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Vol 16, No 2 (2022)

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Reviews

Ibuprofen for intravenous administration: new possibilities for the use of NSAIDs in postoperative pain management

Ovechkin А.M., Politov M.E., Sokologorskiy S.V.

Abstract

Non-steroidal anti-inflammatory drugs are an essential component of postoperative multimodal analgesia. Their analgesic efficacy has been confirmed by data from evidence-based medicine. The appearance of an intravenous form of ibuprofen on the Russian pharmaceutical market expands the possibilities of using NSAIDs in postoperative pain managment schemes. Ibuprofen characterized a high analgesic potential and an optimal safety profile in relation to the risk of gastrointestinal and cardiovascular complications.

Regional Anesthesia and Acute Pain Management. 2022;16(2):91-101
pages 91-101 views

Possibilities of clinical application of articaine

Bayalieva A.Z., Yankovich Y.N., Mohsin M., Davydova V.R.

Abstract

Articaine is an intermediate-potency and short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. Articaine was widely used in dental practice, but now has an effective form for surgical and anesthetic use. Articaine is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when intravenously injected for regional anesthesia. Comparative trials have not revealed a generally significant difference in its clinical effects from those of other short-acting local anesthetics, such as lidocaine, prilocaine, and chloroprocaine, and no conclusive evidence has demonstrated above-average neurotoxicity. Thus, this review discusses the pharmacokinetics and pharmacodynamics, clinical efficacy, and possible side effects of articaine.

 

Regional Anesthesia and Acute Pain Management. 2022;16(2):103-114
pages 103-114 views

Unintentional subarachnoid administration of tranexamic acid during spinal anesthesia

Koriachkin V.A., Beleshnikov I.L., Litus S.N., Safray A.E., Zabolotskiy D.V., Evgrafov V.A.

Abstract

An accidental intrathecal tranexamic acid injection is a rare but extremely unpleasant case, which can lead to severe complications, including death. This review aimed to describe the clinical, pathophysiological changes and outcomes occurring in patients with unintentional tranexamic acid subarachnoid injection during spinal anesthesia. The review includes studies published in PubMed, The Cochrane Library, Google Scholar, and the Russian Science Citation Index databases. There were 31 reports (27 literature reports and 4 own observations) of unintended tranexamic acid administration during spinal anesthesia, including 12 cases in traumatology and orthopedics, 11 cases in cesarean section, and 8 cases in urology and general surgery. Typical signs and symptoms reported by the authors include severe pain in the lower back, buttocks, and lower extremities, seizure syndrome, marked tachycardia and arterial hypertension, and ventricular arrhythmias. Ten (32.1%) patients recovered without any consequences and six (19.4%) patients required long-term rehabilitation after hospital discharge due to severe neurological deficits or cognitive impairment. Of 11 females, 9 died during cesarean section and 4 of 12 patients died in traumatology and orthopedics. Overall, 15 (48.4%) patients had a fatal outcome. An unintentional subarachnoid tranexamic acid injection is a catastrophic event with extremely high patient risk and is accompanied by high mortality, especially in obstetric practice. Intensive care should include intravenous propofol or sevoflurane inhalation in the case of unintentional intrathecal tranexamic acid injection, and cerebrospinal fluid lavage is promising. Developing a formalized protocol for intrathecal administration of local anesthetic solutions is advisable to avoid errors associated with accidental drug administration not intended for spinal anesthesia.

Regional Anesthesia and Acute Pain Management. 2022;16(2):115-127
pages 115-127 views

Original articles

Intravenous lidocaine infusion in children

Felker E.Y., Fataliev M.S., Kolosov A.O., Ibragimov R.N., Tantseva T.V., Ivanova L.V., Gromov P.V., Zabolotsky D.V., Koryachkin V.A.

Abstract

BACKGROUND: The problem of adequate analgesia in the early postoperative period is not relevant at present, both in our country and abroad because >50% of children experience pain after surgical interventions despite the ongoing therapy. Inadequate “ideal” method for assessing the pain syndrome severity, age restrictions with several drugs, and difficult communication with young children, as well as drug selection, lead to inadequate detection in pediatric practice.

AIM: This study aimed to evaluate the effectiveness and safety of intravenous infusion of lidocaine in the early postoperative period in children operated on the abdominal cavity organs.

MATERIALS AND METHODS: This study included 119 children who were randomized into 3 groups, in which intravenous lidocaine infusion, prolonged epidural blockade, or systemic fentanyl analgesia were used for pain relief after abdominal surgery. Hemodynamic parameters, respiratory system, pain intensity, resolution time of intestinal paresis, cortisol, glucose and lidocaine levels in blood plasma, and complications were monitored and compared intergroup.

