Vol 15, No 1 (2021)

The article is a response to an editorial published in the February 2021 issue of Anesthesia that negatively assessed the prospects for the intravenous infusion of lidocaine as a component of postoperative analgesia. The issues regarding the effectiveness and safety of this technique are considered. The data on evidence-based medicine confirming the advisability of perioperative intravenous infusion of lidocaine are presented.

BACKGROUND: Chronic pain is a common problem that exerts a significant impact on individuals and society as a whole. Pain syndrome is one of the most common explanations for patients’ need for medical care, and it causes major suffering in humans. Thus far, chronic pain lacks a generally accepted terminology and classification.

The review aimed to present the current terminology and classification of chronic pain.

MATERIALS AND METHODS: Two independent researchers searched for publications for the period of January 2010 to October 2020 in the databases PubMed, MEDLINE, EMBASE, The Cochrane Library, Google Scholar, and the International Association for the Study of Pain. The last search query was performed on October 25, 2020. The search identified 423 studies, and 397 of them were excluded because they described the pathophysiology and treatment of chronic pain syndromes. The remaining 26 publications formed the basis of this review.

RESULTS: The review presents the current terminology and classification of chronic pain, which is defined as pain that lasts for 3 months or more after the underlying pathology is cured. The work presents the description of terms such as chronic primary pain, chronic secondary pain, cancer-associated chronic pain, chronic postoperative or post-traumatic pain, chronic neuropathic pain, chronic secondary cephalgia or orofacial pain, chronic secondary visceral pain, and chronic secondary musculoskeletal pain. Additional characteristics of chronic pain, including the intensity of pain, the severity of suffering, and physical dysfunction, are also given.

CONCLUSION: The presented modern terminology and classification of chronic pain will contribute not only to the correct formulation of diagnosis established in a patient with chronic pain but also to the implementation of multimodal analgesia, epidemiological studies and, ultimately, the choice of proper strategy for addressing chronic pain by healthcare organizers. The result is also expected to lead to adequate funding for resolving this intricate problem.

BACKGROUND: To date, surgical interventions continue to be accompanied by a high proportion of complications and even death. In half of the cases, mortality and serious postoperative complications could have been prevented. After a comprehensive study of the factors affecting the prolongation of hospitalization and rehabilitation (Kehlet H., 1997; Kehlet H., Wilmore D., 2002), surgical stress response was identified as the most significant inducer of dysfunction among various organs and systems. General anesthesia, in its classical sense, is not able to provide patients with complete protection against surgical trauma. Comprehensive protection can be obtained through a combination of general and local anesthesia and stress-protective drugs.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of the proposed scheme of stress-limiting anesthesia in ophthalmic surgery patients with corneal transplantation.

MATERIALS AND METHODS: This study provides a comparative characterization of the severity of the stress response and pain syndrome in patients operated under the conditions of “classical” general anesthesia (group K) and those who received the scheme of stress-limiting anesthesia (group DB). Multicomponent anesthesia was administered in both groups. Sibazone was used for sedation in group K, whereas dexmedetomidine was used in group DB. The patients in group DB underwent local anesthesia before surgery. The main criteria for assessing the results were as follows: hemodynamic stability, blood glucose, level of venous blood leukocytes, and severity of pain according to the VAS in the postoperative period.

RESULTS: Both schemes helped avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. The analysis of blood glucose and leukocyte counts showed that patients in group K had a more significant deviation for both indicators from the preoperative level than those in group DB. In the study of pain syndrome, group K showed higher levels of pain according to the VAS than group DB.

CONCLUSION: The scheme of stress-limiting anesthesia enables the control of postoperative pain without the additional use of narcotic analgesics and blockades in the postoperative period.

This article examines and analyzes the dependence of the state of the central nervous system (CNS) in the postoperative period in patients who underwent penetrating keratoplasty.

