Method Of Regional Anesthesia Research Articles

Ultrasound-Guided Greater Ischiatic Notch Plane Block Combined with the Caudal Quadratus Lumborum Block (GIN-TONIC Block) in Dogs Undergoing Pelvic Limb Surgery: Preliminary Results.

This study assessed the analgesic and motor effects of the GIN-TONIC block, a combination of the greater ischiatic notch plane block and the caudal lateral quadratus lumborum block, in 24 dogs undergoing pelvic limb surgery. Dogs were randomly divided into two equal groups: GA received acepromazine [(20 µg kg-1 intravenously (IV)] as premedication, and GD received dexmedetomidine (2 µg kg-1 IV). General anesthesia was maintained with isoflurane, and both groups received a GIN-TONIC block using 2% lidocaine. Nociception during surgery and postoperative pain [assessed using the Glasgow Composite Measure Pain Score (GCMPS-SF)] were assessed. Fentanyl (2 µg kg-1 IV) was administered if nociception was noted and morphine (0.5 mg kg-1 IV) was administered during recovery if the pain scores exceeded the predefined threshold. Motor function was assessed during the recovery period using descriptors previously reported. All dogs received analgesics at the 4 h mark before being discharged. Three and two dogs in GD and GA required fentanyl once. Postoperative pain scores remained ≤4/20 for all dogs except one. Dogs achieved non-ataxic ambulation within 38.9 ± 10.3 and 35.1 ± 11.1 min after extubation in GD and GA, respectively. This study highlighted the potential of the GIN-TONIC block as a feasible regional anesthesia method for delivering perioperative analgesia in dogs undergoing pelvic limb orthopedic surgery.

Multimodal anesthesia: integrated strategies to improve pain management and recovery: a literature review

With the overprescription of opioids fueling the opioid epidemic, postoperative pain management has emerged as a crucial component of surgical treatment. The shift to multimodal anesthesia as a substitute for postoperative pain management is examined in this review of the literature, with a focus on the contribution of ERAS protocols to lower opioid use and enhance patient outcomes. A methodical exploration of PubMed, Google Scholar, and Scopus was carried out to ascertain pertinent publications released during the last five years. Included were articles on non-opioid analgesics, local anesthetic, regional anesthesia, and multimodal analgesia approaches. Targeting different pain pathways and lowering opioid use, multimodal anesthesia incorporates a number of drugs and strategies, such as NSAIDs, acetaminophen, gabapentin, dexamethasone, and NMDA receptor antagonists. Research indicates that multimodal anesthesia is beneficial in lowering postoperative pain, improving healing, and minimizing opioid-related side effects in a variety of surgical specialties. By placing an emphasis on customized preoperative and postoperative therapies, the use of ERAS protocols further optimizes perioperative care. Multimodal anesthesia reduces postoperative pain, shortens hospital stays, and enhances patient satisfaction, according to studies. Nevertheless, obstacles including insufficient funding and poor training prevent regional anesthesia methods from being widely used. To address the effects of the opioid crisis on patient health and healthcare systems, as well as to advance surgical treatment, it is imperative that multimodal anesthesia procedures be clinically implemented and researched further.

Sacrococcygeal pilonidal cyst with the disease onset as an anterior perianal abscess: a clinical case

The aim. To analyze the clinical case of surgical treatment of a patient with a pilonidal cyst (PC) of the sacrococcygeal area, which manifested as an anterior perianal abscess, and to justify the need for an in-depth differential and diagnostic search in patients with corresponding clinical manifestations of perianal pathology. Description of a clinical case. The article describes a clinical case of successful treatment of a 24-year-old patient with a pilonidal cyst of the sacrococcygeal area and a purulent secondary fistula that mimicked a perianal abscess with an incomplete external fistula of the rectum. Data are given on the step-by-step performance of the diagnostic process and the choice of optimal surgical treatment tactics. Results and discussion. The described clinical case is interesting for specialists and its detailed coverage due to: a) the presented atypical course of PC; b) selected diagnostic tactics; c) the selected method of operative treatment of the patient. The points mentioned above are described in detail in the section, with coverage and visualization of possible alternative options for the patient's diagnosis and the use of various tactics for surgical treatment. Conclusions. Conducting an extended differential diagnostic search using additional instrumental imaging methods is justified in patients with pilonidal disease with an atypical or blurred course. Performing a complete perioperative set of examinations allows for choosing the correct surgical tactics for treating such patients. The use of a full-fledged invasive examination of the perianal area using methods of regional or general anesthesia is reasonably justified in case of suspicion of insufficient informativeness of clinical-instrumental, laboratory, and imaging methods of examination

