scholarly journals The comparison of effectiveness of two variants of preventive anesthesia/analgesia in cancer surgery

Pain medicine ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 44-50
Author(s):  
I I Lisnyy
Keyword(s):  
Plasma Level ◽  
Pain Intensity ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Surgical Interventions ◽  
Perioperative Analgesia ◽  
Contentious Issue ◽  
Comparison Of Effectiveness

Despite modern drugs and technologies in medicine, the questions of adequate analgesia in the postoperative period remain quite relevant. The effectiveness of preventive analgesia in the perioperative period remains a contentious issue. The study included 53 oncosurgical patients. Gr.1 received dexketoprofen in combination with paracetamol for perioperative analgesia before the operation, Gr.2 the same medication was given before closing the operating wound. Anesthesia in both groups included an inhaled (Sevoran) and an extended epidural. The study showed that the pain intensity on ANI monitoring and the total dose of fentanyl was less in Gr.1, compared to Gr.2. Cortisol plasma level and the level of glycemia in the perioperative period were less in patients in Gr.1 than in Gr.2. Pain intensity after surgery during first postoperative day was lower in Gr.1, then in Gr.2. The administration of multimodal analgesia with paracetamol and dexketoprofen prior to the surgical interventions provides for the best quality of perioperative analgesia in oncological surgical interventions.

scholarly journals Paracetamol as a basic component of a modern approach to adequate perioperative analgesia

Pain medicine ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 15-22
Author(s):  
Khrystyna Zakalska ◽  
O Babiichuk
Keyword(s):  
Side Effects ◽  
Mechanism Of Action ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Evidence Base ◽  
Modern Approach ◽  
Surgical Interventions ◽  
Perioperative Analgesia ◽  
Intravenous Paracetamol ◽  
Current Health Care System

The problem of adequate perioperative anesthesia is one of the most pressing in the current health care system, given its medical, humanistic and socio-economic aspects. Currently, the standard of postoperative analgesia is multimodal analgesia (MMA). One of the major and required components of MMA is paracetamol, which has antipyretic and analgesic effects with limited peripheral anti-inflammatory activity. Most authors consider intravenous paracetamol as a base drug in a multimodal analgesia strategy for a variety of surgical interventions, which reduces the need for opioids and reduces the side effects of the latter, which in turn significantly affects the results of treatment and the length of hospital stay.Numerous studies in many countries have created a broad evidence base for the clinical use of this drug. Due to its pharmacokinetic and pharmacodynamic properties, it has been shown that intravenous paracetamol has several advantages over oral and rectal forms: early and more effective onset of analgesia and stable maintenance of the therapeutic dose of paracetamol are explained by the formation of a faster and higher peak in the concentration of the drug. The side effects of using paracetamol can be compared with placebo. The mechanism of action of the drug is different from the mechanism of action of NSAIDs, however, is still not fully understood. It may possibly involve inhibition of cyclooxygenase, cannabinoid, or nitric oxide pathways in the central nervous system. Intravenous paracetamol is a safe and effective first-line drug for the treatment of moderate pain in the perioperative period.

scholarly journals Nefopam hydrochloride as a component of multimodal analgesia in the postoperative period

Pain medicine ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. 68-75
Author(s):  
Andrii Semenenko
Keyword(s):  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Pain Syndrome ◽  
Multimodal Analgesia ◽  
Early Postoperative Period ◽  
Modern Approach ◽  
Surgical Interventions ◽  
Reduction Of Pain ◽  
Effective Drugs

