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Vol 16, No 1 (2022)

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Current understanding of complex regional pain syndrome

Petrushin A.L., Antipin E.E., Bragina S.V., Yakovenko M.P., Bochkareva N.A., Koroleva N.I.


Complex regional pain syndrome (CRPS) is a multifactorial pathology characterized by chronic pain, autonomic disorders, and motor dysfunction. This review discusses the mechanisms of CRPS development, as well as methods of its diagnosis, treatment, and prevention. In addition to drug treatment and physical therapy, issues of interventional methods for the treatment of CRPS are also covered. Along with sympathetic blocks and various ablation techniques under ultrasound and fluoroscopic guidance, a new waveform for spinal cord stimulation and new stimulation targets such as dorsal root ganglia have been proposed.

Regional Anesthesia and Acute Pain Management. 2022;16(1):5-21
pages 5-21 views

Possibilities of using paravertebral blockade in laparoscopic kidney surgery

Lapkina I.V., Ovechkin A.M., Alekseeva T.M., Slusarenko R.I., Bezrukov E.A.


A main goal of modern anesthesiology is to reduce the body’s stress response to surgical aggression. This needs a multidisciplinary approach: surgeons reduce the invasiveness of surgery, and anesthesiologists use a multimodal approach in the intraoperative and postoperative periods. They combine general anesthesia with epidural anesthesia (EA), which has not only undeniable and proven advantages but also several disadvantages. An interesting alternative is paravertebral block (PVB), a compromise between neuroaxial (EA) and peripheral nerve block. PVB provides analgesic efficacy comparable to that of EA, but with significantly fewer complications and side effects. Many studies have described the widespread and successful use of PVB in thoracic surgery and endoscopic urology. However, the literature on the use of PVB in laparoscopic renal surgery anesthesia is extremely scarce. Thus, large multicenter studies are needed to determine the place of PVB in the anesthetic management of laparoscopic renal surgery.

Regional Anesthesia and Acute Pain Management. 2022;16(1):23-31
pages 23-31 views

Hypnosis in anesthesiology and neurosurgery

Solenkova A.V., Lubnin A.Y.


The review presents data on the use of hypnotic techniques in anesthesiology and neurosurgery. The authors describe the historical data, methodology of hypnotic communication, modern use of hypnosis, and methods of hypnotic communication in clinical practice. Hypnotherapy techniques have shown excellent results in pain management and can be effective in reducing preoperative anxiety and intraoperative surgical stress.

Regional Anesthesia and Acute Pain Management. 2022;16(1):33-44
pages 33-44 views

Treatment of acute postoperative pain in patients undergoing open abdominal aortic repair (current state of the problem)

Kozhanova A.V., Plotnikov G.P.


The epidemiology of acute postoperative pain and complications associated with inadequately controlled acute postoperative pain syndrome were considered. The paper presents treatments for acute postoperative pain, the clinical value of multimodal analgesia in enhanced recovery, and reduction of mortality in patients undergoing open abdominal aortic repair. The problem associated with the limitations of the methods in postoperative pain management after open surgical abdominal aortic repair is also considered. The paper also presents alternative methods of multimodal analgesia in patients undergoing other abdominal surgery. The choice of the optimal method in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair is now significantly limited, as a comparative analysis of alternative methods of analgesia and epidural analgesia in vascular surgery was not conducted. Multicenter studies on multimodal analgesia in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair are therefore required when deviating from the standard protocol.

Regional Anesthesia and Acute Pain Management. 2022;16(1):45-58
pages 45-58 views

Сomparative effectiveness of various methods of epidural administration of glucocorticosteroids in treating root pain syndromes

Fedorov D.A., Khinovker V.V., Koriachkin V.A.


This review aimed to compare the effectiveness of different methods of epidural glucocorticosteroid (GCS) use in the treatment of root syndrome pain according to literature over the past 20 years. A literary search was conducted in the databases of PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar, as well as a manual search of bibliographies of famous primary and review articles and abstracts of scientific meetings between 2000 and 2020. During the search, 637 studies were identified, of which 615 were excluded, as they did not correspond to the topic of the article. The remaining 22 studies were included in this review.

Scientific papers describe three ways to deliver glucocorticosteroids, namely, epidural–interlaminar injection, transforaminal injection, sacral–epidural injection.

For sciatica, 5 out of 8 comparative randomized controlled trials found the transforaminal route of administration to be superior to the sacroepidural or interlaminar route of administration. In a number of studies, the sacroepidural route of administration was comparable in efficiency with transfor-real with low herniated discs.