Indicators of pain syndrome in the postoperative period during endoprosthesis of hip and knee joints in patients with diabetes

Hip and knee arthroplasty refer to the widespread surgical interventions. Diabetes mellitus is one of the common diseases that negatively affect the results of these operations.
 Objective — to determine pain syndrome during anesthesia and in the early postoperative period during hip and knee arthroplasty in patients with concomitant diabetes mellitus.
 Materials and methods. The study involved 69 patients who underwent hip and knee arthroplasty surgery. The patients were divided into 3 groups according to the scheme of anesthesia provision. Patients of the first group (n=20) underwent multicomponent low‑flow anesthesia with artificial lung ventilation; in the second group (n=24) spinal anesthesia was used for pain relief; in the third group (n=25) combined spinal‑epidural anesthesia with dexmedetomidine sedation was performed.
 Results. The significant difference in the severity of pain has been reveled in the study groups in the postoperative period after 6 hours, 12 hours, 18 hours and 24 hours. In particular, after 6 hours in group 1, the pain was more severe than in group 2 (p<0,001) and group 3 (p<0,001); in group 2 and group 3, the pain was of the same intensity (p>0,05). At 12 hours postoperatively, the pain in patients in group 1 was significantly higher than in group 2 (p<0,01) and group 3 (p<0,001); and the pain in group 2 was more severe than in group 3 (p<0,05). After 18 hours, the pain in group 1 and group 2 was significantly worse than in group 3 (both p<0,001); at the same time, the pain level in group 1 and group 3 did not differ (p>0,05). At 1 day postoperatively, significantly more pain was observed in group 1 compared to group 3 (p<0,001), and in group 2 compared to group 3 (p<0,001); pain in group 1 and group 2 did not differ (p>0,05).
 Conclusions. Any of the proposed methods can be used for anesthetic support of hip and knee arthroplasty operations, but regional anesthesia methods provided the best results of pain relief in the postoperative period compared to general anesthesia. Patients from group 3 (combined spinal‑epidural anesthesia) were best anesthetized.

Modern methods of regional and postoperative anesthesia during cesarean section: a literature review

The number of cesarean section (CS) deliveries increases annually in Russia. General anesthesia involves certain risks, including difficult or unsuccessful intubation, aspiration, and infectious and thromboembolic complications. Therefore, regional anesthesia is the method of choice for CS. To date, choosing the most effective method of regional anesthesia remains challenging, including in the postoperative period. Thus, this review aimed to compare the effectiveness of regional anesthesia methods used in CS and identify the most preferred ones for use in clinical practice. The authors conducted a literature search in the electronic databases PubMed (MEDLINE), eLibrary, and Google Scholar using the following keywords and their combinations in English and in Russian: «cesarean section», «neural morphine», «regional analgesia», «epidural analgesia», «peripheral nerve block», nerve block», «paravertebral block», «cesarean section», neuroaxial use of opioids», «regional analgesia», «epidural analgesia», «peripheral nerve blockade», «blockade», and «paravertebral blockade». The search results revealed 3 558 in the PubMed database, 94 in eLibrary, and 2 662 in Google Scholar. The results show that the neuroaxial administration of opioids remains the gold standard of pain relief after CS; however, information on the analgesic effectiveness of new blockades, such as anterior block of the quadratic lumbar muscle and block of the muscle straightening the spine, continues to accumulate.

Effectiveness of erector spinae plane block in children with pectus excavatum deformity during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex: a prospective randomized comparative study

