Early Activation Of Patients Research Articles

Transversus abdominis plane block as a component of anesthesia in kidney transplantation

Aim. To evaluate the safety and efficacy of the transversus abdominis plane block in kidney transplantation from deceased donor.Material and methods. The first stage included a retrospective comparative analysis of the results using the transversus abdominis plane block in renal transplantation. Group I (n=30) included patients who underwent transversus abdominis plane block after kidney transplantation; in comparative group II (n=58) the TAP-block wasn’t performed. We assessed the daily requirement for trimeperidine on the first day after kidney transplantation. The second stage was a prospective randomized placebo-controlled study. The patients were randomly divided into 2 groups with respect to whether the transversus abdominis plane block was provided with an active drug, or placebo was used; so the sodium chloride 0.9% was injected into the transversus abdominis plane in the intermuscular fascial plane between the internal oblique and transversus abdominis muscle in patients of Group III (n=31), and a local anesthetic was injected in patients of Group IV (n=34).) The daily requirements for trimeperidine, tramadol were assessed as well as the pain severity according to visual analogue scale at 1, 6, 12, 24 hours after surgery, the incidence of adverse events in the gastrointestinal tract; and several laboratory parameters (cortisol, interleukin-1, interleukin-6) related to pain syndrome were analyzed.Results. As a result of pseudorandomization, 17 cases were included in each of two retrospective stage, which were comparable in terms of patients' main characteristics (p>0.05). The daily requirement for trimeperidine in the transversus abdominis plane block group (Group I) was lower than in the comparison group with a trend toward statistical significance (p=0.07). The median daily dose of trimeperidine in Group III (placebo control) was 59.5 mg (interquartile range: 51.5–72.0), which was higher than in Group IV (45.5 mg; interquartile range: 38.5–62.0) (p=0.039). The postoperative pain severety assessed by visual analogue scale was also statistically significantly higher in group III at the timepoint of 12 hours after surgery, making 4.0 points (interquartile range: 2.5–5.0) versus 1.5 points (interquartile range: 0.5–2.5) in group VI (p=0.015). There were no differences between the groups in pain severity at 1, 6, and 24 hours after surgery. The daily requirement for tramadol was also statistically significantly higher in Group III, amounting to 50 mg (interquartile range: 0–100) versus 0 (interquartile range: 0–55 mg) in the active drug Group IV (p=0.045).Conclusion. Our study showed that the use of the transversus abdominis plain block was safe and effective, yielding encouraging results, which demonstrated a clinically significant reduction in the need for opioid analgesics and in the incidence of adverse events in the postoperative period after transversus abdominis plane block which contributes to the early activation of patients. Therefore, further studies are needed to improve the package of multimodal perioperative analgesia after kidney transplantation.

Multimodal approach to perioperative protection in children in abdominal surgery: A prospective comparative study

OBJECTIVE: To increase the effectiveness of perioperative protection by using combined multimodal analgesia (CMA) with epidural blockade (EA) with bupivacaine in combination with low-flow anesthesia with sevoflurane in traumatic abdominal surgery in children.
 MATERIALS AND METHODS: A prospective comparative study was conducted (n=102, from 1 to 17 years). Surgical planned pathology: Hirschsprung disease, Ledd and Payr syndrome, liver echinococcosis, enterocystoma, pancreatic cyst. Study period: 20182022. Patients were divided into two groups depending on the technique of anesthesia and management of the postoperative period. Group 1 (n=55) received CMA + EA with bupivacaine 0.5%. In the postoperative period prolonged EA with bupivacaine 0.25% 0.51 mg/kg. Comparison group 2 (n=47) traditional general anesthesia based on opioids. For the treatment of postoperative pain syndrome (PPS) promedol 0.3 mg/kg. The effectiveness of perioperative analgesia in pediatric abdominal surgery, the time of development and intensity of postoperative pain syndrome were evaluated.
 RESULTS: The data obtained as a result of the study clearly showed that the advantages lie behind the optimized method of combined multimodal analgesia CMA + EA with bupivacaine 0.5%. In general, the effectiveness of CMA in combination with epidural analgesia in the intraoperative period was quite high. Additional intraoperative administration of fentanyl was registered in 8 (14.5%) of cases. The stability of hemodynamic parameters and neuroendocrine status was noted in almost all patients of the main group. Analyzing the time of development and intensity of PPS, it can be argued that patients of group 1 had better indicators: the duration of the pain-free period was 2 times longer and the intensity of PPS was lower than in children of group 2. Motor blockade gradually resolved in patients on average, after 20946 minutes. By this time, there was a recovery of the sensation of a pinprick and motor activity in 32 (58.1%) of patients according to the Bromage 2 scale. Analysis of the results of an oral survey of patient satisfaction with pain relief conducted 24 hours after surgery showed that in group 1 the number of cases 43 (78.1%) satisfied with the level of pain relief was 1.5 times higher compared to the control group 24 (51.1%).
 CONCLUSION: Combined multimodal analgesia in combination with epidural blockade with bupivacaine in traumatic abdominal surgery in children provides sufficient perioperative stability of the hemodynamic and neuroendocrine status, significantly reduces the pharmacological burden, reduces complications, early activation of patients and rapid postoperative rehabilitation compared to the traditional method.