RESULTS: Lidocaine infusion had no effects on the hemodynamics and respiratory system in children. Cortisol level was markedly decreased through the day to baseline (320±65 nmol/l). Early recovery of peristalsis corresponded to 23±3.75 h postoperatively. The pain syndrome intensity during the observation period did not exceed 2 points. The maximum level of free lidocaine in blood plasma was 2.81±1.31 µg/ml, and the time spent in the intensive care unit (ICU) was 48±10 h.

CONCLUSION: Intravenous infusion of lidocaine after abdominal surgery in children is a safe method that provides effective pain relief, restores peristalsis early, and reduces the length of ICU stay.

Regional Anesthesia and Acute Pain Management. 2022;16(2):129-138
pages 129-138 views

Towards the efficacy of erector spinae plane block in lumbar spinal fusion

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

Abstract

AIM: This study aimed to assess the efficacy and safety of the erector spinae plane block (ESP-block) in lumbar spinal fusion in the perioperative period.

MATERIALS AND METHODS: This prospective randomized study included 200 patients aged 45–65 years undergoing decompression and lumbar spinal fusion. All the patients were divided into three groups depending on the anesthesia method. The first group received general anesthesia in combination with a single bilateral ESP-block; the second group received general anesthesia in combination with a prolonged bilateral ESP-block; the third (or, control) group was given general anesthesia. The parameters of intraoperative hemodynamics, the postoperative pain according to the visual analog scale, the need for opioid analgesics during and after surgery, the incidence of postoperative nausea and vomiting, and other anesthesia-induced adverse reactions were assessed.

RESULTS: Patients who received the single bilateral ESP-block have exhibited adequate pain relief, leading to minimal opioid analgesic consumption in the early postoperative period. However, prolonged ESP-block with bilateral catheters is the most efficacious postoperatively, and patients hardly needed narcotic analgesics and featured a low incidence of postoperative nausea and vomiting (hazard ratio: 0.32; 95% confidence interval: 0.213–0.464; р <0.001).

CONCLUSION: The bilateral ultrasound-assisted ESP-block in lumbar decompression and spinal fusion ensures adequate pain relief both intra- and postoperatively, resulting in a reduced need for opioid analgesics and minimizing their related incidence of adverse reactions.

Regional Anesthesia and Acute Pain Management. 2022;16(2):139-149
pages 139-149 views

Neuropathic pain treatment with xenon

Khinovker V.V., Veselova O.F., Khinovker E.V., Koryachkin V.A.

Abstract

THE AIM: This study aimed to evaluate the effects of xenon on neuropathic pain during parapulmonal injections in the rat model. Xenon is a drug for inhalation anesthesia that is assumed to have an analgesic effect when administered parapulmonary (similar to nitrous oxide and cyclopropane) and can later be used as an alternative analgesic drug in patients with pain syndrome that is not controlled by standard methods.

MATERIALS AND METHODS: The experiment used in vivo model of neuropathic pain by Bennet and Xie (1988) on rats with sciatic nerve transection. Additionally, a special scoring was adopted based on known behavioral changes of experimental animals (self-harm of limbs, neatness, activity, and bedding conditions). The control group was subcutaneously administered air daily for 5 days, and the experimental group received medical xenon at 40 ml/kg. The pain was assessed with the subcutaneous introduction of air and xenon in the experimental and control groups.

RESULTS: Study results revealed that rats from the experimental group (xenon) showed fewer signs of neuropathic pain syndrome development compared to the control group (air).

CONCLUSION: Therefore, parapulmonal injections of xenon showed a high analgesia effect in animal models of chronic neuropathic pain.

Regional Anesthesia and Acute Pain Management. 2022;16(2):151-159
pages 151-159 views

Forum

Diagnostics and treatment of chronic pain in Siberia

Khinovker V.V., Khinovker E.V., Koryachkin V.A.

Abstract

This article is about I Russian scientific and practical conference with the international participation «Actual questions of chronic pain management» held on May 13-14 in Krasnoyarsk. The conference was organized by the Federal State Budgetary Institution of Healthcare of the Federal Scientific and Practical Center of the Federal Medical and Biological Agency of Russia, the KrasSMU, and the Association of Interventional Pain Treatment. Speakers from nine cities discussed wide and narrow questions of interventional and cancer pain treatment and other pain management directions. Additionally, two regional anesthesia under ultrasound control master classes were conducted. Approximately 360 people participated in the conference, both online and offline.

Regional Anesthesia and Acute Pain Management. 2022;16(2):161-166
pages 161-166 views


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