BACKGROUND: Despite the widespread use of regional blocks in children, ensuring adequate perioperative pain control during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex remains a problem. The introduction of ultrasound navigation has allowed specialists to increasingly give preference to peripheral blockades; paravertebral anesthesia has proven to be effective in thoracic surgery. However, safer interfascial blocks, including erector spinae plane block, are rarely used in pediatrics, and there is no evidence base for the effectiveness of the method.
 OBJECTIVE: Our aim was to compare the effectiveness of erector spinae plane block with paravertebral blockade during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex in children.
 MATERIALS AND METHODS: A prospective randomized comparative study of children who underwent minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex was conducted from September 2022 to April 2023. According to the inclusion criteria, the selected 39 children were divided into groups: I — paravertebral blockade, and II — erector spinae plane block. The mean arterial pressure, heart rate during the perioperative period stages, postanesthesia recovery by Aldrete scale and pain intensity by the Wong–Baker scale, and stress response markers (cortisol and lactate) were assessed.
 RESULTS: No significant differences were observed in the study groups when comparing mean arterial pressure and heart rate at any of the measurement points of the perioperative period (p 0.05). Further, no significant differences were noted between the groups when comparing cortisol and lactate levels (p 0.05). The awakening level was characterized by a short recovery period and did not differ between the groups (p 0.05). The intensity of pain during the observation period did not exceed 5 points on the verbal rating scale in both groups, and the severity of pain was significantly higher in the group with blockade of the erector spinae plane block only 2 hours after surgery (p 0.05).Postoperative nausea and vomiting were more common in children with erector spinae plane block (p 0.05). No other adverse events were recorded.
 CONCLUSION: Erector spinae plane block is an effective and simple method of regional anesthesia for minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex and can be used as an alternative to paravertebral blockade in children.

Comparison of Caudal Block and Sacral Erector Spina Block for Postoperative Analgesia following Pediatric Circumcision: A Double-Blind, Randomized Controlled Trial

Introduction: Caudal block (CB) and erector spina plane block (ESPB) have been shown to provide effective postoperative analgesia following circumcision. Our aim was to compare the analgesic efficacy of sacral ESPB and CB, as well as the time to first analgesic requirement and postoperative complications. Methods: Patients aged 1–7 years in the ASA I-II group, who were scheduled for circumcision, were included in the study. Blocks were performed under general anesthesia before the operation. Postoperative pain was evaluated using the Face, Legs, Activity, Cry, and Consolability (FLACC) scores. Analgesic requirements in the first 24 h postsurgery, the time of first analgesia requirement, and postoperative complications were recorded. Results: A total number of 150 patients were included in the study. In the CB group, urinary retention was observed. No side effects were observed in the sacral ESPB group. The 4th and 6th h postoperative FLACC scores were lower in the ESP group. The number of analgesic consumption in the first 24 h postsurgery was significantly lower in the ESPB group (p Conclusion: Based on our results, sacral ESPB performed with ultrasonography is a simple and safe regional anesthesia method that can be used to provide effective postoperative analgesia for circumcision.

Blok Pleksus Servikalis Superfisialis pada Insisi Abses Submandibula

This case study explores the use of bilateral superficial cervical plexus block as a regional anesthesia method in a 44-year-old male patient with a submandibular abscess. The patient, who has comorbidities of type 2 diabetes mellitus, renal insufficiency, and grade 1 obesity, underwent a 60-minute abscess drainage incision operation. This technique was chosen based on patient factors and the medical team's preference, avoiding the risks associated with general anesthesia. Lidocaine 2% at 6cc per side was used, demonstrating the effectiveness of the cervical plexus block in this procedure and others such as lymph node dissection and laceration repair. The study confirms that regional anesthesia guided by ultrasound is a quick, resource-efficient, and safe option, with the potential to avoid improper analgesic dosing. For longer procedures, local anesthetics like ropivacaine or bupivacaine can be utilized. The main conclusion is that the superficial cervical plexus block is an effective and safe alternative for anesthesia in certain neck procedures.

Surgeon-administered regional nerve blocks during radical cystectomy: a feasibility study.

To describe the technique for surgeon-administered, ultrasound-guided transversus abdominis plane (SU-TAP) blocks performed during radical cystectomy as a component of multimodal, perioperative pain management. Retrospective, case series of patients receiving SU-TAP blocks just prior to incision for RC. TAP blocks were performed by the surgeon with a standard technique using US guidance to instill an anesthetic solution. The primary outcome was opioid consumption at the intervals of 0-12, 12-24, 24-36, and 36-48h postoperatively. Opioid consumption was reported as oral morphine milligram equivalents (MME). Secondary outcomes included time to perform SU-TAP blocks, and safety of block procedure. 34 patients were included. During the median length of stay of 4days (interquartile range [IQR] 3-7), only 30/34 (88%) of patients required opioids within the first 12h post-op, decreasing to 38% by 48h post-op. The median consumption decreased in the first 48h from 21 MMEs (IQR 9-38) to 10 MMEs (IQR 8-15) at the 0-12 and 36-48h intervals, respectively. The median time to perform block procedure was 6min (IQR 4-8min) and there were no safety events related to the SU-TAP blocks. Limitations include no comparative arm for opioid consumption. Our data suggest that urologists may feasibly perform US-guided TAP blocks as a practical, efficient, and safe method of regional anesthesia. SU-TAP blocks should be considered in ERAS protocols for RC. Future comparative studies on opioid consumption compared to local infiltration and alternative block techniques are warranted.