Surgical Treatment of Fractures of the Trochanteric Zone of the Femur in Older Patients

Summary. Treatment of fractures of the trochanteric zone of the femur in the elderly still remains one of the problems that need further study.
 Objective: to analyze clinical application of internal osteosynthesis for fractures of the trochanteric zone in older and senile patients.
 Materials and Methods. The results of treatment of 102 older patients with fractures of the trochanteric region of the femur were analyzed. All patients were treated surgically using a proximal femoral nail antirotation (PFNA); the indicators at the inpatient stage of treatment and long-term consequences up to 3 years after treatment were analyzed using improved standards for evaluating the quality of treatment of injuries and diseases of the organs of movement and resistance with modification.
 Results and Discussion. Analyzing the treatment of 102 patients with fractures of the trochanteric region type A1, A2, A3 according to the AO classification, it was found that surgical treatment with the use of PFNA proves its effectiveness due to minimally invasive access, minimal intraoperative blood loss, a short time of surgical intervention, and the possibility of early activation of patients and provides low rates of postoperative complications and mortality.
 Conclusions. 1. The conducted clinical study allows us to confirm the effectiveness of the PFNA system in the surgical treatment of older patients with fractures in the trochanteric zone in a trauma hospital. 2. In older patients with fractures of the trochanteric zone of the femur, PFNA osteosynthesis allows restoring the function of the hip joint in 54.6% (55% СІ 85.4-55.8) of cases. 3. PFNA can be recommended as a priority in the treatment of older patients with fractures of the trochanteric region of the femur in a trauma hospital.

Justification of the expediency of using harmless analgesia in bariatric surgery: prospective randomized study

BACKGROUND: The presence of various comorbid conditions in patients with obesity increases operational risk, and high sensitivity to sedatives and opioid drugs can contribute to their aggravation.
 OBJECTIVE: To compare and evaluate two methods of perioperative analgesia, namely, multimodal without opioid and non-opioid when performing longitudinal gastric resection for patients with morbid obesity using the enhanced recovery after surgery protocol.
 MATERIALS AND METHODS: A prospective randomized study of patients with morbid obesity was conducted. Depending on the type of analgesic component of anesthesia, the patients are divided into two groups. In both groups, low-flow desflurane inhalation was used; in group 1 (n=30), the technique of non-opioid analgesia was used, which included intraoperative infusion of ketamine, dexmedetomidine, lidocaine, and magnesium sulfate. In group 2 (n=30), traditional combined anesthesia using fentanyl was administered. In the postoperative period, the infusion of the above drugs continued for 10 h in group 1. Central and peripheral hemodynamic parameters, and the depth of anesthesia were studied, and TOF-monitoring was carried out. Postoperative rehabilitation was assessed based on the time of extubation, achievement of 13 points on the PARS scale, first getting up on ones feet, appearance of overstrain, and gas discharge. Postoperative analgesia was assessed on a 10-point visual analog scale, and anesthesia-related complications were recorded.
 RESULTS: Surgical intervention under low-flow inhalation anesthesia based on desflurane in combination with multimodal opioid-free analgesia reduced the need for opioid analgesics intraoperatively (in group 1, the fentanyl dose was 0.2 [01; 0.2] mg; in group 2 0.4 [0.3; 0.5] mg; p=0.002), provided less fluctuation of intraoperative hemodynamic parameters (AvBP: stage 1: group 1 102 [100; 103]; group 2 102 [98; 105], p=0.96; stage 2: group 1 93 [90; 95]; group 2 96 [93; 99], p=0.003; stage 3: group 1 95 [95; 97]; group 2 100 [96; 102], p 0.001; stage 4: group 1 95 [92; 97]; group 2 98 [98; 101], p 0.001; CI stage 1: group 1 492.2; group 2 49.52.2, p=0.39; stage 2: group 1 44.42; group 2 44.62.1, p=0.26; stage 3: group 1 45.52.11; group 2 50.62.8, p=0.001; stage 4: group 1 44.52.1; group 2 48.82.5 p 0.001), and contributed to a lower level of pain and faster rehabilitation. In addition, anesthesia-related complications such as postoperative nausea and vomiting, hypoxemia, and dysphoria were less frequently recorded.
 CONCLUSION: The use of multimodal non-opioid analgesia contributes to a lesser fluctuation in hemodynamic parameters, a low level of postoperative pain, early activation of patients and restoration of peristalsis, and a decrease in the number of postoperative complications in patients who underwent longitudinal gastric resection for morbid obesity.