The modern approach to the multimodal scheme of postoperative analgesia includes the mandatory use of drugs that have a small number of side effects and at the same time have a polymodal effect on the pathogenetic links of pain development. Nefopam hydrochloride is able to prevent the development of: opioid hyperalgesia, stop pain stimuli without respiratory depression, affect platelet aggregation and the condition of the mucous membrane and motility of the gastrointestinal tract, which distinguishes it from classical NSAIDs. Nefopam hydrochloride is characterized by a low risk of addiction with prolonged use, a pronounced anti-sensory effect, especially significant at the stage of awakening and in the early postoperative period. Postoperative analgesia based on nefopam hydrochloride as a component of multimodal analgesia is effective and safe in the absence of absolute contraindications. The planned use of nefopam hydrochloride for the correction of pain reduces complications in the postoperative period and improves the quality of life of patients. Nefopam hydrochloride is one of the most effective drugs for the correction of postoperative tremor syndrome. The use of nefopam hydrochloride as a drug, which is a part of premedication before surgical interventions and a component of multimodal analgesia, improves the quality of the postoperative period due to: reduction of pain syndrome, planned correction of postoperative tremor syndrome and correction of complications arising from inadequate treatment of pain syndrome.

Postoperative Pain Management Surgery

2018 ◽  
Author(s):  
Abhishek Parmar
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Perioperative Period ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Anesthetic Techniques ◽  
Clinical Approach ◽  
Acute Setting ◽  
Pain Medications

Optimal pain management in the perioperative period is essential to improving patient quality of life, preventing postoperative complications, and ensuring improved surgical outcomes.1 This review discusses the optimal clinical approach to pain management in the acute setting, centering on the concept of multimodal analgesia. Various opioid and nonopioid medications available for treating acute pain are discussed, with a focus on the “pain ladder,” adverse effects of pain medications, epidural and regional anesthetic techniques, and common pitfalls to avoid when managing postoperative pain. This review does not discuss chronic pain management.

scholarly journals Tibiotalocalcaneal arthrodesis in osteoarthritis deformation of ankle and subtalar joint – evaluation of treatment results

2020 ◽  
Author(s):  
Tomasz Stołtny ◽  
Bogdan Dugiełło ◽  
Jarosław Pasek ◽  
Karol Szyluk ◽  
Michał Pyda ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Intensity ◽  
Postoperative Period ◽  
Intramedullary Nail ◽  
Clinical Condition ◽  
Early Period ◽  
Early Postoperative Period ◽  
Tibiotalocalcaneal Arthrodesis ◽  
Quality Of Life Scale

Abstract Background Tibiotalocalcaneal arthrodesis (TTCA) is an increasingly used method of stiffening the ankle and subtalar joints in advanced degenerative deformities. Material and methods The study group consisted of 19 men who were subjected to intramedullary and intra-osseous arthrodesis using an intramedullary nail. The average age of patients was 46 years (19–68). The main indication for surgical treatment was post-traumatic arthrosis 11 (58%). In the studied group of patients, clinical condition was assessed using the AOFAS classification, quality of life using the SF-12 scale, and assessment of pain intensity using the VAS scale. The above parameters were evaluated before surgery in the early (under 2 years), intermediate (from 2–5 years) and late (over 5 years) postoperative period. Results Analysis of the results showed that the assessed clinical condition on the AOFAS scale improved from an average of 20.6 points before TTCA to 63.5 points after the procedure. The result was statistically significant (p < 0.0001). Analyzing the results obtained using the SF-12 quality of life scale, a statistically significant increase was found. In the physical sphere of quality of life PCS-12 increased from 26.5 points to 44.2 points (p = 0.0004) and in the mental sphere of quality of life MCS-12 from 46.1 points to 52.6 points (p = 0.030). The intensity of pain ailments, assessed in the VAS scale, decreased in all three periods of postoperative observation (in the early period p < 0.05, in the intermediate period p = 0.23, and in the late period p < 0.05), with the strongest analgesic effect (reduction of pain intensity by 4.3 points on the VAS scale) was observed in the early post-operative follow-up period. Conclusions Tibiotalocalcaneal arthrodesis using an intramedullary nail causes a significant improvement in the clinical condition according to the AOFAS classification, enabling most patients to move independently, a significant improvement in the physical and mental quality of life assessed in the SF-12 scale and a significant reduction in the intensity of pain ailments assessed in the VAS scale, especially in the early postoperative period.