In cases of cervicobrachialgia, the transforaminal route of administration is recognized by most authors as unsafe, with risks of accidental intravascular injection. In this regard, at the cervical level, interlaminar access is considered preferable. In addition, the differences between the epidural use of water-soluble and dispersed (not approved for use in the Russian Federation) glucocorticosteroids are described.

The review describes the techniques of various approaches to the epidural space with their advantages and disadvantages.

Different methods require different material equipment of clinics. Sacral access, with relatively high efficiency, allows for “blind” use, in contrast to transforaminal access at the lumbar level and interlaminar access at the cervical level, which require X-ray navigation.

Regional Anesthesia and Acute Pain Management. 2022;16(1):59-70
pages 59-70 views

Original study articles

Comparison of the effectiveness of ultrasound-guided and ultrasound-guided subgluteal nerve blocks with peripheral nerve electrical stimulation: A randomized controlled feasibility trial

Piacherski V.G., Muzyka L.V.


AIM: The efficacy of sciatic nerve blockade with subchondral access under ultrasound guidance (USG) versus ultrasound guidance in combination with EPN (USEPN) is unknown. Data on studies of these techniques for blockade of other peripheral nerves are inconsistent. This study evaluated the feasibility of a randomized trial to compare the efficacy of sciatic nerve blockade with USG-guided sciatic access with the current practice of USEPN.

MATERIALS AND METHODS: Forty patients were randomized into two groups in which USG or USEPN guidance was used to perform sciatic nerve blockade with sciatic access. The primary endpoint was the quality of the sensory block. The secondary endpoint was the quality of the motor block.

RESULTS: Two groups of 20 patients each were analyzed. All patients developed successful motor and sensory blocks of the sciatic nerve when using USG and USEPN. All cases were followed. Three patients were excluded before randomization because of the unsatisfactory ultrasound imaging of the sciatic nerve.

CONCLUSION: The results show that a prospective study of alternative techniques of sciatic nerve block by subchondral access is possible. In our pilot study, sciatic nerve block performed under USG guidance without EPN was effective in all cases.

Regional Anesthesia and Acute Pain Management. 2022;16(1):71-77
pages 71-77 views

Myocardial injury in patients with hypertonic disease at osteosynthesis of the hip and spinal anesthesia

Komarov A.S., Sokolov D.A., Ganert A.N., Lyuboshevskii P.A.


BACKGROUND: Perioperative myocardial injury (MI) and MI after noncardiac surgery (MINS) makes a significant contribution to the structure of complications and mortality in non-cardiac surgery, including those in traumatology. Spinal anesthesia (SA) is usually used for hip surgery. It may be accompanied by arterial hypotension, which, under certain conditions, becomes a leading factor in MI development. Features of both hypotension and MI in patients with concomitant cardiovascular pathology operated on for hip injury remain insufficiently studied.

AIM: To determine the frequency of intraoperative arterial hypotension and MI after intraosseous osteosynthesis of the hip under spinal anesthesia in patients with concomitant cardiovascular pathology.

MATERIAL AND METHODS: In 275 patients with concomitant cardiovascular pathology, intraosseous synthesis of the hip was performed with SA. The functional class of the patients was assessed according to the American Society of Anesthesiologists scale and the risk of cardiac complications according to the Revised Cardiac Risk Index scale. Blood pressure, heart rate, electrocardiogram, and ST segment were monitored. Before surgery and 1–3 days thereafter, the troponin T level was measured. The frequency of MI and surgical outcomes were assessed.

RESULTS: In the studied sample of patients with hypertonic disease, arterial hypotension associated with SA was observed in 34.2% of cases. Its frequency increased from 15.7% in patients without other comorbidities to 42.9% in patients with a combination of hypertonic disease, CAD, and CHF. A significant relationship was noted between arterial hypotension and MI. A highly sensitive troponin test revealed a significant incidence of myocardial damage (18.2%), and the associated 3-day mortality was 4%.

CONCLUSION: SA-induced arterial hypotension is associated with MI risk and appears to be the most dangerous in patients with a combination of hypertonic disease, CAD, and CHF. Monitoring of troponin T levels in patients with risk factors of MI is one of the ways to reduce postoperative mortality and improve surgery outcomes.

Regional Anesthesia and Acute Pain Management. 2022;16(1):79-86
pages 79-86 views

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