Lifestyle Medicine in Diabetes Care: The Lifedoc Health Model.

The relevance of lifestyle medicine in diabetes treatment is now incorporated in clinical practice guidelines but finding an exemplar for the creation of a Lifestyle Medicine Program (LMP) is a difficult task. To use Lifedoc Health (LDH) as a LMP exemplar by describing their multidisciplinary team (MDT) approach to diabetes care along with tactics to address sustainability challenges. The LDH model facilitates early activation of patients with diabetes and other cardiometabolic risk factors, MDT approaches, and protocols/policies that are able to overcome barriers to equitable healthcare in the community. Specific programmatic targets are clinical outcomes, effective dissemination, economic viability, and sustainability. Infrastructure centers on patient-driven problem-based visits, shared medical appointments, telemedicine, and patient tracking. Further discussions on program conceptualization and operationalization are provided. Even though strategic plans for LMPs that specialize in diabetes care are well represented in the literature, implementation protocols, and performance metrics are lacking. The LDH experience provides a starting point for those healthcare professionals interested in translating ideas into action.

Calculation and application of a safe range of load on the limb in patients after osteosynthesis of the femoral neck

BackgroundFractures of the femoral neck occupy a leading place in the total injury rate in the Russian Federation. Despite significant advances in the field of osteosynthesis of femoral neck fractures, there is still a high percentage of unsatisfactory treatment outcomes, including the cases when functional load is applied in the early activation of patients. Therefore, it is very important to find ways to dose the load on the operated limb in the postoperative period in patients with fractures of the femoral neck. The aim of the study is to demonstrate the successful experience of calculating and applying a safe range of load on the limb in patients after osteosynthesis of the femoral neck and substantiate its effectiveness using a universal personalized method of evaluating the results of treatment. MethodsThe study involved 80 patients with fractures of the femoral neck, who had undergone osteosynthesis with various metal structures. A safe range of load on the limb was applied using a method determined by us. The postoperative period results of the selected patients, who formed a comparison group and a study group, were then analyzed using a universal method of personalized evaluation of treatment results. A prospective study was applied. ResultsIt was shown that in the study group of 40 patients, using the method developed by us for dosing the load on the limb, 12 months after surgery, 20.5% more excellent and good treatment results were obtained than in the comparison group. ConclusionsPatients can have a better postoperative outcome owing to the possibility of determining the optimal range of load on the operated limb, which makes it possible to draw up an individual plan for dosing the load from the first day of the postoperative period to the onset of consolidation.

