Vol 10, No 4 (2016)

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Total hip replacement is an important orthopedic surgery allowing to increase high-activity profile and longevity of the elderly patients suffered from arthritis and proximal hip fracture. For the good outcome of the surgery we have to use enhanced recovery strategy which in turn needs performing adequate postoperative analgesia. Using painkillers only (per os, i.v., i.m., s.c.) after THR is not enough to reach this aim (well pain relief at rest and during movement) due to low analgesic potency of the non-opioid drugs and adverse reactions related to opioids, so, the regional analgesia methods are widely spread. Considered before as a «gold standard» epidural analgesia method is not quite suitable for the aged patients as so as the sympathetic and motor blocks hinder an enhanced recovery after THR. In recent decades the interest in peripheral regional analgesia methods has been gradually increasing. Fascia iliaca and psoas compartment blocks, local wound infiltration analgesia are getting the modern regional THR postoperative analgesia armamentarium. Each of them has some benefits and pitfalls and only face-to-face comparisons within the scope of clinical trials will give us the basic for the constituting the local and national post-THR analgesia guidelines.

This review is devoted to the treatment of postoperative pain in bariatric surgery. At present, the prevalence of patients with a high degree of obesity is an epidemic that leads steadily growing number of bariatric operations. Showing the risk factors in the traditional approach to the use of opioids in these patients, as well as the consequences of inadequate analgesia in these patients. Details are presented modern pharmacological agents acting on different levels nociceptive system. Substantiates the role of a multi-modal approach to perioperative analgesia, mandatory use of regional anesthesia. The attention to the visualization neuroaxial structures using ultrasound in the context of the implementation of the efficacy and safety of regional anesthesia in patients with morbid obesity. Possible prospects for pain control in bariatric surgery.

The review is concerned the actual problem - the prevention of chronic postthoracotomy pain syndrome in cancer surgery. The analysis of modern investigations and trends dedicated this problem is presented. The advantages and controversies of each method of perioperative management of patients with malignant pulmonary neoplasms underwent lung resections via thoracotomy approach are reported. The authors also present their original method, which reduces two times the incidence of chronic postthoracotomy pain syndrome.

Acute pancreatitis (AP) is one of the most frequent gastrointestinal diseases requiring hospital of microcirculation and ischemia of the pancreas are the main causes of pancreatic necrosis. There is currently no specific therapy of acute pancreatitis. Symptomatic therapy admissions worldwide. AP has an overall mortality of 1%, increasing to 30% in its severe form. Violation focuses on aggressive rehydration, early nutrition, acceptable analgesia, oxygenation, and use of antibiotics is the main treatment for OP. Increasing evidence shows benefits of TEA in animal AP: improved splanchnic and pancreatic perfusion, improved pancreatic microcirculation, reduced liver damage, and significantly reduced mortality. This article provides an overview of research on the use of thoracic epidural anesthesia in the treatment of acute pancreatitis.