Method Of Postoperative Analgesia Research Articles

Transverses Abdominis-Plane Block for Postoperative Analgesia in Inguinal Hernia Repair under Spinal Anesthesia

Aim: To compare outcome of transverses abdominis plane block versus placebo for postoperative analgesia in inguinal hernia repair under general anaesthesia Study design: Randomized controlled trial Place and duration: Department of Anesthesia Jinnah Postgraduate Medical Centre, Karachi from 6th September 2017 to 6th February 2018 Methodology: One hundred patients with inguinal hernia repair under spinal anaesthesia were enrolled. They were divided into two groups; group A (receiving Bupivacaine) and group B (receiving normal saline). Outcome was checked by comparing both the groups for pain score and analgesic consumption. Results: There were 64(64%) males where as 36(36%) females with mean age of 40.32±6.710 years. In group A, the mean pain score was 4.64±1.54and mean analgesic consumption was 139.38±46.98 while in group B it was 5.62±1.29and 238.30±44.49. Conclusion: The ultrasound directed transversus-abdominis plane block delivers an efficient and virtuous post-operative analgesia method. It also decreases the requirement of analgesic with provision of reliable visual analogue scale scores having reduced complications after the surgery of inguinal hernia. Keywords: Pain score, Analgesic consumption, Spinal anesthesia, Inguinal hernia

“COMPARISON OF USG GUIDED BILATERAL TRANSVERSUS ABDOMINIS PLANE BLOCK V/S PORT SITE INFILTRATION OF LOCAL ANAESTHETIC FOR POST OPERATIVE ANALGESIA IN LAPAROSCOPIC SURGERIES”

Introduction: Transversus abdominis plane Block and Port site inltration with Local Anaesthetic are different method for postoperative Analgesia. Here, we compared analgesic effectiveness of these two methods for postoperative Analgesia in laproscopic surgeries. Material and methods: After obtaining institutional ethical committee approval and informed written consent this study was conducted in 100 patients, randomly divided in two groups belonged to either port site inltration (group P) or USG guided TAP block (group T) for postoperative analgesia in laparoscopic surgeries. They were compared in terms of demographic characteristics, hemodynamic parameters, VAS score, duration of analgesia, Time to rst rescue analgesic requirements and any side effect related to drug and procedure. Duration of analgesia, VAS score and Result: Hemodynamic parameters were comparable among both the groups. Duration of analgesia is more in group T than group P. VAS score is higher in group P than group T. Lesser complications were observed with TAP block (group T). Bila Conclusion: teral USG Guided TAP Block with inj. ropivacaine after completion of elective laparoscopic surgeries renders patients relatively longer duration of pain free period post operatively as compared to Port site inltration with inj. ropivacaine

Methods of local anesthesia in postoperative anesthesia of oncosurgical operations on the nasopharynx in children

BACKGROUND: Postoperative analgesia should begin even in the operating room, so that at the time of awakening the patient does not experience pain and discomfort. The work is devoted to the problems of postoperative analgesia using local anesthesia techniques in oncosurgery of the nasopharynx in children.
 AIM: The aim of the study to analyze the primary results of the use of local anesthesia methods in postoperative analgesia in pediatric oncosurgery of the nasopharynx.
 MATERIALS AND METHODS: A study was conducted in the immediate postoperative period (16 hours) in ten patients, whose average age was 14 years with ENT surgical pathology. The physical status of the children corresponded to the III class according to the ASA classification. The patients were divided into two equal groups of 5 people: the 1st group included children who, for the purpose of postoperative analgesia at the end of the surgical intervention, underwent conduction anesthesia of the nose from three points according to Weisblat; the 2nd group (comparison group) is represented by patients in whom infraorbital anesthesia was used after surgery. Non-invasive monitoring of systolic and diastolic blood pressure, heart rate was carried out. The oxygen status was monitored by pulse oximetry.
 RESULTS: The data obtained from the analysis of hemodynamic parameters, pain assessment by VAS (Visual Analog Scale) testified to the effectiveness of pain relief in patients in the study groups. The main hemodynamic parameters and pain assessment data for the groups were similar to each other and were within the reference values. There were differences in the duration of postoperative analgesia.
 CONCLUSIONS: The proposed methods of postoperative analgesia make it possible to abandon the use of narcotic drugs, synthetic opioid analgesics, non-steroidal anti-inflammatory drugs, but not excluding analgesics antipyretics. The positive first results of this study provide for the need for a further set of observations, possibly in different clinics due to the relative rarity of oncological pathology of the nasopharynx in childhood.