MATERIAL AND METHODS: The analysis of cognitive status was performed using neuropsychological testing involving the scale of frontal dysfunctions (Frontal Assessment Battery–FAB) and a short scale for assessing mental status (Mini-Mental State Examination–MMSE). The results were assessed on the eve of the operation, 6 h after the operation, and 7 and 21 days after the operation. Depending on the applied method of anesthesia, several groups were identified. In group d, general anesthesia (OA) was used with dexmedetomidine infusion 40 min before surgery. In group b (before surgery), a wing-palatine fossa block was performed 20 min, in addition to general anesthesia. Anesthesia was maintained with sevoflurane–oxygen mixture at a low gas flow. The groups were statistically comparable in terms of age and gender. The depth of anesthesia and sedation was assessed using the bispectral index and analgesia nociception index, respectively.

RESULTS: According to the results of testing on the MMSE and FAB scales, the cognitive indicators in the first 6 h after surgery were higher in group d than in group b. However, by day 21, these indicators differed slightly (p < 0.05). Thus, the following tendencies were observed in group b 6 h after the operation: a decrease in indicators on the MMSE scale by 20.8% and on the FAB scale by 28.6% from the initial level. For group d, the indicators on the MMSE scale were reduced by 8.3%, and those on the FAB scale were reduced by 13.3% at the same stage of the study. When testing on the same scales 21 days after surgery, the indicators of cognitive functions were restored to the initial level in both groups.

CONCLUSION: The levels of cognitive functions of ophthalmic surgical patients after surgery involving regional anesthesia and dexmedetomidine differed significantly in the first hours of the postoperative period. After 21 days, the neuropsychological status did not differ significantly (p > 0.05).

This report presents a clinical case of combined anesthesia in a patient with videothoracoscopic atypical resection of the right lung. In the operating room, the patient underwent ultrasound-assisted blockade in the plane of the m. erector spinae (ESP block) using 20 mL of 0.375% levobupivacaine solution, after which general anesthesia was induced. Opioid consumption per surgery was 0.3 mg of fentanyl. In the postoperative period, high-quality multimodal pain relief was achieved without the use of opioids. Within 7 h after the operation, the patient could actively expectorate with minimal discomfort. The article demonstrates the possibility of the effective application of the ESP block to reduce the risk of respiratory complications during lung surgery and to prevent the development of neuropathic post-thoracotomy pain syndrome.

The guidelines contain information on the prevention and treatment of arterial hypotension during cesarean section under neuraxial anesthesia. Vasopressors, elastic compression of lower extremities, co-infusion of crystalloids, low doses of local anesthetics, lateral position, and ondansetron are proposed. A positive effect is achieved only through the joint application of preventive measures.

The life and work of academician Alexander Alexandrovich Vishnevsky are presented. During the Great Patriotic War, Alexander Alexandrovich served as an army surgeon and chief surgeon for a number of fronts. He became the director of the A.V. Vishnevsky of the USSR Academy of Medical Sciences in 1948 and later served as the chief surgeon of the USSR Ministry of Defense starting in 1956. As a student and the closest associate of his father A.V. Vishnevsky, Alexander Alexandrovich participated in the creation of a domestic surgical school and then became its leader after his father’s death. Analysis of the early works of Alexander Alexandrovich reveals his devotion to the anatomical substantiation of local anesthesia based on the method of “creeping infiltrate.” The well-known monograph “Novocaine blockade and oil-balsamic antiseptics as a special type of pathogenetic therapy” (1952), written by Alexander Alexandrovich and his father, is the result of many years of research on the role of nervous trophism in the pathogenesis of a number of surgical diseases. Alexander Alexandrovich also found that in the advanced stages of medical evacuation, surgical interventions on the wounded can be performed under local anesthesia by using the creeping infiltrate method. In peacetime, A.A. Vishnevsky continued to investigate the issues related to anesthesia and nervous trophism and collaborated with his colleagues to address a number of other pressing problems, including the surgery of the heart and blood vessels, mechanisms for compensating for impaired functions of organs and systems, the use of cybernetics and electronics in surgery, burn injuries, and the use of polymers in surgery. Moreover, A.A. Vishnevsky was the first surgeon in Russia to perform a successful open-heart surgery under the conditions of artificial circulation (1957). He was awarded the highest René Leriche International Prize for his work on local anesthesia during heart surgery (1955).