Analgesic efficacy and safety of regional anesthesia methods in the perioperative period of surgical treatment of unstable spinal fractures: a randomized study

INTRODUCTION: Perioperative anesthesia in spinal surgery is important areas of anesthesiology. Comparison of spine-straightening muscle block (Erector spinae plane block, ESP block) and epidural anesthesia (EA) during spinal surgery may access its effectiveness and safety. OBJECTIVE: To evaluate the efficacy and safety of a single and extended ESP block compared with epidural analgesia in the perioperative period of treatment of unstable vertebral fractures. MATERIALS AND METHODS: A prospective trial involved 110 patients. Three groups of patients were identified: group 1 (n = 35) — with bonuses P block; group 2 (n = 30) — with prolonged ESP block, group 3 (n = 45) — with prolonged epidural analgesia. Systemic hemodynamics, total opioid consumption, pain intensity, complications, the need for additional analgesia were evaluated. RESULTS: There were no differences in hemodynamics and opioid consumption in the intraoperative period. Six hours after surgery the groups with prolonged ESP block (group 2) and prolonged epidural analgesia (group 3) had lower pain indicators on the VAS scale than for group 1. The need for anesthesia (tramadol) for group 1 was significantly higher than for other groups, and amounted to 78 %. The need of opioid was 3 % for group 1, in other groups it was not required. PTR was present in a small percentage in each of the groups, but no statistical differences were found (p = 0.45). In the group with EA, there were 3 cases of urinary retention, 1 case of hip paresthesia. CONCLUSIONS: The use of ESP block allows to achieve effective and safe analgesia during spinal surgery for unstable vertebral fractures. Longer analgesia is provided by prolonged use of the ESP block than by its single use. When compared with prolonged EA, no significant differences were found in the effectiveness of analgesia, the consumption of opioids and the frequency of PTR.

Regional anesthesia for hip surgery in children: A review

Hip joint diseases are one of the most common and difficult problems in pediatric orthopedics, often requiring surgical treatment. In children, intra- and postoperative analgesia after hip surgery is more conservative and limited to epidural anesthesia, which has known disadvantages and limitations, despite the high quality of pain relief. Peripheral regional blocks in hip surgery are widespread in adults. Ultrasound navigation makes peripheral blockades safer and more effective. This largely influenced the spread of their use in children and contributed to the introduction of new methods of planar blockades into practice. The authors analyzed studies on the efficacy and safety of modern methods of peripheral regional blockade used in children during hip surgery. The literature search was conducted in the eLibrary, PubMed, and Scopus databases. By using keywords, 750 literature sources were found, and 65 sources relevant to the purpose of the study were included in the review. The lumbar plexus block and fascia iliaca block are the most studied regional techniques in children, which are not inferior in analgesic efficacy to lumbar epidural and caudal anesthesia. A new and promising method of regional anesthesia of the hip is the pericapsular nerve group block, which has been well studied in adults. However, none of the peripheral regional techniques used for analgesia after hip surgery, has not proven its advantages. Further clinical studies are needed to investigate peripheral regional anesthesia techniques and determine their efficacy and safety in pediatric hip surgery.

Regional Anesthesia for Acute Pain Treatment in Pre-Hospital and In-Hospital Emergency Medicine.