scholarly journals Protocol of intravenous lidocaine infusion in the postoperative period in children operated on abdominal organs

2021 ◽  
Vol 15 (1) ◽  
pp. 41-47
Author(s):  
Evgeny Y. Felker ◽  
Dmitry V. Zabolotskii
Keyword(s):  
Postoperative Period ◽  
Pediatric Anesthesia ◽  
Pain Syndrome ◽  
Early Postoperative Period ◽  
Standards Of Care ◽  
World Federation ◽  
Intravenous Lidocaine ◽  
Surgical Interventions ◽  
Perioperative Analgesia ◽  
Abdominal Organs

BACKGROUND: Many studies indicate the effectiveness of intravenous lidocaine infusion for perioperative analgesia and treatment of intestinal paresis in adults. In the scientific literature, only a few publications focus on the intravenous infusion of lidocaine in pediatric practice. The purpose of the work is to increase the effectiveness of the treatment of pain syndrome after operations on abdominal organs in children by creating a protocol for intravenous lidocaine infusion. MATERIALS AND METHODS: In the development of the clinical protocol, publications included in the databases PubMed, Cochrane, American Society of Anesthesiologists, World Federation of Pediatric Intensive and Critical Care Societies, and American Academy of Pediatrics were considered. The recommendations and standards of care for this problem from the Committee on Pediatric Anesthesiology (Statement on Practice Recommendations for Pediatric Anesthesia, 2016), Society for Paediatric Anesthesia Anaesthesiology, and our own materials for our research performed at the St. Petersburg State Pediatric Medical University. RESULTS: The developed protocol includes 11 provisions, including indications and contraindications to the use of lidocaine infusion, preoperative examination, a list of necessary equipment, the method of infusion, methods of evaluation, and control of postoperative pain syndrome. CONCLUSIONS: A protocol for the management of children in the early postoperative period using intravenous lidocaine infusion, as an alternative to prolonged epidural blockade and systemic anesthesia, is developed. The authors express confidence that further implementation of the protocol in clinical practice will improve the quality of medical care for children after abdominal surgical interventions.

scholarly journals Possibilities of therapy with beta‑blockers in the perioperative period in patients during cardiac and extra‑cardiac surgery

The Clinician ◽  
2020 ◽  
Vol 14 (1-2) ◽  
pp. 73-81
Author(s):  
D. P. Kotova ◽  
V. S. Shemenkova ◽  
V. A. Demina
Keyword(s):  
Postoperative Period ◽  
Beta Blockers ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Successful Outcome ◽  
Myocardial Oxygen Demand ◽  
Cardiac Events ◽  
Perioperative Therapy ◽  
Surgical Interventions ◽  
Wide Range

Сardiac complications are the most frequent non-surgical complications after surgical interventions, increasing the length of the patient’s stay in the hospital, the economic costs and the percentage of deaths. The frequency of patients with cardiovascular diseases who require surgery is also high. Optimization of drug therapy in the perioperative period is one of the factors of successful outcome of the surgical intervention.The pathophysiological basis for the development of many cardiac events in the postoperative period is an increase in the activity of the sympathetic nervous system, which leads to an increase in heart rate (HR) and myocardial oxygen demand. These changes may increase the risk of myocardial ischemia, arrhythmias, and other cardiovascular events in the early postoperative period. For example, the development of myocardial infarction (MI) in the perioperative period leads to an increase in hospital mortality by 15–25 %, and increase in the risk of developing cardiac death in the next few months.The main group of drugs for relieving these effects is beta-blockers (BB). This drug class has a wide range of applications: treatment of angina, arrhythmias, hypertension, MI, heart failure. Currently, there is a large evidence for the possibility and feasibility of using BB in patients undergoing surgery.In this article, the authors highlights the issues of prescribing BB in patients with comorbid pathology in the perioperative period. The analysis and comparison of studies on various aspects of BB use in the perioperative period performed. Currently, there is a mixed opinion about the benefits and risks of perioperative therapy of BB, which causes the high relevance of this issue for discussion.

