Vol 15, No 2 (2021)

In the March 2021 issue of the journal Pharmacoepidemiology & Drug Safety, an article by K. Bykov et al. was published, which contains an analysis of the use of opioid and non-opioid analgesics in US clinics in the period 2007–2017. According to the authors, the frequency of use of drugs in this group does not tend to decrease, despite the previously announced “opioid epidemic” in the USA. In Russia, the problem of the emergence of opioid dependence due to the perioperative use of drugs of this group is of little relevance. The existing legal restrictions on the prescription of opioid analgesics minimize this risk. But these same limitations make the idea of opioid-free analgesia very attractive in our country.

The American Society of Anesthesiologists (ASA) Classification of Physical Status is a widely used system for assessing the preoperative status of patients. The ASA class definitions have been amended several times since 1941, which caused some difficulties in using the classification. There are some difficulties in the assessments, especially between the I–II and II–III classes of the ASA. To overcome this problem, clinical samples presented in the latest edition of the classification play a significant role. In this article, we have presented an updated classification of the physical condition of patients on the ASA scale before anesthesia and surgery, which is sufficiently simple, reproducible, and can be successfully used not only in adults, but also in pediatric and obstetric anesthesiology.

This paper presents the key data on the effectiveness and safety of the regional anesthesia of the scalp, also known as the scalp block, for providing perioperative analgesia for supratentorial craniotomy. The authors describe the technique and its limitations and also trace the implementation of the scalp block method into the routine practice of the largest Russian neurosurgical clinic based on personal experience, results of the own research, and analysis of literature data.

BACKGROUND: The retrobulbar block in children is used to enucleate analgesia in the intra- and postoperative period and prevent oculocardiac reflex (OCD), postoperative nausea, and vomiting. However, when the block is performed blindly, it results in serious complications.

AIM: This study aimed to evaluate the efficacy and safety of a retrobulbar block performed under ultrasound guidance compared with a retrobulbar block performed blindly during enucleation of the eyeball in children with retinoblastoma.

MATERIALS AND METHODS: A prospective randomized controlled trial was performed. The study included 40 patients who met the inclusion criteria. The patients were divided into two groups: 20 patients who underwent ultrasound-guided retrobulbar blockade (RBВ + ultrasound) and 20 patients who underwent blindly retrobulbar blockade (RBВ).

RESULTS: There was an insignificant decrease in intraoperative opioid requirements in the RBB + ultrasound group, where the average dose of fentanyl was 4±1.4 μg/kg, and in the RBB group, 4.7±0.8 μg/kg (p <0.05).

The time before the administration of the first dose of analgesic in the postoperative period was 4.7±0.8 h in the RBB group and 11.7±3.3 h in the RBB + ultrasound group (p <0.05). VAS and CHIPPS scores obtained 6 h after the end of surgery in the RBB + ultrasound and RBB groups were 1.8 (1.2; 2) and – 2.5 (3.8; 4.5) points (p <0.05), respectively.

CONCLUSION: There was no statistically significant difference between the time of the retrobulbar blockade under ultrasound guidance and the retrobulbar regional block performed blindly. Retrobulbar blockade performed under ultrasound guidance provides a decrease in intraoperative opioid requirements, stable intraoperative hemodynamics, and longer postoperative analgesia.

BACKGROUND: Excessive production of reactive oxygen species (ROS) by leukocytes can cause damage to intrinsic tissues. The pathogenesis of sepsis is based on an excessive inflammatory response of the body. Several studies have reported the inhibitory effect of lidocaine on neutrophilic granulocytes.

AIM: This study aimed to analyze the effect of lidocaine on the oxidative activity of phagocytes.

MATERIALS AND METHODS: Blood from 16 healthy donors was used in this study. Leukocyte mass was extracted using spontaneous sedimentation. Half of the leukocyte samples were incubated in buffered physiological saline with lidocaine. The other half of the leukocyte samples were incubated in physiological saline without lidocaine. The generation of ROS was studied using two methods. Method 1 included a nitro blue tetrazolium (NBT) test), which is based on the ability of ROS to reduce NBT to insoluble diformazan. Method 2 was based on the chemiluminescence reaction. A culture of S. Aureus was used to induce the production of ROS.

RESULTS: NBT test revealed a decrease in the oxidative activity of leukocytes in the presence of lidocaine by 18% (p <0.05). The study of luminol-dependent chemiluminescence of leukocyte suspension in the presence of lidocaine revealed a significant 2-fold decrease in both spontaneous and stimulated respiratory activity of cells.

CONCLUSIONS: After incubation with lidocaine, phagocytes generated ROS to a significantly lower extent. However, their complete blockade was not recorded. This property of lidocaine may be used in clinical practice to treat an excessive inflammatory response in sepsis.

This study describes two clinical cases of unexpectedly long duration of motor block after anterior sciatic nerve block. In two patients who underwent total knee replacement, the motor block reversion in the area of sciatic nerve innervation did not occur at the expected time. Ultrasound examination revealed the deposition of a local anesthetic near the sciatic nerve. In these two clinical cases, unintentionally prolonged sciatic nerve blockade was caused by combined age-related factors of reduced tissue perfusion and the vasoconstrictor properties of levobupivacaine. Subsequently, the block was successfully resolved in 36–38 h without any neurological consequences.

30 июня 2021 г. исполнилось 90 лет доктору медицинских наук, профессору Виктору Ивановичу Страшнову. Профессор В.И. Страшнов родился в 1931 г. в Винницкой области. В 1954 г. с отличием окончил I Ленинградский медицинский институт им. акад. И.П. Павлова, затем был оставлен в клинической ординатуре на кафедре госпитальной хирургии. По предложению акад. АМН СССР Ф.Г. Углова Виктор Иванович занялся изучением новой для того времени специальности – анестезиологии, которой впоследствии посвятил всю свою жизнь. С 1956 по 1957 г. прошёл стажировку по анестезиологии и реаниматологии в НИИ сердечно-сосудистой хирургии им. А.Н. Бакулева, в 1960–1961 гг. обучался на международных курсах Всемирной организации здравоохранения по анестезиологии в Дании, где получил диплом анестезиолога Копенгагенского университета. В период с 1961 по 1964 г. Виктор Иванович заведовал отделением анестезиологии и реаниматологии на кафедре госпитальной хирургии I Ленинградского медицинского института им. акад. И.П. Павлова, с 1964 г. он избирается по конкурсу на должность ассистента этой же кафедры.