Преимущества местного анестетика Левобупивакаина в амбулаторной эндовитреальной хирургии

Purpose. Comparative analysis of local anesthetics for retrobulbar block in outpatient endovitreal interventions. Material and methods. The study included 30 patients who underwent combined anesthesia: local (regional) and ataralgesia during outpatient endovitreal operations. Local anesthesia was performed in form of retrobulbar block in the muscle cone delineating the retrobulbar space with introduction of 3.0 ml of local anesthetic. Ataralgesia included benzodiazepines and intravenous fentanyl. According to the type of anesthetic, 2 groups of patients were identified: 1st group – 15 patients who received 2% lidocaine solution; 2nd group – 15 patients – 0.75% solution of levobupivacaine. Results. In all 2 groups, a sufficient level of anesthesia was achieved, which made it possible to perform surgical interventions as planned, without complications. The average duration of operation in each group was 15–20 minutes. Stable course of operation, anesthesia and early postoperative period were allowed patient to be discharged for further treatment at place of residence on day of operation. Conclusion. In all patients, the applied method of combining regional anesthesia with ataralgesia made it possible to achieve an excellent level of pain relief and turned out to be approximately comparable in efficiency with both levobupivacaine and lidocaine. The advantage of using levobupivacaine for regional anesthesia was greater strength and duration of anesthesia. The technique was characterized by development of pronounced neurovegetative blockade and protection from surgical stress response, early activation of patients and ability to discharge patient for further treatment at place of residence on day of surgery. Keywords: endovitreal interventions, outpatient surgery, regional anesthesia, ataralgesia, levobupivacaine, lidocaine.

Clinical justification of small-intestine decompression in children with common appendicular peritonitis

The aim of this work: to evaluate the effectiveness of the developed methods of intestinal decompression in the treatment of spilled appendicular peritonitis in children. Materials and methods. The study was conducted on the basis of the 2nd SamMI clinic in the period from 1990 to 2014. Long-term decompression of the small intestine was carried out through appendicostomy or cecostomy, the technique of which was significantly different in the main group (79 patients) and the comparison group (34 patients). Results. The methods we developed for decompression of the small intestine in children with common appendicular peritonitis (WAP) contributed to an earlier restoration of intestinal motility and the appearance of the first independent stool (on day 4), normalization of body temperature by 4-5 days, and a reduction in the duration of the gastric tube (up to 3 days) and early activation of patients (2-3 days).

Minimally Invasive Posterolateral Approach for Surgical Resection of Dumbbell Tumors of the Lumbar Spine.

Minimally invasive spine surgery (MISS) has many advantages over traditional open surgical procedures that can be conducted for the therapy of different diseases of the spine. MISS provide many prospective advantages such as, for example, small incisions, less damage to soft tissues, early activation of patients, and a shorter postoperative hospital stay. The aim of the study was to evaluate institutional experience with Dumbbell tumors and metastatic lesions of the lumbar spine and compare it with traditional open surgical resection of this type of tumors. Fourteen patients underwent the surgery with minimally invasive posterolateral approach in experimental group, and 10 patients of the control group were operated using the traditional open surgery procedure at the Department of spinal neurosurgery and pathology of peripheral nervous system of JSC “National Center for Neurosurgery.” The intraoperative neuro monitoring system (ISIS IOM System Compact, Inomed, Germany) was used in both groups. Sensory and motor evoked potentials were intraoperatively recorded. The present study was approved by the local Ethics Committee of the National Center for Neurosurgery. Patients signed informed consent before the surgical procedure. The experimental group included 14 patients, that underwent the surgery during the period from January 2020 till March 2021. And the control group included 10 patients that was operated from January 2018 to December 2019. The results of the treatment in both groups were assessed according to the generally accepted visual analog scale (VAS) and the Oswestry scales before, on the third day, and 3 months after the surgery. In experimental group, average reduction of the pain syndrome of 3.36 points (from 3 to 0 points) was observed in patients postoperatively according to the VAS 3 days, and of 4.0 points (from 2 to 0 points) 3 months after surgical procedures. Improvement by 23.86% (36–16%) was also observed using the Oswestry Disease Index (ODI) 3 days after the surgery, and then reduced to 21.00% (16–34%) in average in 3 months. All patients were revived 3 h after transfer to the specialist department. The average stay in the hospital was 6.5 (9–4) days in both groups. In control group, average reduction of the pain syndrome of 2.60 points (from 4 to 1 points) was observed postoperatively according to the VAS 3 days after the operation, and of 3.9 points (from 2 to 0 points) 3 months after the surgery. The ODI of patients was also improved by an average of 35.40% (50–20%) 3 days after the surgical procedure, and reduced to 24.20% (16–32%) in average 3 months after the surgery.