scholarly journals Influence of the choice of the method of perioperative analgesia on the possibility of early initiation of enteral nutrition as part of early rehabilitation in pediatric laparoscopic oncosurgery

2021 ◽  
Vol 7 (4) ◽  
pp. 43-47
Author(s):  
O. A. Petina ◽  
N. V. Matinyan
Keyword(s):  
Gastrointestinal Tract ◽  
Enteral Nutrition ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Epidural Block ◽  
Surgical Interventions ◽  
Perioperative Analgesia ◽  
Early Activation ◽  
Caudal Epidural Block ◽  
Caudal Epidural

Introduction. The need to perform nutritional support for children with cancer is widely recognized. The body of a child suffering from a malignant tumor needs additional amounts of energy and plastic substrates. Patients with signs of protein-energy insufficiency are at risk of developing complications in the early postoperative period. A significant role in compliance with early rehabilitation after surgery (ERAS) protocol is played by the method of perioperative analgesia. Caudal epidural block is the most widely used regional method of analgesia in children, allowing to start earlier enteral nutrition and prevent the development of postoperative paresis of the gastrointestinal tract (GIT), thereby speeding up the recovery of patients after surgery. In this study, we evaluated the effectiveness and safety of early enteral nutrition tactics in oncology children, in the postoperative period during laparoscopic surgical interventions, in order to prevent gastrointestinal paresis in combination with early activation of patients. In the present study, we evaluated the effectiveness of the tactics of choosing perioperative analgesia from the perspective of the possibility of early initiation of enteral nutrition in children with oncopathology, in the postoperative period after laparoscopic surgical interventions, in order to prevent paresis of the gastrointestinal tract in combination with early activation of patients.Materials and methods. The study included 40 patients of the research Institute of Children's Oncology and Hematology of the Russian Ministry of health, ASA II—III, operated in 2017—2019for malignant abdominal tumors by laparoscopic method. Patients were divided into 2 groups randomly. The CB group included 23 children who were treated with caudal epidural block as a regional component of combined anesthesia (CB group, n = 23). The control group-GA included 17 children who underwent General anesthesia (group GA, n = 17).The analysis of the early postoperative period (day 1) was performed. Postoperative nutritional support was performed to prevent gastrointestinal paresis in combination with early activation of patients and consisted of early (from day 1 after surgery) enteral nutrition. We used a therapeutic mixture of Alfare® based on whey protein hydrolysate (for children under 1 year) and Peptamen® Junior based on hydrolyzed whey protein, a complete balanced dry mix (for children from 1 year to 10 years). The volume of enteral nutrition was calculated based on the number of calories per kg of body weight. We started therapeutic nutrition with volumes of 1/2-2/3 of the calculated volume and increased the volume to the required patient tolerance.Results. Enteral nutrition in children in the CB group was connected from 4.7 ± 0.5 hours. In the GA group, enteral nutrition was switched on in 10 (59 %) patients 20 hours after the end of surgery. 5 children developed gastrostasis, which required medication to stimulate the gastrointestinal tract.Conclusions. This study demonstrates that in the conditions of effective neuroaxial blockade in the perioperative period, it is possible to start enteral nutrition as early as possible, reducing to a minimum the frequency of postoperative intestinal paresis during laparoscopic surgical interventions, contributing to early and rapid recovery of patients.

scholarly journals Multimodal perioperative analgesia with minimally invasive interventions on the mammary gland

Pain medicine ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 43-46
Author(s):  
D. E. Korenyuk ◽  
A. G. Tkachuk ◽  
Yu. M. Terzi ◽  
V. Ya. Lagunov ◽  
A. G. Antonenko ◽  
...  
Keyword(s):  
Mammary Gland ◽  
Minimally Invasive ◽  
Postoperative Period ◽  
Breast Tissue ◽  
Pain Syndrome ◽  
Multimodal Analgesia ◽  
Aspiration Biopsy ◽  
Perioperative Analgesia ◽  
Vacuum Aspiration ◽  
Full Life

