СРАВНИТЕЛЬНАЯ ОЦЕНКА ЭФФЕКТИВНОСТИ И БЕЗОПАСНОСТИ ПРОДЛЕННОЙ ЭПИДУРАЛЬНОЙ ИЛИ ПРОВОДНИКОВОЙ АНАЛЬГЕЗИИ ПОСЛЕ ЭНДОПРОТЕЗИРОВАНИЯ КРУПНЫХ СУСТАВОВ НИЖНИХ КОНЕЧНОСТЕЙ У ОНКОЛОГИЧЕСКИХ БОЛЬНЫХ

During the prospective non-randomized study 340 patients were operated due to bone tumors in the volume of tumor removal with consequent defect replacement with megaprothesis of the hip (n = 52), knee (n = 254), ankle (n = 11) joints and total endoprosthesis of femur (n = 23). The combination of spinal or superficial general anesthesia with epidural (n = 101) or conduction (n = 239) analgesia was used for pain relief. The regional pain relief after surgery continued for 3-4 days. The level of pain, need for additional pain relief, frequency of failures and complications were studied as per the digit rating scale. The following nonparametric analysis methods were used for statistical processing: U-Mann-Whitney test or Fisher’s exact test. The number of patients with acceptable pain level after surgery and the need for additional pain relief were non statistically different in the groups with epidural or conduction pain relief. With post-surgery epidural pain relief compared to conduction analgesia arterial hypotension (12% versus 5%, p = 0.035) and dysuric disorders (5% versus 0.4%, p = 0.010) developed more often. The conduction analgesia turned out to be more complicated from technical point of view. Conclusion: given the similar efficiency of pain relief the conduction analgesia compared to epidural one has been followed by the less number of the side effects. В проспективном нерандомизированном исследовании 340 больным выполнены операции по поводу опухолей костей в объеме удаления опухоли с последующим замещением дефекта мегапротезом тазобедренного (n = 52), коленного (n = 254), голеностопного (n = 11) суставов, тотальным эндопротезом бедренной кости (n = 23). Для обезболивания применяли сочетание спинальной или неглубокой общей анестезии с эпидуральной (n = 101) или проводниковой (n = 239) анальгезией. После операции регионарное обезболивание продолжали в течение 3–4 сут. Изучали уровень боли по цифровой рейтинговой шкале, потребность в дополнительном обезболивании, частоту неудач и осложнений. Для статистической обработки применяли непараметрические методы анализа: U-тест Манна – Уитни или точный критерий Фишера. Количество больных с допустимым уровнем боли после операции, а также потребность в дополнительном обезболивании статистически не различались в группах эпидурального или проводникового обезболивания. На фоне послеоперационного эпидурального обезболивания, по сравнению с проводниковым, более часто отмечали развитие артериальной гипотензии (12% против 5%, p = 0,035) и дизурических нарушений (5% против 0,4%, p = 0,010). Технически более сложной оказалась проводниковая анальгезия. Вывод: при одинаковой эффективности обезболивания проводниковая анальгезия, по сравнению с эпидуральной, сопровождалась меньшим количеством побочных эффектов.

Первый опыт применения блокады запирательного нерва в целях предотвращения спазма приводящих мышц бедра при трансуретральной резекции мочевого пузыря

The objective is to study the possibility of using the obturator nerve block under the control of nerve stimulator to prevent the thigh adductor muscles spasm during transurethral resection of bladder tumor.Materials and methods. The prospective randomized study included data obtained during the surgical treatment of 50patients with lateral wall bladder tumor, which was subjected transurethral resection of the bladder. In the GA group (n = 25) was performed general anesthesia with use muscle relaxants, in the NS group (n = 25) spinal anesthesia was performed in combination with obturator nerve block by 10 ml of a 2 % solution of lidocaine under the control of nerve stimulation.Results. The thigh adductor muscles spasm was observed in 5 cases (25 %) in the GA group and in 3 cases (12 %) in the NS group (p = 0.702), this was the cause of bladder perforation in 1 (4 %) patient in the NS group. The incidence of arterial hypotension in the NS group was lower than in the GA group (0 % versus 32 %; p = 0.004), as well as the incidence of sinus bradycardia (12 % versus 48 %; p = 0.012). The time of being in operating room in the NS group was 45 minutes (40; 53) versus 60 minutes (50; 85) in the GA group (p = 0.006).Conclusion. The spinal anesthesia in combination with obturator nerve block under the control of nerve stimulation, as well as the general anesthesia with use muscle relaxants did not guarantee the absence of adductor muscles spasm during transurethral resection of the lateral wall bladder. The obturator nerve block under the control of nerve stimulation only can not be recommended to prevent perforation of the bladder wall in these interventions.Цель исследования — изучение возможности применения блокады запирательного нерва под контролем нейростимулятора для предупреждения спазма приводящих мышц бедра при трансуретральной резекции мочевого пузыря.Материалы и методы. В проспективное рандомизированное исследование включены данные, полученные при хирургическом лечении 50 больных, которым в связи с новообразованием, расположенным на боковой стенке мочевого пузыря, была выполнена трансуретральная резекция мочевого пузыря. Пациентам контрольной группы (группа ОА; n = 25) проводили общую анестезию с использованием миорелаксантов, исследуемой группы (группа НС; n = 25) — спинальную анестезию в сочетании с блокадой запирательного нерва 2 % раствором лидокаина 10 мл под контролем нейростимуляции.Результаты. Спазм приводящих мышц бедра отмечался у 5 (20 %) пациентов группы ОА и 3 (12 %) группы НС (р = 0,702), что стало причиной перфорации мочевого пузыря у 1 (4 %) больного группы НС. Частота артериальной гипотензии в группе НС была ниже, чем в группе ОА (0 % против 32 %; p = 0,004), также как и частота синусовой брадикардии (12 % против 48 %; p = 0,012). Время нахождения в операционной в группе НС составило 45мин (40; 53) против 60 мин (50; 85) в группе ОА (р = 0,006).Заключение. Спинальная анестезия с блокадой запирательного нерва под контролем нейростимуляции, как и общая анестезия с мышечными релаксантами, не гарантировала отсутствие спазма приводящих мышц бедра во время резекции боковой стенки мочевого пузыря. Блокада запирательного нерва только под контролем нейростимуляции не может быть рекомендована для предупреждения перфорации стенки мочевого пузыря при данных вмешательствах