Posterior quadratus lumborum block versus epidural analgesia for postoperative pain management after open radical cystectomy: A randomized clinical trial.

In open abdominal surgery, continuous epidural analgesia is commonly used method for postoperative analgesia. However, ultrasound (US)-guided fascial plane blocks may be a reasonable alternative. In this randomized controlled trial, we compared posterior quadratus lumborum block (QLB) with epidural analgesia for postoperative pain after open radical cystectomy (ORC). Adult patients aged 18-85 with bladder cancer (BC) scheduled for open RC were randomized in two groups. Exclusion criteria were complicated diabetes mellitus type I, lack of cooperation, and persistent pain for reasons other than BC. In one group, a bilateral US-guided single injection posterior QLB was performed with 3.75 mg/ml ropivacaine 20 ml/side. In the other group, continuous epidural analgesia with ropivacaine was used. Basic analgesia was oral paracetamol 1000 mg three times daily, and long-acting opioid twice daily in both groups. All patients had patient-controlled rescue analgesia with oxycodone. Postoperative cumulative rescue opioid consumption was recorded for the day of surgery, and the following 2 postoperative days (POD 0-2). Secondary outcomes were postoperative pain and nausea and vomiting. In total, 20 patients (QLB), and 19 patients (epidural analgesia) groups, were included in the analyses. Cumulative rescue opioid consumption on POD 0, being of duration 9-12 h, was 14 mg (7.6-33.3) in the QLB group versus 6.1 mg (2.0-16.1) in the epidural analgesia group, p = 0.089, and as doses, 8 doses (3.6-15.7) versus 4 doses (1.3-8.5), p = .057. On POD 1 consumption was 25.3 mg (11.0-52.9) versus 18.0 mg (14.4-43.7), p = .749, and as doses 12 (5.5-23.0) versus 10 (8-20), p > .9, respectively. On POD 2 consumption was 19.1 mg (7.9-31.0) versus 18.0 mg (5.4-27.6) p = .749, and as doses 8.5 (5.2-14.7) versus 11 (3.0-18.0) p > .9, respectively. Opioid consumption did not differ significantly between posterior QLB and an epidural infusion with ropivacaine for the first 2 postoperative days following RC. ClinicalTrials.gov identifier NCT03328988.

Fascia iliaca compartment block using ropivacaine 0.5% for postoperative analgesia in lowerlimb orthopaedic surgeries

Background and Purpose: Conventional treatment of postoperative pain with routine analgesics during orthopaedic surgery leads to undesirable side effects, especially in the elderly. Therefore, this study was designed to evaluate the efficacy of compartment block of the fascia iliaca in postoperative analgesia with ropivacaine. Methods: We performed compartment block of the fascia iliaca with 30 ml of 0.5% ropivacaine in 20 patients undergoing lower limb orthopaedic surgery under general anaesthesia. Results: Verbal pain score (VPS) decreased significantly 1 hour after blockade, and the mean duration of analgesia was 4.85±2.86 hours. Conclusion: Compartmental block of the iliac fascia is a very useful method for postoperative analgesia in orthopaedic procedures of the lower limbs.

Research progress on the analgesic effect of acupuncture on laparoscopic patients

Laparoscopic surgery is an effective means to treat abdominal diseases, but it can also lead to postoperative pain symptoms, so relieve postoperative pain plays a vital role in patients. Acupuncture is an ancient Chinese medical method, which is considered to be one of the most effective postoperative analgesia methods. Acupuncture can not only relieve pain, but also reduce postoperative body reactions, such as postoperative inflammatory reaction and gastrointestinal reaction, enhance human immunity, enable patients to have a good convalescence experience, and reduce the occurrence of postoperative pain, which has a very important value. This paper will introduce in detail the analgesic mechanism of acupuncture on postoperative pain in laparoscopic patients. To discuss the clinical progress of acupuncture in the treatment of postoperative pain in laparoscopic patients.

