prevented by unilateral anesthesia. Thus, presented herein are the most common complications and their prevention methods.

Regional Anesthesia and Acute Pain Management. 2021;15(3):179-188
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Original study articles

Optimization of regional analgesia after total knee arthroplasty based on ipack-block

Ezhevskaya A.A., Zhulina E.A., Andrianova T.O., Morunova A.Y.


AIM: To study the efficacy and safety of a combination of the IPACK and the adductor canal blocks (ACB) and compare with the femoral nerve block after total knee arthroplasty (TKA).

MATERIALS AND METHODS: Double-blind, prospective, randomized, controlled trial with 101 patients. Three groups were distinguished, differing in the chosen method of regional anesthesia. Group 1 included patients with a combination of afferent canal block and IPACK block, group 2 included patients with femoral nerve block, and group 3 included patients with femoral nerve block and IPACK block. Pain at rest and during movement, the need for opioid analgesics in the postoperative period, and the possibility of early activation of patients after knee arthroplasty were assessed on a visual analog scale. The incidence of side effects associated with regional anesthesia was also noted.

RESULTS: The study showed that the combination of adductor canal blockade and IPACK blockade showed the best effectiveness of pain syndrome control. Patients were less likely to need narcotic analgesics, there was no development of motor block and, as a result, patients were more satisfied with anesthesia. The combination of blockades made it possible to accelerate the rehabilitation of patients in the postoperative period, due to a decrease in pain and the absence of a motor block.

CONCLUSIONS: The use of IPACK blockade in combination with adductor canal blockade provides effective analgesia and reduces the use of analgesics, as well as increases the patient's rehabilitation potential.

Regional Anesthesia and Acute Pain Management. 2021;15(3):189-198
pages 189-198 views

Is wound catheter needed for local high-volume infiltration anesthesia in total knee replacement?

Tarasov D.A., Bagdasarov P.S., Yavorovskiy A.G., Lychagin A.V.


BACKGROUND: The use of local high-volume infiltration anesthesia (LHVIA) is becoming increasingly popular for postoperative analgesia in total knee arthroplasty (TKA). However, one of the elements of the technique is the use of an intraarticular or wound catheter to prolong the analgesic effect.

AIM: Therefore, the investigation aimed to estimate wound catheter use as a component of LHVIA in TKA.

MATERIALS AND METHODS: The study included 102 patients who underwent primary TKA for stage 3 gonarthrosis under spinal anesthesia with intravenous sedation. Two groups were formed by envelope randomization: the LHVIAc group (n=51) in which the wound catheter was placed at the end of the operation and followed by the infusion of the local anesthetic solution for 24 h; and the LHVIA group (n=51) in which the patients were treated without a catheter.

RESULTS: The groups were comparable in terms of sex, age, and the nature of the pathology. The LHVIAc group showed a significantly decreased severity of pain in 4–6 h after surgery, both at rest and during flexion of the knee (p=0.001 and p=0.003). On postoperative day 1, the use of the wound catheter contributed to a significantly decreased severity of pain syndrome when flexing the knee (p=0.002). No infectious complications or significant adverse reactions were recorded in the groups.

CONCLUSION: 1) LHVIA is an effective method of postoperative analgesia in TKA; 2) the use of the catheter in the early postoperative period increased the analgesic effect of LHVIA without increasing the frequency of infectious and other complications; 3) the use of the wound catheter reduced the severity of pain syndrome in postoperative day 1 during activation, which facilitates postoperative rehabilitation of patients with TKA.

Regional Anesthesia and Acute Pain Management. 2021;15(3):199-206
pages 199-206 views

Method for assessing the degree of external dislocation of an epidural catheter when carrying out a combined two-level spinal-epidural anesthesia

Yamshchikov O.N., Marchenko A.P., Emelyanov S.A., Cherkaeva A.V., Ignatova M.A., Marchenko R.A.


AIM: To present the practical importance of the proposed method for assessing the degree of external dislocation of an epidural catheter in the daily work of an anesthesiologist-resuscitator, with which a doctor can assess the risk of deterioration in the quality of anesthesia and, using the developed algorithm, take measures to prevent epidural catheter loss and epidural analgesia termination.

MATERIALS AND METHODS: This study selected 62 patients who underwent the two-level combined spinal-epidural anesthesia with fixation of an epidural catheter in the subcutaneous canal during operations of lower limbs fractures. All patients underwent postoperative epidural analgesia.

A method for assessing the degree of external dislocation of an epidural catheter and an algorithm of actions when detecting a dislocation of an epidural catheter has been developed. The degree of dislocation of the epidural catheter was assessed when changing the fixing aseptic sticker and additional measures were taken to enhance the fixation of the epidural catheter when a pronounced dislocation was detected.