More than half of all emergency department patients seek help for acute pain, which is usually of musculoskeletal origin. Acute pain is often inadequately treated even today, particularly in children and in older patients. In this study, we assess the potential role of regional anesthetic methods in improving the treatment of pain in the preclinical and clinical emergency setting. Pain-related reasons for admission were identified and quantified from emergency admission data. A structured literature search was carried out for clinical studies on the treatment of pain in the emergency setting, and a before-and-after comparison of the pain relief achieved with established vs. newer regional anesthetic methods was performed. 43% of emergency patients presented with acute musculoskeletal pain. The literature search yielded 3732 hits for screening; data on entity-specific pain therapy spectra were extracted from 153 studies and presented for the main pain regions. The degree of pain relief obtained through regional anesthetic procedures, on a nominal rating scale from 0 to 10, was 4 to 7 points for acute back and chest wall pain, >6 for shoulder pain, 5 to 7 for hand and forearm injuries, and >4 for hip fractures. These results were as good as, or better than, those obtained by analgesia/sedation with strong opioids. Modern regional anesthetic techniques can improve acute pain management in the emergency department and, to some extent, in the pre-hospital setting as well. Pain relief with these techniques is quantifiably better than with strong opioids in some clinical situations; moreover, there is evidence of further advantages including process optimization and fewer complications. Data for comparative study remain scarce because of a lack of standardization.

FACTORS THAT INFLUENCE THE NEGATIVE RESULTS OF TREATMENT OF COMBATANTS' PAIN AFTER MINE-BLAST WOUNDS DURING THE WAR IN UKRAINE

Introduction: In 83.3% of cases, pain in combatants who sustained mine-blast injuries during the war in Ukraine becomes chronic. Chronic pain leads to a number of negative aspects that affect the quality of life of combatants, and when they return to military service after treatment for professions that require people to act under pressure, it increases the risk not only for them but also for their teammates and the mission. Therefore, the issue of pain chronicity in this category of patients requires further study, and the identification of factors that influence the frequency of chronicity can potentially improve the results of treatment of this category of patients.
 The aim: to identify factors that influence the negative results of pain treatment in combatants after mine-blast wounds during the war in Ukraine
 Materials and methods: We analyzed the treatment of 660 combatants with mine-blast wounds. Treatment outcomes were assessed using a visual analog scale (VAS). Groups were compared using the Mann-Whitney test and the chi-square test with a continuity correction. To analyze the association of the risk of a negative treatment outcome with the factor characteristics, we used the method of building univariate and multivariate logistic regression models. The quality of the models was assessed by the area under the ROC curve (AUC). The odds ratio was calculated to quantify the degree of influence of the factor attribute.
 Results: It was found that the factors of negative results of pain treatment in combatants with mine-blast wounds are: 1) method of pain treatment (p<0.001), OR=0.06 (95% CI 0.04-0.09); 2) high intensity of pain according to VAS on admission (p<0.001), OR=3.16 (95% CI 2.52-3.98); 3) anesthetic risk according to ASA (p=0.049) OR=0.67 (0.45-0. 99); 4) number of injured anatomical body parts (p=0.015), OR=1.17 (95% CI 1.03-1.32); 5) a combination of indicators: method of pain treatment, patient age and number of injured anatomical body parts AUC=0.82 (95% CI 0.79-0.85).
 Conclusions: Our study demonstrates that if combatants with mine-blast wounds use a method of pain treatment that does not provide reliable control over the intensity of pain, then during evacuation to a medical facility, such pain becomes high-intensity pain. In addition, the conditions of the injury (combat conditions) and the injury itself cause a significant anesthetic risk according to the ASA. Such patients are associated with a higher risk of chronic pain. In the future, in-depth studies are needed to demonstrate the effectiveness or benefits of combining pain management with regional anesthesia methods. High-quality pain control during the medical evacuation of wounded from the battlefield to a medical facility could potentially improve the treatment outcomes of these combatants and reduce the incidence of pain chronicity.

Brachial plexus block using only 1% lidocaine to reduce pain during the endovascular treatment of dysfunctional arteriovenous access.