The effect of paravertebral block as a part of multimodal analgesia for laparoscopic cholecystectomy surgery

Aims: In laparoscopic cholecystectomy surgery (LCS), for anesthesiologist and surgeons postoperative analgesia method is still problem. The aim of this study is to evaluate the effect of preoperative paravertebral block (PVB) application as a part of multimodal analgesia on postoperative pain management in this surgery.
 Methods: In this prospective, randomized, single blinded study, over 18 years old, 70 (ASA I-II) patients who underwent elective LCS were included. In the control group, analgesia was managed with only traditional multimodal analgesia methods, while ultrasound- guided PVB (20 ml of 0.5% bupivacaine,T7 level) was added to multimodal anagesia in the study group. Postoperative pain reduction was evaluated using VAS at 1, 6, 12 and 24 hours postoperatively, and morphine consumption amount was caLCSulated with IV patient-controlled analgesia in the postoperative period.
 Results: Demographic data were similar in both groups. VAS scores at 1 and 6 hours were statistically significantly lower in the PVB group (p<0.05). When evaluated in terms of morphine consumption, it was observed that significantly less morphine was consumed in the PVB group compared to the control group in the first 24-hour period (p< 0.001). Shoulder pain was seen only in 3 patients in the control group.
 Conclusions: In LCS, it was observed that PVB application under the guidance of US increased the effectiveness of multimodal anagesia and decreased postoperative morphine consumption. In addition, problems such as postoperative nausea, vomiting and shoulder pain were less common.

Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review.

Laparoscopic cholecystectomy (LC), unlike laparotomy, is an invasive surgical procedure, and some patients report mild to moderate pain after surgery. Transversus abdominis plane (TAP) block has been shown to be an appropriate method for postoperative analgesia in patients undergoing abdominal surgery. However, there have been few studies on the efficacy of TAP block after LC surgery, with unclear information on the optimal dose, long-term effects, and clinical significance, and the analgesic efficacy of various procedures, hence the need for this review. Five electronic databases (PubMed, Academic Search Premier, Web of Science, CINAHL, and Cochrane Library) were searched for eligible studies published from inception to the present. Post-mean and standard deviation values for pain assessed were extracted, and mean changes per group were calculated. Clinical significance was determined using the distribution-based approach. Four different local anesthetics (Bupivacaine, Ropivacaine, Lidocaine, and Levobupivacaine) were used at varying concentrations from 0.2% to 0.375%. Ten different drug solutions (i.e., esmolol, Dexamethasone, Magnesium Sulfate, Ketorolac, Oxycodone, Epinephrine, Sufentanil, Tropisetron, normal saline, and Dexmedetomidine) were used as adjuvants. The optimal dose of local anesthetics for LC could be 20 mL with 0.4 mL/kg for port infiltration. Various TAP procedures such as ultrasound-guided transversus abdominis plane (US-TAP) block and other strategies have been shown to be used for pain management in LC; however, TAP blockade procedures were reported to be the most effective method for analgesia compared with general anesthesia and port infiltration. Instead of 0.25% Bupivacaine, 1% Pethidine could be used for the TAP block procedures. Multimodal analgesia could be another strategy for pain management. Analgesia with TAP blockade decreases opioid consumption significantly and provides effective analgesia. Further studies should identify the long-term effects of different TAP block procedures.

Cryoablation in 350 Nuss Procedures: Evolution of Hospital Length of Stay and Opioid Use

