THE INFLUENCE OF THE TYPE OF ANESTHESIA ON EARLY POSTOPERATIVE RECOVERY IN PATIENTS WITH ABDOMINAL WALL HERNIAS

Abstract

Introduction. Pathways to improved recovery after surgery are aimed at reducing surgical stress, maintaining physiologic homeostasis and returning to the patient's baseline functional level prior to surgery.A significant number of patients are operated on each year for hernias of the abdominal wall. One of the unwanted frequent complications is chronic postoperative pain. It can begin as an acute postoperative pain that is difficult to control, the provoking factor can be opioid hyperalgesia. A multimodal analgesia strategy involves combinations of analgesics to achieve clinically necessary analgesia while minimizing significant side effects and reduces dependence of any drug and is an important component of enhanced recovery after surgery (ERAS) protocols.
 Goal. To assess the efficiency of the types of anesthesia regarding postoperative analgesia and the speed of recovery from the standpoint of patient safety.
 Materials and methods. 66 patients who underwent surgical treatment of abdominal wall hernias took part in the study. They were divided into 3 groups according to the type of anesthesia (general, neuraxial and fascial blockades of the abdominal wall). Analyzed according to the risk of anesthesia. At different stages of the perioperative period, the use of analgesics was analyzed, the speed of awakening and the intensity of pain according to the VAS scale on the first day were assessed.
 Results and discussion. The number of patients with the risk of ASA II was greater in the first group (general anesthesia), with the risk of ASA III in the second and third groups (neuraxial anesthesia and fascial blocks), which to some extent affected the choice of the type of anesthesia. According to the Aldrete awakening scale, after the operation, the patients of group 3 had the highest score, respectively, and the shortest time of transfer to the postoperative ward. 42% of patients in group 1 and all patients in group 2 received postoperative analgesia with the use of narcotic analgesics once. Patients in group 3 did not receive narcotic analgesics for postoperative analgesia.
 Conclusions. The choice of anesthesia method is important to achieve effective results of rapid recovery. Neuraxial and fascial blocks promote faster recovery and allow to reduce or avoid the use of opioid analgesics during surgery. Fascial blocks of the abdominal wall provide long-term and adequate analgesia in the first day of the postoperative period after hernioplasty of the abdominal wall.