Monolateral spinal anesthesia

Spinal anesthesia is a simple and affordable method of anesthesia that provides a sufficient level of intraoperative and postoperative analgesia, muscle relaxation, and early activation of patients. Like all other techniques, it has advantages and disadvantages. The most common side effect of anesthesia is the central hemodynamic disturbance, such as hypotension, which is prevented by unilateral anesthesia. Thus, presented herein are the most common complications and their prevention methods.

Optimization of regional analgesia after total knee arthroplasty based on ipack-block

AIM: To study the efficacy and safety of a combination of the IPACK and the adductor canal blocks (ACB) and compare with the femoral nerve block after total knee arthroplasty (TKA).
 MATERIALS AND METHODS: Double-blind, prospective, randomized, controlled trial with 101 patients. Three groups were distinguished, differing in the chosen method of regional anesthesia. Group 1 included patients with a combination of afferent canal block and IPACK block, group 2 included patients with femoral nerve block, and group 3 included patients with femoral nerve block and IPACK block. Pain at rest and during movement, the need for opioid analgesics in the postoperative period, and the possibility of early activation of patients after knee arthroplasty were assessed on a visual analog scale. The incidence of side effects associated with regional anesthesia was also noted.
 RESULTS: The study showed that the combination of adductor canal blockade and IPACK blockade showed the best effectiveness of pain syndrome control. Patients were less likely to need narcotic analgesics, there was no development of motor block and, as a result, patients were more satisfied with anesthesia. The combination of blockades made it possible to accelerate the rehabilitation of patients in the postoperative period, due to a decrease in pain and the absence of a motor block.
 CONCLUSIONS: The use of IPACK blockade in combination with adductor canal blockade provides effective analgesia and reduces the use of analgesics, as well as increases the patient's rehabilitation potential.

Efficiency of Early Activation of Patients after Onco-Orthopedic Operations in the Framework of Stage I of Rehabilitation

Patients with tumors of the long bones and axial skeleton are at risk of developing significant functional disorders that not only negatively affect socialization and quality of life, but also the results of therapy. At present, there is no consensus on the choice of tactics for early postoperative rehabilitation after arthroplasty of large joints and decompression and stabilization operations in onco-orthopedics. The article analyzes the influence of early postoperative rehabilitation on the general condition of patients after onco-orthopedic operations. Comprehensive rehabilitation improves the general condition of patients after surgical treatment of patients with tumors of the musculoskeletal system.

Uterine fibroids, laparoscopic surgery and morcellation: comparative analysis of the results of organ-preserving operations

Aim. To conduct a comparative analysis of the results of organ-preserving laparoscopic operations performed for uterine fibroids with the use of plastic containers for morcellation and without it.
 Materials and methods. We examined 57 patients with a diagnosis of uterine fibroids who were admitted to the Department of Innovative Oncology and Gynecology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology for organ-preserving surgical treatment. To achieve the goal of the study, the patients were divided into the following groups: the main group 29 patients who underwent laparoscopic myomectomy and morcellation of removed nodes using plastic containers. The control group consisted of 28 patients who underwent morcellation during laparoscopic myomectomy without the use of plastic containers.
 Results. The duration of laparoscopic operations performed using plastic containers main group was 85.6925.87 minutes. Laparoscopic conservative myomectomies, performed without the use of limiting systems, took a slightly longer amount of time control group 88.7530.36 minutes. There were no statistically significant differences, but in the second group, more prolonged sanitation of the abdominal cavity and removal of small fragments of myomatous nodes after morcellation outside the sacs were required. Autoinfusion was used in 6 (20.69%) patients in the main group, in 7 (25%) patients in the control group. Blood transfusion was not used in any case. Average blood loss was 120.6967.50 ml in the main group, 125.0099.54 ml in the control. The duration of hospitalization in the main group was 4.661.76 days, in the control group 5.793.62 days. In the main group, histological examination revealed leiomyoma in all cases, leiomyoma was detected in 96.4% (27 patients) of cases in the control group, and leiomyosarcoma in 1 patient (3.6%).
 Conclusion. In all groups of patients, there was a favorable course of the postoperative period, early activation of patients. In the group of laparoscopic operations, one patient (3.6%) after morcellation of the myomatous node without the use of a plastic container was found to have leiomyosarcoma. The use of plastic containers in our study did not increase the duration of operations and did not affect the volume of blood loss, the frequency of intra- and postoperative complications. In contrast, the operation time was slightly higher among patients who were operated without the use of containers. In all likelihood, this was due to the fact that the morcellation stage itself took longer, since it was required to extract small fragments of myomatous nodes, as well as thorough and prolonged sanitation of the abdominal cavity. It should be noted that the use of plastic containers, of course, requires the development of certain skills from the surgeon, taking less and less time in parallel with the learning curve. Of course, further studies are required to assess the risk of tumor spread in patients undergoing surgery using plastic containers, but preliminary data indicate that ablastic morcellation can and should be used in organ-preserving surgery for uterine myoma.