Interventional endovascular treatments of dysfunctional arteriovenous (AV) access for hemodialysis can cause pain and discomfort to the patients. Ultrasound-guided brachial plexus block (BPB) is an alternative regional anesthesia method, but conventional BPB using ropivacaine or bupivacaine may cause long-lasting motor power loss, significantly reducing patient satisfaction. This study aimed to introduce BPB using only 1% lidocaine, which induces sensory loss while minimizing motor block, and evaluate the efficacy and safety of this procedure. This retrospective study was conducted on 277 consecutive patients with dysfunctional AV access requiring percutaneous transluminal angioplasty (PTA). Of these, 174 patients underwent the BPB procedure using 1% lidocaine. Time data were recorded, and the motor strength grade (MRC scale, grade 0-5) was evaluated. Numeric rating pain score (NRPS, grade 0-10) was asked during every PTA, and overall NRPS and satisfaction scores (scale 1-3) were asked after the procedure was completed. Of the 174 patients who received BPB, the success rate was 100%, and there were no significant complications related to BPB. The MRC scale measured at the time when the complete sensory loss was achieved was 1.99 ± 0.63, and that at the point of sensory recovery when the block effect expired was 3.93 ± 0.62, indicating a good grade of motor strength. The average NRPS during PTA in the BPB group was significantly lower than that of the control group without BPB (1.04 ± 2.04vs 6.30 ± 2.71, p < 0.001). The overall satisfaction score was significantly higher in the BPB group than in the control group (2.79 ± 0.50vs 2.00 ± 0.81, p < 0.001). BPB using only 1% lidocaine can induce a sensory block while minimizing the effect on motor function. It can be applied safely in an outpatient clinic setting with relatively higher satisfaction.

Responsiveness to Infusion Load under Regional Anesthesia after Off-Pump Coronary Artery Bypass Graft Surgery

Objective. To evaluate the effect of erector spinae plane block (ESPB) and epidural anesthesia on responsiveness to infusion load after coronary bypass surgery on a beating heart.Materials and methods. A prospective randomized single-center study included 45 patients who were grouped into 3 equal arms based on anesthesia techniques: general anesthesia in combination with ESPB (GA+ESPB), general anesthesia and epidural anesthesia (GA+EA) and general anesthesia without regional techniques (GA). Patient’s response to volume loading was assessed using dynamic and orthostatic tests after transfer from the operating room and at the end of the first postoperative day. Passive leg raise (PLR) and standard bolus injection tests were done at the first stage; changes in hemodynamic parameters during verticalization were additionally evaluated at the second stage. Patients with 10% cardiac index (CI) increase after PLR test and 15% increase after bolus injection test were categorized as responders.Results. The concordance of obtained results in PLR and bolus injection tests for the GA+ESPB, GA+ EA and GA groups at the first stage was 0.53 (95% CI 0.12–0.94), 0.68 (95% CI 0.30–1.00) and 0.61 (CI 0.24–0.99), at the second stage — 0.70 (0.32–1.00), 0.84 (95% CI 0.55–1.00) and 0.82 (95% CI 0.47–1.00), respectively. There were no differences in distribution of responders between the groups. CI dynamics did not differ between the groups during verticalization, and there were no associations of CI changes during verticalization with the preceding PLR test results. The dynamics of troponin T and NT-proBNP did not differ between the groups.Conclusion. Methods of regional anesthesia (SPB or EA) do not significantly affect the responsiveness to infusion therapy in the postoperative period after coronary bypass surgery on a beating heart.

Comparison of the eficiency of prolonged ultrasound-guided erector spinae plane block and prolonged epidural anesthesia in minimally invasive coronary bypass surgery

The objective of the study was to evaluate the effectiveness of prolonged ESP-block in comparison with prolonged thoracic epidural anesthesia in MIDCAB surgery. Materials and methods. We conducted a prospective randomised two centre study with 45 patients who underwent MIDCAB surgery. In addition to general anesthesia, prolonged ESP-block was performed in group 1 (n = 22), and prolonged epidural anesthesia was performed in group 2 (n = 23). Results. The decrease in blood pressure caused by the development of the regional block at all stages of anesthesia was more pronounced when using epidural anesthesia. In group 2, the dosage of norepinephrine was higher: 0.06 (0.05; 0.0725) mcg/kg–1/min–1 in group 1 and 0.16 (0.16; 0.16) mcg/kg/min in group 2, p &lt; 0.001. The duration of prolonged mechanical ventilation in group 1 was lower and amounted to 102.5 (90; 110) minutes versus 110 (110; 115) minutes in group 2. The duration of surgery did not differ between the groups, the fentanyl consumption for anesthesia was higher in group 1: 0.7 (0.6; 0.8) mg versus 0.6 (0.5; 0.1) mg in group 2 (p &lt; 0.001). Postoperatively, pain was rated as mild to moderate in both groups, with less pain in the group with epidural analgesia at stages 4 to 32 hours at rest and on coughing. After 48 hours, there were no statistical differences between the groups. The score of pain during coughing in both groups did not exceed 3 points, and patients did not need emergency analgesia. Conclusion. In MIDCAB operations, the prolonged ESP-block is an effective method of regional anesthesia. While providing a sufficiently high level of analgesia, the use of the ESP-block during surgery only slightly increases the fentanyl usage. In the postoperative period, when using the ESP-block, extubation occurs earlier, and analgesia is almost as good as epidural blockade.