The article presents the study of the use of parenteral forms of drugs Infulgan and Nalbuphine on the base of the Regional Mammological Center and the Department of Anesthesiology N 1 of Clinical Oncology Dispensary (Dnipro). We have generalized the experience of using these agents as part of multimodal perioperative analgesia in 15 patients who underwent a vacuum aspiration biopsy of the mammary gland using the “Mammotome HH” device. We assessed the intensity of pain in the postoperative period and the need for additional anesthesia. The results of the study showed that the pre-emptive multimodal analgesia with the use of par cetamol in the form of an infusion of Nalbuphine was effective and safe for perioperative analgesia in outpatient minimally invasive diagnostic and therapeutic operations on breast tissue. Such anesthesia made it possible to reduce the doses of anaesthetics used in the postoperative period, facilitating the return of patients to a full life after breast vacuum aspiration biopsy. Our experience may be recommended for relief of the pain syndrome after minimally invasive surgery interventions.

Low opioid anesthesia and opioid free anesthesia use in pain control treatment in postoperative period

2019 ◽  
Vol 32 (1) ◽  
Author(s):  
Ewa Komorowska-Wojtunik ◽  
Anna M. Lotowska-Cwiklewska ◽  
Urszula Kosciuczuk ◽  
Andrzej Siemiatkowski
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Pain Control ◽  
Scientific Evidence ◽  
Opioid Analgesics ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Control Treatment ◽  
Anesthetic Techniques ◽  
Post Operative Nausea

Postoperative pain is a complex and multifactorial symptom that requires a well thought approach using different treatments to achieve the optimal outcome after surgery. Contemporary anaesthesiology, looking for an alternative to analgesia with the use of opioids, more often turns to the protocols of low-opioid and opioid free treatment and pain control. By replacing opioids with non-opioid analgesics, koanalgetics, as well as using local and regional anesthetic techniques, we limit or avoid adverse effects of opioids while maintaining a satisfactory level of analgesia for the patient. Methods of general anesthesia without or with the minimum amount of opioid drugs are of particular importance in bariatric surgery due to a reduction in the incidence of post-operative respiratory depression and excessive sedation. They also allow to achieve and maintain cardiovascular stability in the intraoperative and postoperative period, prevent the occurrence of opioid-induced hyperalgesia (the so-called opioid paradox), and improve the comfort of patients in the post-operative period due to the lower incidence of post-operative nausea and vomiting and constipation. The particular significance of regional and local analgesia techniques, which supplement general anesthesia and reduce the need for analgesics in the perioperative period, is emphasized. This analysis presents the theoretical foundations of multimodal analgesia and existing scientific evidence confirming its benefits in improving pain control after surgery.

scholarly journals Perioperative assessment of cardiological risk in non-cardiac surgical interventions

2020 ◽  
pp. 61-65
Author(s):  
B. S. Ezugbaia ◽  
I. Yu. Sholin ◽  
V. A. Avetisyan ◽  
V. A. Koryachkin ◽  
D. A. Baturin
Keyword(s):  
Water Balance ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Perioperative Period ◽  
Mortality Rates ◽  
Cardiovascular Complications ◽  
Noncardiac Surgery ◽  
Review Of The Literature ◽  
Surgical Interventions ◽  
Perioperative Assessment

During the postoperative period, cardiological complications occupy the first position regarding morbidity and mortality rates. They depend on various factors such as compromised cardiovascular history and type of surgical intervention, features and type of anesthesia, water balance and postoperative care of the patient. To prevent complications, one should reply two questions: is there a risk of cardiovascular complications in the perioperative period and how to avoid them. The article presents a review of the literature on current views on the perioperative assessment of cardiac risks in patients undergoing noncardiac surgery.

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