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

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.

Cystatin C level as a prognostic risk factor for postoperative complications in elderly patients

Annotation. An important criterion for assessing the course of urgent surgical pathology in elderly patients is the concomitant state of sarcopenia. Decreased blood levels of cystatin C, which correlates with decreased muscle mass and strength, is an important screening criterion for perioperative intensive care therapy in these patients. The aim of the study was to increase the effectiveness of intensive care in patients with low sarcopenic index by improving the methods of influencing perioperative risk factors. We examined 90 elderly patients (73.3±7.9 years) with surgical pathology of the abdominal cavity, who underwent emergency surgery under general anesthesia based on sodium thiopental with artificial lung ventilation. Patients were divided into 3 randomized groups by age, sex, anthropometric data, volume and duration of surgery, concomitant comorbid background and perioperative intensive care: group I (n=30) – patients undergoing standard intensive perioperative therapy, group II (n=30) – standard intensive care with the addition of levocarnitine; group III (n=30) – standard intensive care with the addition of levocarnitine and a solution of D-fructose-1,6-diphosphate sodium salt hydrate. Muscle mass was determined by bioimpedancemetry on the analyzer “MEDASS” ABC-02, muscle strength was assessed by wrist dynamometry, muscle-skeletal mass index was calculated. The serum cystatin C concentration was determined by latex-enhanced immunoturbidimetry (DIALAB GmbH, Austria). The significance of the obtained data was checked using the r-Pearson correlation coefficient. It is established that additional prescription of levocarnitine and D-fructose-1,6-diphosphate sodium hydrate salt significantly reduces the number of days of treatment in the intensive care unit, improves prognosis, and promotes early activation of patients. Metabolic changes caused by a decreased sarcopenic index require further research.

Experience of application of accelerated rehabilitation programs in patients with distal pancreas resection

Introduction. The implementation of ERAS (Enhanced recovery after surgery) protocols has been shown to be effective in orthopedics, bariatric and colorectal surgery. However, the safety and feasibility of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection is not well studied. The objective was to analyze the results of the application of accelerated rehabilitation protocols in patients underwent distal pancreatic resection. Methods and materials . A retrospective - prospective, single-center study was conducted. The study included 60 patients. Patients were divided into two groups (control group - 30 patients, perioperative management was carried out according to standard methods and the main group - 30 patients, perioperative management was carried out according to the accelerated rehabilitation protocol). All patients included in the study underwent distal pancreas resection. Results. Patients in the analyzed groups were comparable by gender, age, body mass index, and ASA score. The frequency and severity of postoperative complications in the compared groups was comparable. The frequency of early activation of patients was significantly higher in the main group (86.7 vs 56.7; p<0.001). Postoperative recovery of gastrointestinal tract function was faster in the main group ((2.4±0.9) vs (3.6±1.2); p<0.001). The total duration of the postoperative hospital bed in the compared groups was comparable ((12.9±6.8) vs (14.1±6.1); p=0.2), however, when analyzing a subgroup of patients without complications and with minor complications, the differences in the duration of the postoperative hospital bed in the main and control groups was statistically significant ((8.9±3.6) and (11.7±3.4), respectively, p=0.01). Conclusion. The study showed the safety and effectiveness of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection.

