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


References

  1. Apfelbaum J.L., Chen C., Mehta S.S., Gan T.J. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97: 534–540. DOI: 10.1213/01.ane.0000068822.10113.9e
  2. Gimbel J.S., Brugger A., ZhaoW., Verburg K.M., Geis G.S. Efficacy and tolerability of celecoxib versus hydrocodone/acetaminophen in the treatment of pain after ambulatory orthopedic surgery in adults. Clin Ther. 2001; 23: 228–241. DOI: 10.1016/s0149-2918(01)80005-9
  3. Brennan F., Carr D. Cousins M. Pain management: a fundamental human right. Anesth Analg. 2007; 105(1): 205–221. DOI: 10.1213/01.ane.0000268145.52345.55
  4. Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. DOI: 10.17226/13172
  5. Benhamou D., Berti M., Brodner G. Postoperative analgesic therapy observational survey (PATHOS): a practice pattern study in 7 Central. Southern European countries. Pain. 2008; 136: 134–141. DOI: 10.1016/j.pain.2007.06.028
  6. Gregory J., McGowan L. An examination of the prevalence of acute pain for hospitalised adult patients: a systematic review. J Clin Nurs. 2016; 25 (5–6): 583–598. DOI: 10.1111/jocn.13094
  7. Rawal N. Current issues in postoperative pain management. Eur. J. Anaesthesiol. 2016; 33(3): 160–171. DOI: 10.1097/EJA.0000000000000366
  8. Murray A., Wilhelm F. Retief acute postoperative pain in 1231 patients at a developing country referral hospital: incidence and risk factors. South Afr J Anaesth Analg. 2016; 22: 19–24. DOI: 10.1080/22201181.2015.1115608
  9. Dolin S., Cashman J., Bland J. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br. J. Anaesth. 2002; 89: 409–423. DOI: 10.1093/bja/aef207
  10. Sommer M., de Rijke J., van Kleef M., et al. The prevalence of postoperative pain in a sample of 1490 surgical inpatients. Eur J Anaesthesiol. 2008; 25(4): 267–274. DOI: 10.1017/S0265021507003031
  11. Wu C., Raja S. Treatment of acute postoperative pain. Lancet. 2011; 377(9784): 2215–2225. DOI: 10.1016/S0140–6736(11)60245–6
  12. Gan T.J., Habib A.S., Miller T.E., et al. Incidence, patient satisfaction, and perceptions of postsurgical pain: Results from a US national survey. Curr Med Res Opin. 2014; 30:149–160. DOI: 10.1185/03007995.2013.860019
  13. Treede R., Rief W., Barke A., et al. A classification of chronic pain for ICD-11. PAIN, 2015; 156: 1003–1007. DOI: 10.1097/j.pain.0000000000000160
  14. Овечкин А.М. Лечение послеоперационной боли — качественная клиническая практика: общие рекомендации и принципы успешного лечения боли. Перевод и общая редакция А.М. Овечкина. М.: Astra Zeneca, 2006. — 55 стр. [Ovechkin A.M. Lechenie posleoperacionnoj boli — kachestvennaya klinicheskaya praktika: obshchie rekomendacii i principy uspeshnogo lecheniya boli. Perevod i obshchaya redakciya A.M. Ovechkina. М.: Astra Zeneca, 2006. — 55 pages (In Russ)]
  15. Bouhassira D., Attal N., Alchaar H., et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005; 114: 29–36. DOI: 10.1016/j.pain.2004.12.010
  16. Elia N., Lysakowski C., Tramer M.R. Does multimodal analgesia with acetaminophen, nonsteroidal anti-inflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient controlled analgesia morphine offer advantages over morphine alone? Anesthesiology. 2005; 103: 1296–304. DOI: 10.1097/00000542-200512000-00025
  17. McDaid C., Maund E., Rice S., et al. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side-effects after major surgery: A systematic review. Health Technol Assess. 2010. iii-iv; 14: 1–153. DOI: 10.3310/hta14170
  18. Moore R., Derry S., McQuay H., Wiffen P.J., et al. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Syst Rev. 2011; 9: CD008659. DOI: 10.1002/14651858.CD008659.pub2
  19. Tzortzopoulou A., McNicol E., Cepeda M., et al. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database Syst Rev. 2011; 10: CD007126. DOI: 10.1002/14651858.CD007126.pub2
  20. Aubrun F., Langeron O., Heitz D., et al. Randomized, placebo-controlled study of the postoperative analgesic effects of ketoprofen after spinal fusion surgery. Acta Anaesthesiol Scand. 2000; 44:934–939. DOI: 10.1034/j.1399-6576.2000.440807.x
  21. De Andrade J.R., Maslanka M., Reines H.D., et al. Ketorolac versus meperidine for pain relief after orthopaedic surgery. Clin Orthop Relat Res. 1996; 301–312. DOI: 10.1097/00003086-199604000-00037