IntroductionCurrent studies show cryoablation decreases opioid requirements and lengths of stay (LOS) in patients undergoing the Nuss procedure for pectus excavatum. This study evaluated the relationship between cryoablation and clinical outcomes for the Nuss procedure. MethodsA retrospective single-center chart review was performed on patients undergoing the Nuss procedure with intercostal cryoablation from December 2017-August 2021. Demographics, hospital course, and postoperative complications were abstracted. To evaluate the evolution of outcomes over time, the earliest quarter (Q1) of cryoablation patients was compared to the last quarter (Q4). ResultsOver 45 months, 350 Nuss procedures with cryoablation were performed. The mean age at operation was 15.7 ± 2.3 years with an average Haller Index of 5.4 ± 4.2. The mean operative time was 136 ± 40.5 minutes. On average, patients used 2.8 ± 2.5 OME/kg of opioid in hospital with a LOS of 2.7 ± 1.1 days. The Q4 patients were discharged 1.3 days earlier (p<0.05) than Q1 patients, with 80% of Q4 discharged by postoperative day #2 vs. 23% in Q1 (p<0.05). Q4 patients received 74% (p<0.05) less opioid in hospital and 21% (p<0.05) less on discharge. Within 90 days postoperatively, complication rates (chest tube placement, wound infection, readmission, neuropathic pain) were similar. Only two patients (0.6%) required reoperation for bar migration/slippage. ConclusionWith increased experience, cryoablation for the Nuss procedure decreased opioid use by 74% and was associated with 80% of patients achieving early discharge. Major complication rates were not increased. Cryoablation can be successfully implemented as an effective method of postoperative analgesia. Level of EvidenceLevel III

Incidence rate of chronic pain after 1.5-2 years of thoracotomy between paravertebral block versus epidural block: a cohort study.

Paravertebral block and epidural block are frequently employed for post-thoracotomy pain relief. It is not clear which postoperative analgesia method is effective for the chronic pain after the postoperative long term progress. Our hypothesis was that paravertebral block would be more effective than epidural block for chronic pain 1.5-2 years after thoracotomy. A cohort study investigating postoperative pain was performed in lung cancer patients undergoing thoracotomy between the ages of 20-80 year-old, employed for another randomized controlled trial. In previously study, the patients were randomly allocated into either the epidural block or paravertebral block group (n = 36/group). Patients in each group received the respective block placement with continuous 0.2% ropivacaine infusion at 5 ml/h. The patients completed a telephone observational survey using the EQ-5D-5L at 1.5-2 years. Forty-eight patients, 23 in the epidural block group and 25 in the paravertebral block group, were included in the final analysis. Quality of life scores at 1.5-2 postoperative years was similar in both groups. Mean scores ± standard deviation and 95% confidence interval were 0.899 ± 0.081 (0.705-0.938) in the epidural block group and 0.905 ± 0.079 (0.713-0.938) in the paravertebral block group, respectively, p = 0.81. The incidence rate of chronic postsurgical pain was eight patients; four in the epidural block group (17.4%) and four in the paravertebral block group (16.0%). There was no difference in incidence rate of long-term chronic postsurgical pain at 1.5-2 years after thoracotomy between the both groups. Our result will be used for further study protocols.

COMPARISON OF INTRA-ARTICULAR INJECTION OF MORPHINE VERSUS DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN ARTHROSCOPIC KNEE SURGERIES FOR POST-OPERATIVE ANALGESIA: A RANDOMISED DOUBLE BLINDED STUDY

Objective Despite its proven pain-relieving properties, the analgesic effect of intra-articular bupivacaine when administered without adjuvants remains short-lived. The aim of this study was to compare intra-articular injection of Morphine versus Dexmedetomidine as an adjuvant to bupivacaine in arthroscopic knee surgeries for post-operative analgesia Methods A randomized double blinded study was conducted in 60 adults of American Society of Anaesthesiologists (ASA) I &amp; II undergoing elective arthroscopic knee surgery. Patients were randomized to receive morphine 5mg (group M) or dexmedetomidine 1microgram/kg (group D) in combination with bupivacaine 0.25% 19cc. Vitals, Ramsay sedation score and VAS were monitored. Diclofenac Sodium (75mg) was administered intravenously as rescue analgesic at VAS &gt;3. Time to rst request of analgesic and dosage of total analgesic consumption in 24 hours were recorded. Adverse effects, if any were noted. Cases in group M had Results adequate analgesia for 16.20 ± 3.75 hours which was signicantly higher (p value &lt;0.001) than those in group D, that lasted for 9.47 ± 1.36 hours. Total number of analgesic injections required were higher in Group D than in group M (p value &lt;0.001). In group M, none had any side effects while 2 out of 30 in group D had hypotension and urinary retention respectively. Conclusion Combination of intra-articular morphine with bupivacaine provides better analgesia than with dexmedetomidine with prolongation of time required to use rescue analgesic in post-arthroscopic knee surgery.