RESULTS: The use of the method for assessing the degree of external dislocation of the epidural catheter and the implementation of the algorithm of actions upon the detection of the epidural catheter dislocation made the conduction of high-quality postoperative anesthesia in 61 patients possible. In 10 patients, when a pronounced dislocation was detected and the threat of the epidural catheter was loss (dislocation of 4–5 degrees, 15–30 mm), special fixation devices “Epi-Fix” were used for additional fixation, which made the continuation of the epidural analgesia possible.

In the first case (1.61%), wherein epidural analgesia had to be discontinued after 48 h, the 6th degree of dislocation of the epidural catheter (33 mm) was established and the catheter was removed. Postoperative pain relief was continued with the introduction of non-steroidal anti-inflammatory drugs.

CONCLUSIONS: Using the method for assessing the degree of external dislocation of an epidural catheter in the daily practice of an anesthesiologist-resuscitator assessed the risk of deterioration and termination of epidural anesthesia possible, thus prevention measures were performed.

Regional Anesthesia and Acute Pain Management. 2021;15(3):207-214
pages 207-214 views

Erector spinae plane blockade in the complex of anesthesia support of aldosteroma surgery

Neymark M.I., Kiselev R.V., Goncharov E.V.


BACKGROUND: The only radical method of treatment of hormonally active adrenal tumors is retroperitoneoscopic adrenalectomy. The modern approach dictates the principles of multimodal analgesia, and avoidance of narcotic analgesics. On the other hand, early activation of such patients in the postoperative period entails a more pronounced postoperative pain syndrome. The relevance of these problems makes us think about better tactics of perioperative management of such patients.

AIM: Feasibility of ESP blockade as a component of analgesia during retroperitoneoscopic surgeries for aldosteroma.

MATERIALS AND METHODS: A randomized study was conducted in 41 patients who underwent retroperitoneoscopic adrenalectomy for aldosteroma. The patients were divided into 2 groups. In the 1st group the operation was carried out under combined anesthesia with Desflurane inhalation and perioperative analgesia by systemic injection of opioids; in the 2nd group the operation was carried out under combined anesthesia with Desflurane inhalation in combination with fascial blockade of the rectifying spine muscle at the operation site by 0.35% Ropivacaine solution.

RESULTS: The use of ESP blockade as an analgesic component of combined anesthesia is indicated for retroperitoneoscopic surgeries for aldosteroma. Firstly, its implementation excludes the use of opioids during anesthesia, which allows to implement the principles of accelerated rehabilitation surgery (ERAS). Secondly, low-flow Desflurane inhalation combined with ESP blockade provides adequate anesthesia during unilateral adrenalectomy for aldosteroma. Thirdly, the analgesic effect of ESP blockade extends to the early postoperative period.


– The use of ESP block in combination with low flow Desflurane inhalation can be considered as the anesthesia method of choice for retroperitoneoscopic adrenalectomy for aldosteroma.

– This technology allows to implement ERAS principles.

– The use of ESP block reduces the number of postoperative complications associated with the use of narcotic analgesics.

Regional Anesthesia and Acute Pain Management. 2021;15(3):215-222
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Effectiveness of transverse abdominis plane blocks in abdominal surgery in hernioplasty

Sorsunov S.V., Efimenko M.Y., Gritsan A.I.


BACKGROUND: Transverse abdominis plane (TAP) block is one of the methods of regional anesthesia, which is characterized by injecting a large volume of anesthetic into the fascial space between the internal oblique and transverse abdominal muscles that contains the nerves from Th7 to L1.

THIS STUDY AIMED to study the effectiveness and safety of TAP block in hernioplasty and conduct a comparative analysis of the TAP block with general anesthesia and extended epidural anesthesia.

MATERIALS AND METHODS: A comparative analysis of 78 patients who underwent hernioplasty was carried out. Patients are divided into three groups (n=26) depending on the features of the anesthesiological aid. The control group had a surgery that was performed in a multicomponent-combined anesthesia setting with total myoplegia and ALV. Group 1 had general anesthesia that was supplemented by TAP, a unit under the United States navigation. Group 2 had general anesthesia in combination with an extended epidural block. The need for narcotic analgesics and the severity of pain syndrome in the perioperative period were determined in the three groups to assess the effectiveness and safety of the method and compare the hemodynamic parameters. The severity of pain syndrome was determined using a visual analog scale (ALV). Changes in hemodynamic parameters were compared to evaluate the safety of the TAP block. The groups were comparable in terms of volume of surgery, age, and sex.

STUDY RESULTS: The need for narcotic analgesics was significantly lower in patients in groups 1 and 2 in intra- and postoperative periods than in the control group. Hemodynamic indicators (blood pressure and HS) were characterized by greater stability without significant fluctuations at all major stages of surgery, which indicates the development of adequate analgesia. A significantly decreased intensity of pain syndrome in the group of patients with a TAP block and extended EA was also noted.

CONCLUSION: Performing a bilateral TAB unit under ultrasound navigation in hernioplasty is an effective and safe method of perioperative pain relief of patients, which in most cases is a preferred alternative to extended EA.

Regional Anesthesia and Acute Pain Management. 2021;15(3):223-232
pages 223-232 views

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