Vol 16, No 1 (2022)

A main goal of modern anesthesiology is to reduce the body’s stress response to surgical aggression. This needs a multidisciplinary approach: surgeons reduce the invasiveness of surgery, and anesthesiologists use a multimodal approach in the intraoperative and postoperative periods. They combine general anesthesia with epidural anesthesia (EA), which has not only undeniable and proven advantages but also several disadvantages. An interesting alternative is paravertebral block (PVB), a compromise between neuroaxial (EA) and peripheral nerve block. PVB provides analgesic efficacy comparable to that of EA, but with significantly fewer complications and side effects. Many studies have described the widespread and successful use of PVB in thoracic surgery and endoscopic urology. However, the literature on the use of PVB in laparoscopic renal surgery anesthesia is extremely scarce. Thus, large multicenter studies are needed to determine the place of PVB in the anesthetic management of laparoscopic renal surgery.

The epidemiology of acute postoperative pain and complications associated with inadequately controlled acute postoperative pain syndrome were considered. The paper presents treatments for acute postoperative pain, the clinical value of multimodal analgesia in enhanced recovery, and reduction of mortality in patients undergoing open abdominal aortic repair. The problem associated with the limitations of the methods in postoperative pain management after open surgical abdominal aortic repair is also considered. The paper also presents alternative methods of multimodal analgesia in patients undergoing other abdominal surgery. The choice of the optimal method in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair is now significantly limited, as a comparative analysis of alternative methods of analgesia and epidural analgesia in vascular surgery was not conducted. Multicenter studies on multimodal analgesia in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair are therefore required when deviating from the standard protocol.

BACKGROUND: Perioperative myocardial injury (MI) and MI after noncardiac surgery (MINS) makes a significant contribution to the structure of complications and mortality in non-cardiac surgery, including those in traumatology. Spinal anesthesia (SA) is usually used for hip surgery. It may be accompanied by arterial hypotension, which, under certain conditions, becomes a leading factor in MI development. Features of both hypotension and MI in patients with concomitant cardiovascular pathology operated on for hip injury remain insufficiently studied.

AIM: To determine the frequency of intraoperative arterial hypotension and MI after intraosseous osteosynthesis of the hip under spinal anesthesia in patients with concomitant cardiovascular pathology.

MATERIAL AND METHODS: In 275 patients with concomitant cardiovascular pathology, intraosseous synthesis of the hip was performed with SA. The functional class of the patients was assessed according to the American Society of Anesthesiologists scale and the risk of cardiac complications according to the Revised Cardiac Risk Index scale. Blood pressure, heart rate, electrocardiogram, and ST segment were monitored. Before surgery and 1–3 days thereafter, the troponin T level was measured. The frequency of MI and surgical outcomes were assessed.

RESULTS: In the studied sample of patients with hypertonic disease, arterial hypotension associated with SA was observed in 34.2% of cases. Its frequency increased from 15.7% in patients without other comorbidities to 42.9% in patients with a combination of hypertonic disease, CAD, and CHF. A significant relationship was noted between arterial hypotension and MI. A highly sensitive troponin test revealed a significant incidence of myocardial damage (18.2%), and the associated 3-day mortality was 4%.

CONCLUSION: SA-induced arterial hypotension is associated with MI risk and appears to be the most dangerous in patients with a combination of hypertonic disease, CAD, and CHF. Monitoring of troponin T levels in patients with risk factors of MI is one of the ways to reduce postoperative mortality and improve surgery outcomes.