Ürolojik robotik cerrahilerde bölgesel analjezi tekniklerinin etkinliği: retrospektif klinik çalişma

Objective: The advantages of robot-assisted surgery include shorter incisions, less postoperative pain, perioperative blood loss, and a faster return to daily functions. Thoracic epidural analgesia (TEA) provides highly satisfactory analgesia in abdominal surgery. However, its hypotensive effect, particularly in minimally invasive procedures, exceeds its contribution to rapid recovery. Fascial plane blocks may be more beneficial in that context. This study evaluated the effects of regional analgesia techniques in robotic prostatectomy, nephrectomy, and cystectomy operations. Material and Methods: Following IRB Ethics Committee approval (2021.467.IRB1.134), the records of patients who had undergone robotic prostatectomy, nephrectomy, and cystectomy surgeries were retrospectively reviewed between January 2018 and January 2022. Results: One hundred and forty patients with full documentation were included in this study. Various regional analgesia methods were used. Fascial plane blocks were seen to be used in addition to epidural analgesia. Transversus abdominis plane (TAP) and rectus sheath blocks exhibited satisfactory results in robotic prostate surgeries and TAP blocks in robotic nephrectomy operations. Conclusion: In robotic prostatectomy and nephrectomy operations, we recommend fascial plane blocks as the first-choice method for postoperative analgesia. Keywords: regional anesthesia, robotic surgery, radical prostatectomy, minimally invasive surgery, fascial plane blocks, recovery after surgery

Randomised controlled trial of intramuscular tramadol versus transdermal buprenorphine patch for early postoperative surgical pain.

This study assesses the efficiency of the buprenorphine patch system compared to the routine use of tramadol intramuscular injections in the context of the South African public healthcare sector. Patients were randomised into two groups, who received routine tramadol injections 100 mg every 8 hours intramuscular and buprenorphine patches 5 mcg every hour. The study assessed the first 48 hours postoperatively. A visual discrete pain scale was used to assess the level of postoperative pain as well as all complications associated with insufficient analgesic administration. The sample size included 75 patients in the tramadol group and 75 patients in the buprenorphine patch group. Nine patients (12%, p-value < 0.0001) who received the buprenorphine patch subsequently required additional analgesia. The pain score was found to be significantly less in the buprenorphine patch group on both day 1 and day 2, as were complications such as vomiting, nausea, nightmares, sweating and insomnia. The pain score in the buprenorphine group as significantly lower compared to the tramadol group. The use of the buprenorphine patch showed a slight increase in costs compared to the tramadol group (R7 800.75 vs R7 537.50; p-value 0.483) in the whole study. The study showed that the use of the buprenorphine patch is a reliable and effective method of postoperative analgesia, although it is slightly more expensive compared to the routine use of tramadol. The buprenorphine patch showed significantly better results in all assessed parameters; thus, it may be recommended for use at the Dr George Mukhari Academic Hospital (DGMAH).

The Effectiveness of Periarticular Anesthetic Infiltration in Postoperative Analgesia of Total Hip Arthroplasty.

Objective The present study aims to evaluate the effectiveness of the periarticular hip infiltration technique in the postoperative period of total hip arthroplasty. Methods This is a randomized double-blind controlled clinical trial in patients with femoral neck fractures or hip osteoarthritis submitted to a total hip arthroplasty at our institution. The periarticular infiltration technique consisted of the administration of an anesthetic (levobupivacaine) and a steroid (dexamethasone) agent in the nociceptor-rich tissues of the hip after orthopedic implants placement. The control group received an injection of 0.9% saline into the same tissues. Pain, range of motion, and use of opioid analgesic agents after 24 and 48 hours of the procedure were evaluated, as well as the presence of adverse effects, time to resume walking, and total hospitalization time. Results The study evaluated 34 patients. The experimental group required fewer opioid agents between 24 and 48 hours. The reduction in pain scores was greater in the placebo group. Conclusion Periarticular anesthetic infiltration as a method of postoperative analgesia for total hip arthroplasty reduced the rates of opioid intake between 24 and 48 hours. It provided no benefits regarding pain, mobility, length of stay, or complications.