ԿՐԾՔԱԳՈՏԿԱՅԻՆ ՄԻՋՓԱԿԵՂԱՅԻՆ ՀԱՐԹՈՒԹՅԱՆ ՊԱՇԱՐՄԱՆ (THORACOLUMBAR INTERFASCIAL PLANE BLOCK - TLIP) ԿԻՐԱՌՈՒՄԸ ՈՂՆԱՇԱՐԻ ԳՈՏԿԱՅԻՆ ՀԱՏՎԱԾՈՒՄ ԿԱՏԱՐՎՈՂ ՎԻՐԱՀԱՏՈՒԹՅՈՒՆՆԵՐԻ ԺԱՄԱՆԱԿ․ ԳՐԱԿԱՆՈՒԹՅԱՆ ՏԵՍՈՒԹՅՈՒՆ

Pain management after spine surgery is challenging and usually not sufficient. Most patients suffer from severe postoperative pain. Numerous studies have demonstrated the effectiveness of various regional anesthetic techniques in postoperative pain management. In recent years, thoracolumbar interfascial plane block (TLIP) has become widely used for perioperative analgesia during lumbar spine surgeries. It is a type of ultrasound-guided plane block, during which a local anesthetic is injected into the fascial plane between the multifidus and longissimus muscles, with the aim of blocking the dorsal rami of the thoracolumbar nerves. TLIP block was first proposed by Hand et al. in 2015. The aim of this study is to review the scientific publications regarding the use of TLIP block in lumbar spine surgery in the most popular electronic databases, such as PubMed, Scopus, Google Scholar, Web of Science, and comparing lumbar spine surgeries with and without TLIP block according to the following criteria: postoperative pain intensity, postoperative analgesic requirement, intraoperative opioid use, incidence of postoperative nausea and vomiting, comparison with other regional anesthesia methods. Analysis of the reviewed literature shows that TLIP block in lumbar spine surgery reduces the requirement of perioperative analgesics, decreases the intensity of postoperative pain up to 24 hours postoperatively, reduces the frequency of postoperative nausea and vomiting, therefore, is an effective method and can be used in daily practice. At the same time, almost all researchers consider that obtained data quality is low and that more studies with a larger number of patients and a longer duration are needed to statistically confirm the obtained data. In particular, studies are needed to determine whether TLIP block is sufficiently effective compared to other regional anesthesia methods, especially erector spinae plane block (ESP), whether TLIP block reduces the incidence of chronic pain syndrome, whether it affects the duration of surgery, postoperative intensive care unit treatment and length of hospital stay, whether TLIP-block reduces intraoperative blood loss, whether it is possible to prolong and enhance the effect of TLIP block with adjuvants, in particular dexamethasone and dexmedetomidine. Thoracolumbar interfascial plane block (TLIP) is a promising method for perioperative analgesia, reduction of analgesic use and postoperative complications in lumbar spine surgery, however, further studies are needed to determine its effectiveness and optimal application methods.

SCALP Block Model in Sprague-Dawley Rats; In Vivo Experimental Study and Model Identification

Introduction: The SCALP block is an important regional anesthesia method. In this study, we analyzed the SCALP block model for the first time in a rat model. Materials and Methods: In this study, 16 rats were divided into four different groups. Six nerve blocks were planned in both halves of the skull for the SCALP block, and three entry points were determined for each. Bupivacaine (Marcaine, AstraZeneca) 0.5 mg/kg was injected in the "low-dose" group, 1 mg/kg in the "medium-dose" group, 2 mg/kg in the "high-dose" group, and 4 mg/kg in the "very high-dose" group. A midline fronto-occipital incision was made, and a craniectomy was performed. At 0, 30, 60, 90, and 120 minutes after the surgical procedure, the rats were evaluated using the Rat Grimace Scale, and their pain scores were evaluated. At the end of 2 hours, the rats were sacrificed, blood samples were taken, and methemoglobin levels were studied. Finally, a comparative analysis was performed between the four groups. Results: In 30, 60, 90, and 120 minutes after surgery, the differences between the grimace scores between low-dose and medium-dose and high-dose and low-dose groups were statistically significant (p&lt;0.001). There was no significant difference between the high-dose and very high-dose groups regarding the grimace scale (p&gt;0.05). Methemoglobin levels were statistically significantly higher after SCALP block with a very high dose of bupivacaine than blockade with a high dose of bupivacaine (p&lt;0.001). Therefore, very high-dose bupivacaine injection was not superior to high-dose bupivacaine injection in pain control. In addition, very high doses of bupivacaine injection can be associated with increased morbidity and mortality due to increased methemoglobin levels. Conclusion: In this SCALP block technique described in rats, a 2 mg/kg bupivacaine injection can be considered an appropriate dosage for both safety and efficacy.

Thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology: A literature review

BACKGROUND: Paravertebral anesthesia is an old regional anesthesia technique, with a history of more than 100 years. Generally, paravertebral anesthesia is used in adults as a strong analgesic tool for pain treatment. Paravertebral anesthesia is not a simple way of inducing regional anesthesia, as it has several complications. Paravertebral anesthesia has been a serious contraindication in pediatric surgery. At present, technical progress in ultrasonography permits the use of paravertebral anesthesia successfully in children in orthopedics and traumatology practice by discovering new possibilities for the surgical treatment of pain.&#x0D; AIM: This study aimed to assess the current state and near-term prospects of using paravertebral anesthesia as a significant component of anesthesia in pediatric orthopedics and traumatology.&#x0D; MATERIALS AND METHODS: Study data were obtained from public scientific sources, which were searched in the PubMed, Crossref, Google Scholar, Scopus, and RSCI databases without language restrictions. The depth of the information search was 90 years (up to 1932). In this study, analysis and synthesis based on the information obtained were used to build an analytic conclusion.&#x0D; RESULTS: Various case reports and case reviews have described the experience of using thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology, as well as reconstructive surgery and revealed that thoracic paravertebral anesthesia (in combination with general anesthesia) is currently the method of choice, competing with the thoracic epidural block and the high back straightening muscle block.&#x0D; CONCLUSIONS: Paravertebral anesthesia as the psoas compartment block with the ultrasonography control is the most reliable and suitable method of regional anesthesia for pelvis orthopedic surgery.

EFFECTIVENESS OF THERAPEUTIC TACTICS FOR ANALGESIA OF PATIENTS WITH GUNSHOT AND MINE-EXPLOSIVE WOUNDS AT THE STAGES OF TREATMENT

Background. The effectiveness of the use of therapeutic tactics for pain relief at the stages of treatment is important considering the fact that chronic pain is diagnosed in 83.3% of patients with mine-explosive wounds, and in 70% of cases with gunshot wounds. In civilian life, among injured patients, this diagnosis occurs in 11-40% of cases. There is not enough data on the reasons for such a high frequency of chronicity. Thus, the study of the effectiveness of treatment tactics for pain relief in patients with gunshot and mine-explosive wounds at the stages of treatment will play an important role and contribute to improving the results of treatment of this category of patients.&#x0D; Aim: To investigate the effectiveness of therapeutic tactics of analgesia in patients with gunshot and mine-explosive wounds at the stages of treatment.&#x0D; Materials and methods. The treatment of 1166 patients with injuries was analyzed. Pain intensity was diagnosed using a visual analog scale. Group comparisons were performed using the Mann-Whitney test and the chi-square test with allowance for continuity correction, Kruskal-Wallis, and post hoc comparisons were performed using Dunn's test.&#x0D; Results. In patients with gunshot wounds, during the analysis, it was found that VAS data significantly depend on the type of anesthesia. Using regional anesthesia, VAS data are the lowest at all measurement points (p&lt;0.05). In patients who received landmine-explosive injuries, VAS data are weakly dependent on the choice of anesthetic support, however, this indicator still has higher values (p&lt;0.05) when using general anesthesia. Two-factor analysis showed a relationship between the dynamics of VAS data and the type of injury (p&lt;0.001), type of anesthesia (p&lt;0.001).&#x0D; Conclusion. Admission of a patient with a wound to a medical center with subsequent analgesia using regional anesthesia methods has the best outcome in terms of pain management and pain control in such patients.