Experience with irrigation analgesia after abdominal hysterectomy

A prospective randomized clinical trial was performed in 100 patients who underwent abdominal hysterectomy under endotracheal anesthesia based on sevoflurane and fentanyl. Intraoperatively, ketorolac 30 mg was administered intramuscularly after induction of anesthesia and paracetamol 1 g was injected intravenously 30–40 minutes prior to surgical termination in a control group (n = 25). For postoperative anal- gesia, promedol, tramadol, and ketorolac were used intramuscularly and paracetamol was given intravenously. Three study groups (n = 2 in each) differed from the control group in that during wound suturing a multiperforated catheter was placed above the peritoneum over a length of 15 cm, through which a 10-ml bolus of 0.75 % ropivacaine was first administered, followed by continuous infusion of 0.2 % ropivacaine at a rate of 8 ml/hour for 36 hours. In one irrigation group, ketorolac 30 mg was injected intramuscularly t.i.d. for 2 days; in another group, the agent was added to a ropivacaine solution calculated with reference to 180 mg for 2 days; in the third group, ketoprofen 100 mg instead of ketorolac was used b.i.d. for 2 days. Pain level (by digital rating scale, 0–10) and the need for analgesics were measured. There was no sta- tistical significant difference in the level of pain and the need for analgesics between the wound irrigation and control groups

Anesthesia and analgesia in oncogynecology

Surgical treatment may be of poor quality due to the fact that an anesthesiologist is unaware of the possible scope of surgery and a surgeon is unaware of different modes of analgesia. To improve the interaction of surgical teammates, the authors describe some rules to prepare patients for surgery, anesthesia options, and the principles of good postoperative analgesia

Safety and efficacy of prolonged epidural analgesia after oncologic colorectal surgery

This study demonstrates effective thoracic epidural analgesia by ropivacain 0.2 %, phentanyl 2 mkg/ml, adrenaline 2 mkg/ml in single-use infusion pumps in 124 patients, who underwent surgery for colorectal cancer. Safe, effective and controllable analgesia was observed during surgery and postoperative period. Prolonged analgesia facilitates early rehabilitation and improves gastrointestinal peristaltic activity.  Prolonged epidural analgesia is the recommended method of analgesia in this group of patients

COMPARATIVE EVALUATION OF EFFICIENCY AND SAFETY OF THE PROLONGED EPIDURAL AND CONDUCTION ANALGESIA AFTER ENDOPROSTHESIS REPLACEMENT OF LARGE JOINTS OF LOWER LIMBS IN CANCER PATIENTS

During the prospective non-randomized study 340 patients were operated due to bone tumors in the volume of tumor removal with consequent defect replacement with megaprothesis of the hip (n = 52), knee (n = 254), ankle (n = 11) joints and total endoprosthesis of femur (n = 23). The combination of spinal or superficial general anesthesia with epidural (n = 101) or conduction (n = 239) analgesia was used for pain relief. The regional pain relief after surgery continued for 3-4 days. The level of pain, need for additional pain relief, frequency of failures and complications were studied as per the digit rating scale. The following nonparametric analysis methods were used for statistical processing: U-Mann-Whitney test or Fisher’s exact test. The number of patients with acceptable pain level after surgery and the need for additional pain relief were non statistically different in the groups with epidural or conduction pain relief. With post-surgery epidural pain relief compared to conduction analgesia arterial hypotension (12% versus 5%, p = 0.035) and dysuric disorders (5% versus 0.4%, p = 0.010) developed more often. The conduction analgesia turned out to be more complicated from technical point of view. Conclusion: given the similar efficiency of pain relief the conduction analgesia compared to epidural one has been followed by the less number of the side effects

EVALUATION OF IMPACT OF CONTINUOUS EPIDURAL ANESTHESIA OF LOWER EXTREMITIES ON MUSCLE STRENGTH AFTER TOTAL ENDOPROSTHESIS REPLACEMENT OF THE KNEE JOINT

A prospective, randomized, controlled study included investigation of data of 45 oncology patients who had total endoprosthesis replacement of the knee joint. The control group (n=23) had the continuous block of peripheral nerves for pain relief, and the trial group (n=22) had continuous epidural anesthesia. With the help of mechanic dynamometer the strength of maximum voluntary isometric muscle contraction by flexion and extension of healthy leg in the knee joint was measured in the early postoperative period. Given the continuous epidural analgesia compared with the control group the maximum difference in the muscle strength of lower extremity was observed in the evening on the day of surgery and it made 37% by the knee joint flexion (7.3 ± 6.1 against 11.6 ± 3.2 kgs ∙ m, p = 0.0065, 95% CI 1.2–7.4) and 41% by extension (9.9 ± 8.8 against 16.9 ± 4.9 kgs ∙ m, p = 0.0023, 95% CI 2.6–11.4). On the 1st and 3rd days after the surgery the muscle strength was not statistically different compared to the control group, but it was lower that the preferred level by 14-8%, p < 0.05; in 5–27 patients the reduction of muscle strength was more than 20% of the one in the preoperative period