Comparing Efficacy of Different Methods for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty: Several Issues Need Special Attention.

Comparing Efficacy of Different Methods for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty: Several Issues Need Special Attention.

Analgesic Effect of Ropivacaine Pumped in the Sub Rectus Abdominis Muscle Sheath after Abdominoplasty.

Abdominoplasty is a major surgical procedure in plastic surgery. It removes excess skin and fat, tightens abdominal muscles and fascia, restores normal abdominal anatomy and reshapes the distorted abdominal contour. According to the statistics released annually by International Society of Aesthetic Plastic Surgery (ISAPS) in 2020, there are more than 900, 000 abdominal wall plastic surgeries performed every year worldwide. However, the most commonly used analgesic methods, such as oral administration, intravenous analgesia and local infiltration anesthesia, do not provide the satisfactory analgesic results. We found that intra-sheath injection of ropivacaine of the rectus abdomen was effective in reducing postoperative pain. To retrospectively study the analgesic effect of continuous pumping ropivacaine into the intra-sheath space of rectus abdominis after abdominoplasty. A retrospective study was conducted on 67 patients with total abdominal wall plastic surgery admitted to Plastic Surgery Hospital of Chinese Academy of Medical Sciences from February 2020 to August 2021. The patients were from 25 to 56 years old, with a mean age of 38.5, ASA grade 1-2, BMI 27-33kg/m2, and rectus abdominis muscle separation range of 4-8cm. Based on the methods of postoperative analgesia, we divided patients into the following two groups: 29 patients in the conventional intravenous analgesic group (group A) and 38 patients in the rectus abdominis intrathecal analgesic group (group B). Group A received PCA with sufentanil 1.0μg/kg+ normal saline diluted to 100ml. Group B received continuous pumping of ropivacaine (0.2625%) through the rectus sheath internal tube in 100mL of normal saline and continued pumping at a rate of 2mL /h. Visual analog pain score (VAS score), analgesic pump pressure times and the degree of postoperative satisfaction were recorded at T1 (24h) and T2 (48h). The incidence of adverse drug reactions and complications related to nerve block within one week after operation were also recorded. The clinical data of patients with total abdominal wall plastic surgery in two groups were collected and analyzed. The patients in group B overall had lower postoperative VAS score, less analgesic pump usage, less nausea, vomiting, drowsiness and restlessness and a higher degree of postoperative satisfaction than those in group A. Continuous pumping of ropivacaine through rectus sheath can effectively relieve postoperative pain, reduce postoperative adverse reactions and improve postoperative satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online instructions to Authors www.springer.com/00266 . Body Contouring LOE IV.

Using a consensus acupoints regimen to explore the relationship between acupuncture sensation and lumbar spinal postoperative analgesia: A retrospective analysis of prospective clinical cooperation

ObjectiveThis study evaluated the effectiveness of acupuncture treatment on postoperative pain in patients with degenerative lumbar spine disease, and explored the relationship between the postoperative analgesic effect of acupuncture and the sensation of acupuncture experienced by the patients. MethodsThis retrospective study analyzed the medical records of 97 patients who had undergone an operation by the same surgeon due to degenerative lumbar disease. These patients were divided into acupuncture group (n = 32), patient-controlled analgesia (PCA) group (n = 27), and oral analgesia group (n = 38) according to the different postoperative analgesic methods. During their hospitalization, patients completed daily evaluations of their pain using a visual analogue scale (VAS), and injection times of supplemental meperidine were recorded. Also, the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS) was used in the acupuncture group. ResultsEach of the three treatment groups showed significant reductions in postoperative pain, as shown by reduced VAS scores. The acupuncture group, however, had less rebound pain (P < 0.05) than the other two groups. Both the acupuncture and PCA groups experienced acute analgesic effects that were superior to those in the oral analgesia group. In addition, the higher the C-MASS index on the second day after surgery, the lower the VAS score on the fourth day after surgery. There was also a significant difference in the “dull pain” in the acupuncture sensation. ConclusionThe results demonstrated that acupuncture was beneficial for postoperative pain and discomfort after simple surgery for degenerative spinal disease. It is worth noting that there was a disproportionate relevance between the patient’s acupuncture sensation and the improvement of pain VAS score.

