Abstract
The objective: to assess the efficiency of spinal analgesia as a part of anaesthesiologic support in laparoscopic colon surgeries within fast track programs. Subjects and methods: 60 patients who had laparoscopic colon surgeries within fast track programs were divided into 2 groups. In Group 1 ( n = 30), peri-operative analgesia was provided through intrathecal administration of 10.0–12.5 mg of bupivacaine and 200 mcg of morphine. In Group 2 ( n = 30), the systemic multi-modal analgesia was provided (nonsteroidal anti-inflammatory drugs, opioids). Results. The maximum intensity of pain at rest within 24 hours after surgery was assessed as 2 (2−3) scores as per the digital rating scale in Group 1 and 5 (4−6) scores in Group 2 ( p < 0.0001). The intensity of pain by the first verticalisation made 3 (2−5) scores in Group 1 and 6 (6−7) scores in Group 2 ( p < 0.0001). Intra-operative consumption of phentanyl, frequency of post-operative nausea, vomit and need for extra pain relief were much lower in Group 1. Conclusion. Intrathecal administration of 10.0−12.5 mg of bupivacaine and 200 mcg of morphine as a part of anaesthesiologic support in laparoscopic colon surgeries provides effective peri-operative analgesia and promotes the implementation of fast track programs in this type of interventions.
Highlights
Subjects and methods: 60 patients who had laparoscopic colon surgeries within fast track programs were divided into 2 groups
In Group 1 (n = 30), peri-operative analgesia was provided through intrathecal administration of 10.0–12.5 mg of bupivacaine and 200 mcg of morphine
Intra-operative consumption of phentanyl, frequency of post-operative nausea, vomit and need for extra pain relief were much lower in Group 1
Summary
Intrathecal administration of 10.0−12.5 mg of bupivacaine and 200 mcg of morphine as a part of anaesthesiologic support in laparoscopic colon surgeries provides effective peri-operative analgesia and promotes the implementation of fast track programs in this type of interventions. Программа ускоренного восстановления (ПУВ) при лапароскопических вмешательствах на толстой кишке предъявляет новые требования к периоперационной анальгезии. Нестероидные противовоспалительные средства (НПВС) и парацетамол не всегда обеспечивают достаточный уровень обезболивания, применение наркотических анальгетиков сопровождается нежелательной седацией и тошнотой, эпидуральная анальгезия может стать причиной слабости в нижних конечностях, а блокада поперечного пространства живота не влияет на висцеральный компонент боли после операции. Особый интерес представляет применение в комплексе анестезиологического пособия у пациентов данной категории спинальной анальгезии. Поскольку рутинное применение торакальной эпидуральной анальгезии при лапароскопических операциях на толстой кишке не рекомендовано [7], практическое значение имеет проведение сравнительной оценки СМА с добавлением морфина гидрохлорида и системной мультимодальной анальгезии. Цель исследования: оценка эффективности СМА в комплексе анестезиологического пособия при лапароскопических операциях на толстой кишке в условиях ПУВ
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