Vol 18, No 2 (2024)

BACKGROUND: High-intensity pain is a common problem in outpatient practice, and adequate examination and interventional treatment may be complicated. An effective, safe, and fast pain relief method should be established.

AIM: To evaluate the efficacy and safety of the use of the analgesic Tafalgin in the outpatient clinic for relief of intense pain due to various causes and compare the efficacy of different Tafalgin dosages.

MATERIALS AND METHODS: Twenty-two patients with high-intensity pain (≥7 points on a numeric rating scale, NRS) were studied. All patients were administered Tafalgin once subcutaneously; pain relief, duration of the analgesic effect, and side effects were observed. Additionally, the differences in the effectiveness and safety of two different doses (i.e., 4 and 7 mg) were analyzed.

RESULTS: Average pain intensity at rest before the injection was 9±2 points according to NRS, and pain intensity in movement was 9±1. After Tafalgin injection, average pain intensity decreased to 3±3 points on NRS (pain intensity at rest and in movement were the same). The initial analgesic effect onset time was 17±9 minutes and average duration of the effect was 202±75 minutes. Adverse events (AE) occurred in 8 of 22 patients (36%); all AEs were mild, did not require any treatment, and regressed spontaneously. Differences in efficacy of two Tafalgin doses were noted: after the injection, pain intensity decreased to 6±3 and 2±2 points in the 4 (p=0.16) and 7 mg (p <0,001) groups, respectively. No difference was found between the two groups in effect onset time, effect duration, and number of AEs.

CONCLUSION: Tafalgin demonstrated a strong analgesic effect in intense pain relief; the 7 mg dose demonstrated a satisfactory result and should be prefer for most patients suffering high-intensity pain. In therapeutic dosages, Tafalgin is a well-tolerated treatment, and good adherence to medication was noted.

BACKGROUND: When performing a brachial plexus block in the proximal subclavian region, the scanning plane is located deeper and posterior to the clavicle midpoint. Data on the angle of the ultrasound probe and visualization of the brachial plexus bundles are limited.

AIM: Our aim was to evaluate visualization and positioning of the neurovascular bundle in the infraclavicular region for proximal brachial plexus block..

MATERIALS AND METHODS: Volunteer patients (добровольцах (n=28, median — 43 years)) at the Military Traumatology and Orthopedics Clinic of the Military Medical Academy, named after S.M. Kirov, were studied. Ultrasound navigation was used to evaluate the neurovascular bundle followed by brachial plexus block.

RESULTS: The study showed that the brachial plexus bundle is best visualized at an average sensor angle of between 90° and the maximum that allows visualization of at least one of the elements of the brachial plexus 64.4° (65.7°, 63°) and amounted to 77.5° (77.9°, 76.5°).

CONCLUSION: The optimal angle for performing a brachial plexus block using the proximal subclavian approach is 77.5°. Optimal visualization of the brachial plexus is possible in the angle range from 64.4° to 90°, which enables selecting the safest trajectory of the needle when performing a blockade in this area, considering the anatomical characteristics of the patient. Further studies are required to compare the sensor angles used in actual clinical practice to the angles obtained in this study.

BACKGROUND: Thoracic epidural anesthesia is the gold standard for postoperative analgesia after thoracic surgery; its alternatives include paravertebral block (PVB) and erector spinae plane block (ESPB). However, ESPB has not been evaluated in comparison with intraoperative PVB for effectiveness and speed of recovery in the early postoperative period after thoracoscopic surgery in children with cancer.

AIM: Our aim was to investigate the analgesic effectiveness of erector spinae muscle block compared to thoracic paravertebral block for intra and postoperative analgesia during thoracoscopic surgical interventions in children with thoracic tumors.

MATERIALS AND METODS: A prospective, randomized, single-center study was conducted. The sample size was 90 patients (ESPB group, 45; PVB group, 45). Randomization was performed using computer-generated codes applying the hidden envelope method. Patient representatives and the investigators collecting outcome data were informed about the study. Participants were children aged <18 years with malignancy, ASA class I–II, and undergoing thoracoscopic surgery. The patients underwent ultrasound-guided blockades with the administration of local anesthetic at 2 mg/kg (ropivacaine) after general anesthesia induction and before surgical incision. Moreover, both groups received the same standardized pain management protocol during and after surgery. The main outcome was the effectiveness of analgesia, determined by the need for additional intraoperative opioid administration. The secondary outcomes included pain scores at rest and with movement within 24 hours postsurgery, 24-hour analgesic consumption, time to first analgesia, and postoperative complication incidence and severity.

RESULTS: The time (min) required to perform the block was significantly shorter (p <0.05) in the ESPB 5.5 (6; 8.5) group than in the PVB 11 (9; 12) group. No significant difference was found in the intraoperative fentanyl dose between the ESPB and PVB groups, which was 150 (100; 300) µg and 150 (100; 200) µg (p <0.65), respectively. The PVB group had lower VAS scores at 24 hours postoperatively (p <0.001). In the ESPB group, the mean (standard deviation) of total tramadol consumption was 120 (25) mg/day, and in the PVB group, 54 (12) mg/day (p <0.001). Pain scores according to the VAS and Wong–Becker scales during movement were lower in the PVB group at 1, 2, 6,12, and 24 hours postsurgery (p=0.025, 0.015, 0.03, 0.02, and 0.006).

CONCLUSION: In children with thoracic tumors who underwent thoracoscopic surgical interventions, ultrasound-guided PVB was more effective compared to ultrasound-guided ESPB performed in the postoperative period and induced a more pronounced and prolonged postoperative analgesic effect, although it was not inferior in providing intraoperative analgesia regarding opioid consumption. However, ESPB was easier to implement and required less time.

BACKGROUND: Every year, the number of publications devoted to the study of various tools for predicting the intensity of pain after cesarean section is growing, which necessitated the generalization and systematization of these data.

OBJECTIVE: Our aim was to identify factors contributing to high-intensity pain after cesarean section (CS).

MATERIALS AND METHODS: a scoping review based on the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines was conducted using PubMed, Cochrane Database of Systematic Reviews, and Google Scholar. The search was performed using the following keywords: “predictors” OR “prediction” OR “forecasting” AND “cesarean section” AND “pain”) in Russian and English, last search date November 30, 2022. The inclusion criteria for the review were formulated using the PICOD method: (P) population: postpartum women; (I) intervention: CS surgery; (C) comparison: surgical approach, anesthesia method, psychological status, pain threshold, genetic characteristics; (O) outcomes: pain intensity scores, analgesic requirements; (D) study design: prospective/retrospective cohort studies. Exclusion criteria were as follows: lack of sufficient data or outcome of interest; duplicate publication; chronic pain; publications devoted to pain relief during childbirth or pain after other surgical interventions; lack of full-text version; reviews and meta-analyses. The quality of selected non-randomized cohort studies was assessed using the Newcastle-Ottawa Scale (NOS).

RESULTS: 30 cohort studies were selected, involving 11,063 patients. Most studies were assigned an NOS score of 6 to 8, which was considered good quality. Two groups of factors were identified as predictors of the intensity of postoperative pain: factors associated with the characteristics of the patient (physical status, psychological status, individual pain threshold and pain tolerance, genetic characteristics) and factors associated with the characteristics of the operation and anesthesia.

CONCLUSION: the scoping review allowed us to identify reliable factors predicting high-intensity pain after CS, which should be taken into account when planning anesthesiological care for patients.