ERAS protocol for perioperative management of patients with non-small cell lung cancer

To evaluate an effectiveness of enhanced recovery program for perioperative support of patients with lung cancer. A prospective single-center study on effectiveness of ERAS protocol in perioperative support of patients with lung cancer was conducted at the Tomsk Regional Cancer Center. According to the study design, patients were divided into three groups. The first group included patients after VATS surgery followed by accelerated recovery. The second and the third groups comprised of patients after open interventions. In these groups, patients were randomized into traditional management or accelerated recovery management groups using the blind envelope method. Patients with indicated lobectomy or bilobectomy were included only. In postoperative period, we analyzed morbidity, pain syndrome and hospital-stay. A total of 235 patients were treated. VATS surgery followed by enhanced recovery program was applied in 61 patients. Eighty-seven patients underwent open operations followed by accelerated recovery protocol and traditional management. ERAS protocol ensured less postoperative morbidity compared to traditional management (p<0.001). Pain syndrome was less pronounced after VATS surgery and did not require an appointment of narcotic analgesics. In the group of open surgery followed by accelerated recovery protocol, narcotic analgesics within 3 postoperative days were required in 38 (43.6%) cases, in the group of traditional management - in 63 (72.4%) patients. Mean postoperative hospital-stay after VATS operations was 6.4 days, after open interventions followed by ERAS protocol - 8.7 days. In patients after open surgery and traditional postoperative management, mean hospital-stay was 14.2 days. One patient died after open surgery followed by ERAS protocol and 3 patients died in the group of traditional management. ERAS protocol ensures less postoperative morbidity, early activation of patients and reduced hospital-stay.

Evaluation of the early mobilization effectiveness after total knee and hip artroplasty

As a result of the introduction of early mobilization, it was possible to achieve early activation of patients, which includes breathing exercises, verticalization and early activation of the operated limb. The introduction of the method of early activation of patients after hip and knee arthroplasty operations allows to achieve a statistically significant reduction of the hospitalization period and allows to provide qualified high-tech assistance medical help to a greater number of patients.

Физическая активность и консолидация переломов проксимального отдела бедра у лиц старческого возраста

We analyzed the results of treatment of 23 patients of old age with proximal hip fractures. We carried out the work on the basis of the trauma department of Kotovsk City Clinical Hospital in the period from 2017 to 2019. After the surgical treatment, patients underwent monthly control examinations, as well as control radiographs after three, six, ten and twelve months. As a result of the study we highlighted three groups. The first group is 8 patients with normal fracture consolidation in accordance with the postoperative treatment term; the second group – 10 patients whose period of consolidation of fracture y exceeded the planned ones; the third group - patients with a non-growing fracture of the femur neck, revealed at control examinations. It is worth noting that all patients, regardless of belonging to one of the groups, performed movement independently or with additional support in the form of walkers, while walking slightly relying on the operated lower limb. Among all patients, we were able to achieve positive results through surgical treatment and subsequent early activation of patients. There were no fatalities.

Optimization of treatment tactics of combined talus and thoracolumbar spine fractures

The combined injuries of the talus and spine are related to severe injuries. There are differences in the choice of tactics for the treatment of injuries of this localization, the sequence and the necessity for surgical interventions, as well as methods of fixation. Unfavorable results of the treatment encourage the need to optimize of treatment tactics, to revise the terms and stages of surgery.Objective: to determine the treatment tactics and optimal surgical technique in patients with combined injuries of the talus and spine.Methods: retrospective analysis of treatment of 5 men aged from 22 to 35 years, with combined damages of talus bone and thoracolumbar spine was made. The tactics of surgical intervention was based on the early activation of patients through the applying of modern methods of osteosynthesis based on the assessment of the morphology of the injury and the prognosis of functional disorders. At the first stage, the measures included the primary anatomical surgical restoration of the talus with internal fixation, at the second stage — stabilization of spinal fractures with posterior transpedicular fixation.Results: the consequences of combined injuries were studied in terms of 1 to 3 years follow-up. Surgical treatment of talus injuries with differential timely approach allowed us to achieve improvement of anatomical and functional results — (90.5 ± 3.2) points according to AOFAS scale, FFI — (4.8 ± 0.4) points (p ˂ 0.05). The loss of correction of kyphotic deformation was 7.9 ± 0.2°. Oswestry index of pain syndrome did not exceed 20 %, which corresponded to a minimum violation and a good follow-up result that allowed patients to return to their previous physical activity.Conclusions: the tactics of surgical treatment of combined injuries of the talus and thoracolumbar spine requires a differentiated approach in the order and timing of surgical interventions, significantly affects the improvement of functional results in most patients.