Vol 17, No 3 (2023)

Regional anesthesia in frequently used during the perioperative period in both adult and pediatric patients to achieve better pain control and faster recovery after surgery. Significant progress in regional anesthesia has been achieved recently due to the availability of ultrasound guidance. In this systematic review and meta-analyses, randomized trials on the use of regional blocks in anesthesiology were evaluated, including new blockade techniques that expand the possibilities of regional anesthesia. Interfascial blocks are considered a subgroup of peripheral nerve blocks, a set of techniques that have been already employed in perioperative pain management. Their advantages include less invasiveness, significant reduction in the need for opioid analgesics, low complication rates, and flexibility of approaches to accommodate specific surgical needs. Despite considerable interest in interfascial blocks in pediatric anesthesiologists, data on its safety are lacking, with a few randomized controlled trials providing low-quality evidence. Future prospective studies are warranted to evaluate interfascial blocks in the pediatric population.

BACKGROUND: Prevention and treatment of pain is the primary goal of any anesthesiologist. This would entail meticulous assessment of pain, especially in children. However, there have been no comprehensive and objective methods developed to assess pain. Only a number of algometers based on the basic biology of the nociceptive system are currently used in clinical practice.

OBJECTIVE: Our aim was to document and analyze the experience of using NeonFSC stress monitoring system (LLC «VKO Fiziomed», Russia) in clinical practice for perioperative pain control in pediatric neurosurgery.

MATERIALS AND METHODS: We conducted a pilot prospective observational study that included 44 patients (18 girls and 26 boys) who were treated at the Burdenko National Medical Research Center for Neurosurgery at the age of 3 months to 18 years (Class I–II ASA). Patients received intraoperative fentanyl and postoperative administration of paracetamol round-the-clock and tramadol as needed. All patients underwent perioperative pain assessment using clinical data and pain assessment scales and the NeonFSC device. All patients were observed in the wake-up ward 3- minutes postextubation until transfer to the pediatric ward. Out of 44 patients, fourteen patients registered stress response in the NeonFSC monitoring system. Pain measured clinically using the Visual Analog Scale and FLACC were compared with NeonFSC data.

RESULTS: No signs of prolonged insufficient analgesia were observed in any patient intraoperatively. The CSP index, an integral indicator of the patient’s status, demonstrated adequate level of anesthesia and analgesia during the operations (from 0 to 18 points). We demonstrated that the CSP index and clinical assessment of pain were concordant in 10 (71%) cases. Four of these children reported moderate pain and six showed mild pain.

CONCLUSION: NeonFSC stress monitoring system is noninvasive and does not cause patient discomfort during recording. However, system indicators should be interpreted in the context of the overall clinical condition of the patient.

BACKGROUND: Regional anesthesia for aortocoronary bypass surgery have shown promise in achieving reduced perioperative pain, need for systemic opioids, and improved surgical outcomes. However, use of neuroaxial anesthesia in cardiac surgery remains controversial due to the lack of studies. Parasternal blockade is a simple, effective technique that can be applied after cardiac surgery.

CLINICAL CASE DESCRIPTION: This is a clinical case presenting the performance of bilateral parasternal blockade in the III–IV intercostal space using the «Single Shot» technique for a patient who underwent aortocoronary bypass surgery. Advantages of this technique are its ease of implementation, safety, and most importantly, effective distribution of local anesthetic in the parasternal interfascial space. This results in blockade of the anterior cutaneous branches of intercostal nerves from T₂ to T₆ that innervate the surgical area.

CONCLUSION: Parasternal blockade is a technically simple, affordable, and promising method for analgesia after aortocoronary bypass surgery. Multicenter studies are required to further evaluate the efficacy of parasternal blockade postcardiac surgery.

Hip arthroplasty is one of the most common surgeries performed globally, with more than 500,000 operations int the US and 3.1 million in Europe performed annually. In 2019, 147,061 hip and knee arthroplasty surgeries were performed in Russia. Hip arthroplasty involves a moderate degree of trauma and is performed under neuraxial anesthesia. However, severe pain in the early postoperative period has been reported postarthroplasty. I had a hip arthroplasty performed under spinal anesthesia with «heavy» bupivacaine (12.5 mg). The operation lasted for 1 hour and motor block regressed 5 hours postsurgery. One hour after the end of the motor block, I experienced mild pain (VAS score 2). The pain intensified to VAS score 7 after 2 hours. Intramuscular injection of 10 mg morphine did not relieve the pain. One hour after morphine administration, 30 mg of ketorolac was administered intramuscularly. After 60 minutes, pain intensity decreased to VAS score 3. Morphine and ketorolac were then administered simultaneously at night and achieved pain levels of VAS score 1–2. The following day, morphine and ketorolac were administered in the morning and evening, resulting in complete pain resolution. No more analgesics were used. In my opinion, the combination of morphine and ketorolac on the day of surgery and twice the next day allows complete elimination of pain after hip arthroplasty.