  22. Grundmann U., Wornle C., Biedler A., et al. The efficacy of the non-opioid analgesic sparecoxib, paracetamol and metamizol for postoperative pain relief after lumbar microdiscectomy. Anesth Analg. 2006; 103: 217–222. DOI: 10.1213/01.ane.0000221438.08990.06
  23. Hernandez-Palazon J., Tortosa J.A., Martinez-Lage J.F., Perez-Flores D. Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery. Anesth Analg. 2001; 92:1473–1476. DOI: 10.1097/00000539-200106000-00024
  24. Kinsella J., Moffat A.C., Patrick J.A., et al. Ketorolac trometamol for postoperative analgesia after orthopaedic surgery. Br J Anaesth. 1992; 69: 19–22. DOI: 10.1093/bja/69.1.19
  25. McNicol E.D., Tzortzoloulou A., Cepeda M.S., et al. Single-dose intravenous paracetamol or propacetamol for prevention or treatment of postoperative pain: A systematic review and meta-analysis. Br J Anaesth. 2011; 106:764–775. DOI: 10.1093/bja/aer107
  26. Ong C., Seymour R., Lirk P., et al. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010: 110(4): 1170–1179. DOI: 10.1213/ANE.0b013e3181cf9281
  27. Maund E., McDaid C., Rice S ., et al. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. Br J Anaesth. 2011; 106 (3): 292–297. DOI: 10.1093/bja/aeq406
  28. Michelet D., Andreu-Gallien J., Bensalah T., et al. A meta-analysis of the use of nonsteroidal antiinflammatory drugs for pediatric postoperative pain. Anesth Analg. 2012; 114 (2): 393–406. DOI: 10.1213/ANE.0b013e31823d0b45
  29. Lee A., Cooper M., Craig J., et al. Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. Cochrane Database Syst Rev. 2007; 2: CD002765. DOI: 10.1002/14651858.CD002765.pub3
  30. Bhala N., Emberson J., Merhi A., et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013; 382(9894): 769–779. DOI: 10.1016/S0140-6736(13)60900-9
  31. Dodwell E.R., Latorre J.G., Parisini E., et al. NSAID exposure and risk of nonunion: A metaanalysis of case-control and cohort studies. Calcif Tissue Int. 2010; 87: 193–202. DOI: 10.1007/s00223-010-9379-7
  32. Li Q., Zhang Z., Cai Z. High-dose ketorolac affects adult spinal fusion: A meta-analysis of the effect of perioperative nonsteroidal anti-inflammatory drugs on spinal fusion. Spine. 2011; 36: E461–E468. DOI: 10.1097/BRS.0b013e3181dfd163
  33. Gorissen K.J., Benning D., Berghmans T., et al. Risk of anastomotic leakage with non-steroidal anti-inflammatory drugs in colorectal surgery. Br J Surg. 2012; 99: 721–727. DOI: 10.1002/bjs.8691
  34. Rushfeldt C.F., Sveinbjornsson B., Soreide K., Vonen B. Risk of anastomotic leakage with use of NSAIDs after gastrointestinal surgery. Int J Colorectal Dis. 2011; 26: 1501–1509. DOI: 10.1007/s00384-011-1285-6
  35. Rutegard J., Rutegard M. Non-steroidal anti-inflammatory drugs in colorectal surgery: A risk factor for anastomotic complications? World J Gastroinest Surg. 2012; 4: 278–280. DOI: 10.4240/wjgs.v4.i12.278
  36. Schug S., Palmer G., Scott D., Hallwell R., Trinca J. (eds). Acute Pain Management: Scientific Evidence. Australian and New Zeland College of Anaesthetists, 4-th edition, 2015. DOI: 10.5694/mja16.00133
  37. Hakkarainen T., Steele S., Bastaworous A., et al. Nonsteroidal anti-inflammatory drugs and the risk for anastomotic failure: a report from Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP). JAMA Surg. 2015; 150(3): 223–228. DOI: 10.1001/jamasurg.2014.2239
  38. Kotagal M., Hakkarainen T., Simianu V., et al. Ketorolac use and postoperative complications in gastrointestinal surgery. Ann Surg. 2016; 263(1): 71–75. DOI: 10.1097/SLA.0000000000001260
  39. Laulin J.-P., Maurette P., Rivat C. The role of ketamine in preventing fentanyl­unduced hyperalgesia and subsequent acute morphine tolerance. Anesth. Analg. 2002; 94: 1263–1269. DOI: 10.1097/00000539-200205000-00040
  40. Gottschalk A., Sharma S., Ford J. The role of the perioperative period in recurrence after cancer surgery. Anesth. Analg. 2010; 110: 1636–1643. DOI: 10.1213/ANE.0b013e3181de0ab6
  41. Woodhouse A., Ward M., Mather L. Intra-subject variability in post-operative patient-controlled analgesia (PCA): is the patient equally satisfied with morphine, pethidine and fentanyl? Pain. 1999; 80(3): 545–553. DOI: 10.1016/s0304-3959(98)00247-4
  42. Coulbault L., Beaussier M., Verstuyft C., et al. Environmental and genetic factors associated with morphine response in the postoperative period. Clin Pharmacol Ther. 2006; 79(4): 316–324. DOI: 10.1016/j.clpt.2006.01.007
  43. Gagliese L., Gauthier L., Macpherson A., et al. Correlates of postoperative pain and intravenous patient-controlled analgesia use in younger and older surgical patients. Pain Med. 2008; 9(3): 299–314. DOI: 10.1111/j.1526-4637.2008.00426.x
