Postoperative analgesia. Guidelines

A.M. Ovechkin1, A.Zh. Bayalieva2, A.A. Ezhevskaya3, A.A. Eremenko4, D.V. Zabolotskij5, I.B. Zabolotskikh6, A.E. Karelov7, V.A. Koryachkin5, A.P. Spasova8, V.E. Khoronenko9, D.N. Uvarov10, G.E. Ulrikh5, R.V. Shadrin11

1 FSAEI of HE “I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation” (Sechenov University), Moscow, Russia

2 FSBEI of HE “Kazan State Medical University”, Ministry of Healthcare of Russian Federation, Kazan, Russia

3 FSBEI of HE “Privolzhsky Research Medical University” of the Ministry of Healthcare of the Russian Federation, Nizhnij Novgorod, Russia

4 FSBSI “National Research Center of Surgery n.a. Petrovsky B.P.», Moscow, Russia

5 FSBEI of HE “St. Petersburg State Pediatric Medical University” of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia

6 FSBEI of HE “Kuban State Medical University” of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia

7 FSBEI HE “North-Western State Medical University n.a. I.I. Mechnikov” of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia

8 FSBEI of HE “Petrozavodsk State University”, Petrozavodsk, Russia

9 “Moscow Oncology Research Center n.a. P.A. Hertsen” — branch of FSBI NMRRC of the Ministry of Healthcare of the Russian Federation, Moscow, Russia

10 FSBEI of HE “Northern State Medical University” of the Ministry of Healthcare of the Russian Federation, Arhangelsk, Russia

11 SBIHC “Childrenʼs Regional Clinical Hospital” of the Ministry of Healthcare of Kuban State of the Russian Federation, Krasnodar, Russia

For correspondence: Aleksey M. Ovechkin — MD, professor of Anesthesiology and Intensive care department of FSAEI of HE “I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation” (Sechenov University), Moscow, Russia; e-mail: ovechkin_alexei@mail.ru

For citation: Ovechkin AM, Bayalieva AZh, Ezhevskaya AA, Eremenko AA, Zabolotskij DV, Zabolotskikh IB, Karelov AE, Koryachkin VA, Spasova AP, Khoronenko VE, Uvarov DN, Ulrikh GE, Shadrin RV. Postoperative analgesia. Guidelines. Annals of Critical Care. 2019; 4:9–33.

DOI: 10.21320/1818-474X-2019-4-9-33


Abstract

This article described the main theses of clinical guidelines of the Russian Federation of Anesthesiologists and Reanimatologists on postoperative pain management. The classification, etiology and pathogenesis of postoperative pain, the basic principles and algorithms for diagnosing pain, and the regional and systemic pharmacotherapy of pain in various fields of surgery are consistently presented. Multimodal analgesia is described in detail as a key concept of a current approach to the treatment of postoperative pain. All presented information is based on evidence-based medical data obtained by Russian and foreign researchers.

Keywords: postoperative pain, multimodal analgesia, pain pharmacotherapy, opioid analgetics, non-steroidal anti-inflammatory drugs, paracetamol, ketamine, gabapentinoids, lidocaine, regional analgesia, infiltration analgesia, peripheral nerve blockade, epidural analgesia

Received: 07.07.2019

Accepted: 03.09.2019


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Intraoperative intravenous lidocaine for prevention of chronic pain syndrome

Ya.I. Vasilev, N.G. Marova, A.E. Karelov, P.A. Grib, N.A. Timofeev

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

For correspondence: Yaroslav I. Vasilev, associate professor Vladimir L. Vanevskii anaesthesiology and reanimatology Department of North-Western State Medical University named after I.I. Mechnikov, St. Petersburg; e-mail: vasiliev.yar@gmail.com, yaroslav.vasilev@szgmu.ru

For citation: Vasilev YaI, Marova NG, Karelov AE, Grib PA, Timofeev NA. Intraoperative intravenous lidocaine for prevention of chronic pain syndrome. Alexander Saltanov Intensive Care Herald. 2019;2:92-97.

DOI: 10.21320/1818-474X-2019-2-92-97


Abstract

Chronic pain after a laparoscopic cholecystectomia represents a considerable problem. One of the directions of prevention and treatment of a chronic pain syndrome are attempts of use of various adjuvants from which the most promising results showed antidepressants, antikonvulsant, antagonists of NMDA of receptors, α2-агонисты and local anesthetics.

The purpose of this single center randomized, and placebo-controlled study was to evaluate the impact of IV lidocaine on CPPS (Chronic Postoperative Pain Syndrome).

Materials and Methods. Following approval of the study protocol by the University ethics committee 96 patients were randomized into 2 groups for participation in this study. All patients were ASA class II and III, aged 21 years and older and undergoing elective laparoscopic cholecystectomy under general anesthesia. All patients were randomly allocated into 2 groups of equal size to receive either lidocaine infusion (Lidocaine group), or 0.9 % sodium chloride infusion (Control group).

Results. The incidence of CPPS after 3 months was significantly lower in the Lidocaine group than in the Control group (10 vs 37,3 %, Fisher’s Exact Test P = 0.0069) with an overall incidence of 29.2 %, and after 6 months 18.3 % (16 vs 19.3 % accordingly, Fisher’s Exact Test P = 1.0). Date evaluation of PRI NWC (total and in each of 3 category) 6 month and 12 month after surgery with Fisher’s Exact Test and t Mann Whitney test, could not find any difference in groups.

Conclusion. No differences between control group and lidocaine in 6 and 12 months were found after surgery.

Keywords: Chronic Postoperative Pain Syndrome, CPPS chronic pain, prevention of chronic pain, lidocaine, adjuvants for CPPS treatment, intraoperative administration of lidocaine

Received: 31.01.2019

Accepted: 26.03.2019


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Experience of Multimodal Non Opioid Analgesia after Highly Traumatic after Cancer Surgery in the Head and Neck

V.V. Balandin, E.S. Gorobets

FGBU «Russian Cancer Research Center. n.a. N.N. Blokhin», Moscow

For citation: Balandin VV, Gorobets ES. Experience of Multimodal Non Opioid Analgesia after Highly Traumatic Cancer Surgery in the Head and Neck. Intensive Care Herald. 2016;2:70–73.


Introduction. 80 clinical observations of the adult patients who underwent high-traumatic operations for tumors of the head and neck. Materials and methods. Anesthesia: an admixture of a Nefopam of 1 % 12 ml (120 mg), Lidocainum of 1 % 284 ml (2840 mg) and a Tenoksikam of 1 % 4 ml (40 mg) intravenously with the help of disposable elastomeric infusional pump (volume 300 ml) within 2 days after operation with rate of 6–8 ml/h are presented. Efficiency of anesthesia was estimated by 10-point visual- analog score system (VAS). Intensity of pain didn’t exceed 2.8 ± 0.84 points on the first, and 2.3 ± 0.68 on the second postoperative day. Additional anesthesia was required to 21 % of patients during the first 24 hours and for 12.5 % of patients at the second postoperative day. It was necessary to add narcotic analgetics only at 8.5 % of patients on the first and 3.5 % on the second day after operation. Results. Side effects were revealed in 8 % of patients and include: tachycardia, nausea and a sweating. Conclusions. The presented results demonstrate strong analgetic effect of the developed scheme of anesthesia and its safety. The technique provided early activization of patients, excluding or minimizing use of narcotic analgetics during the postoperative period.

Keywords: postoperative pain, multimodal analgesia, head and neck tumors, nefopam, lidocaine, NSAIDS

Received: 26.04.2016


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