Вплив ТАР-блоку на хірургічні стресові реакції після абдомінальної гістеректомії

Мета дослідження — проведення аналізу різних варіантів післяопераційного знеболювання з точки зору їх впливу на прояви хірургічної стрес-відповіді для оптимізації методу аналгезії. Пацієнтки (n = 105) були розділені на три групи залежно від методу післяопераційного знеболювання. Контролювалися показники варіабельності серцевого ритму, рівень добового кортизолу сечі, а також динаміка рівня глюкози крові. В результаті дослідження було встановлено, що у контрольній групі активація відділів вегетативної нервової системи була несуттєвою. У II групі відзначалася вегетативна дисфункція з підвищенням тонусу парасимпатичного відділу. Застосування ТАР-блоку характеризувалося активацією відділів вегетативної нервової системи. В післяопераційному періоді відзначалася гіперглікемія у всіх групах. Найбільш високі показники були в контрольній групі, в II і в III групах рівень глюкози був нижчим. Показники екскреції кортизолу сечі в контрольній групі були в 3 рази вище порівняно з нормою. У II і III групі — вище в 2,1 і 2,2 раза відповідно. Збільшення екскреції добового кортизолу свідчить про наявність хірургічного стресу в післяопераційному періоді. Застосування ТАР-блоку в післяопераційному періоді характеризується збереженням адаптаційно-компенсаторних реакцій у відповідь на хірургічне втручання, що вигідно відрізняє його від інших методів післяопераційної аналгезії.

Paravertebral Block in Thoracotomy—Comparison between Single-Shot and Catheter Methods

Aim: Thoracic paravertebral block is increasingly used as a method of postoperative analgesia in thoracic surgery. We aimed to compare two different methods of implementation: paravertebral thoracic block with a catheter placed in the epidural space, and a single injection of anesthetic at the end of surgery. Methods: We randomized 60 patients undergoing VATS, in 17 (group A) single-dose paravertebral block, and in another 21 (group B) catheter technique and postoperative infusion of local anesthetic were used, and in the latter, the control group (C) of 22 patients, analgesia was performed according to a standardized protocol with non-steroidal analgesics and opioids as needed. In all patients, in the early postoperative 48 hours, we measured the intensity of pain and opioid consumption. Results: There were no statistically significant differences between the collected preoperative data in the three groups of patients. There were no significant differences in subjective pain sensations in the early postoperative period (up to 12 hours). However, the number of opioids used was significantly lower in groups A and B compared to the control group, and in group B (with catheter technique) after the 12th to 48th hour after surgery there was almost no need for strong analgesics. Conclusion: Continuous infusion of local anesthetic in the area of the surgical incision provides much better pain relief than a single paravertebral block in the area of the incision.

Postoperative prolonged epidural analgesia using disposable elastomeric pumps in elderly patients after spinal neurosurgery

BACKGROUND: Postoperative pain is a significant problem in patients that causes various complications.&#x0D; AIM: To evaluate the efficacy and safety of prolonged epidural analgesia using&#x0D; disposable elastomeric pumps in elderly patients undergoing spinal neurosurgery and its comparison with the traditional method of postoperative analgesia in 80 patients.&#x0D; MATERIALS AND METHODS: Hemodynamic parameters were recorded and the efficiency of pain relief and nature of postoperative complications were assessed in comparable groups. The concentration of interleukin-6 (IL-6) and IL-2 were determined.&#x0D; RESULTS: In the group with prolonged epidural analgesia with 0.2% ropivacaine solution, an adequate level of analgesia was achieved in 92% of the patients. The revealed changes in the blood serum levels of cytokines IL-6 and IL-2 may indicate a balanced response of the immune system in the group with prolonged epidural analgesia.&#x0D; CONCLUSIONS: Prolonged epidural analgesia using disposable elastomeric pumps provides complete pain relief for patients and correction of individual links of the surgical stress response.