  44. Fletcher D., Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a metaanalysis. Br J Anaesth. 2014; 112(6): 991–1004. DOI: 10.1093/bja/aeu137
  45. Marret E., Kurdi O., Zufferey P., et al. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology. 2005; 102(6): 1249–1260. DOI: 10.1097/00000542-200506000-00027
  46. Roberts G., Bekker T., Carlsen H., et al. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg. 2005; 101(5): 1343–1348. DOI: 10.1213/01.ANE.0000180204.64588.EC
  47. Jarzyna D., Jungquist C.R., Pasero C., et al. American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression. Pain Manag Nurs. 2011; 12: 118–145. DOI: 10.1016/j.pmn.2011.06.008
  48. Bell R., Dahl J., Moore R., Kalso E. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev. 2006: CD004603. DOI: 10.1002/14651858.CD004603.pub2
  49. McCartney C., Sinha A., Katz J. A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth. Analg. 2004; 98: 1385–1400. DOI: 10.1213/01.ane.0000108501.57073.38
  50. Laskowski K., Stirling A., McKay W., et al. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth. 2011; 58(10): 911–923. DOI: 10.1007/s12630-011-9560-0
  51. Wu L., Huang X., Sun L. The efficacy of N-methyl-D-aspartate receptor antagonists on improving the postoperative pain intensity and satisfaction after remifentanil-based anesthesia in adults: a meta-analysis. J Clin Anesth. 2015; 27(4): 311–324. DOI: 10.1016/j.jclinane.2015.03.020
  52. Barreveld A., Witte J., Chahal H., et al. Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth Analg. 2013; 116(5): 1141–1161. DOI: 10.1213/ANE.0b013e318277a270
  53. Urban M., Ya Deau J., Wukovits B., et al. Ketamine as an adjunct to postoperative pain management in opioid tolerant patients after spinal fusions: a prospective randomized trial. HSS J. 2008; 4(1): 62–65. DOI: 10.1007/s11420-007-9069-9
  54. Chaparro L., Smith S., Moore R., et al. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev. 2013; 7: CD008307. DOI: 10.1002/14651858.CD008307.pub2
  55. Peng P., Wijeysundera D., Li C. Use of gabapentin for perioperative pain control — a meta-analysis. Pain Res. Manage. 2007; 12: 85–92. DOI: 10.1155/2007/840572
  56. Straube S., Derry S., Moore R., et al. Single dose oral gabapentin for established acute postoperative pain in adults. Cochrane Database Syst Rev. 2010; 5: CD008183. DOI: 10.1002/14651858.CD008183.pub2
  57. Tiippana E., Hamunen K., Kontinen V. Do surgical patients benefit from perioperative gabapentin / pregabalin? A systematic review of efficacy and safety. Anesth. Analg. 2007; 104: 1545–1556. DOI: 10.1213/01.ane.0000261517.27532.80
  58. Zhang J., Ho K., Wang Y. Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth. 2011; 106(4): 454–462. DOI: 10.1093/bja/aer027
  59. Chou R., et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologistsʼ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. Pain. 2016; 17 (2): 131–157. DOI: 10.1016/j.jpain.2015.12.008
  60. Clivatti J., Sakata R., Issy A. Review of the use of gabapentin in the control of postoperative pain. Rev. Bras. Anesthesiol. 2009; 59: 87–98. DOI: 10.1590/S0034–70942009000100012
  61. Cohen S., Mao J. Is the analgesic effect of systemic lidocaine mediated through opioid receptors? Acta Anaesthesiol Scand. 2003; 47:910–911. DOI: 10.1034/j.1399-6576.2003.00163.x
  62. Nagy I., Woolf C. Lignocaine selectivity reduces C fibre-evoked neuronal activity in rat spinal cord in vitro by decreasing N-methyl-D-aspartate and neurokinin receptor-mediated postsynaptic depolarizations; implications for the development of novel centrally acting analgesics. Pain. 1996; 64: 59–70. DOI: 10.1016/0304-3959(95)00072-0
  63. Marret E., Rolin M., Beaussier M., Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br. J. Surg. 2008; 95:1331–1338. DOI: 10.1002/bjs.6375
  64. Vigneault L., Turgeon A., Cote D., et al. Perioperative intravenous lidocaine infusion for postoperative pain control: A meta-analysis of randomized controlled trials. Can J Anaesth. 2011; 58: 22–37. DOI: 10.1007/s12630-010-9407-0
  65. Martin F., Cherif K., Gentili M., et al. Lack of impact of intravenous lidocaine on analgesia, functional recovery, and nociceptive pain threshold after total hip arthroplasty. Anesthesiology. 2008; 109(1): 118–123. DOI: 10.1097/ALN.0b013e31817b5a9b
  66. Insler S., O’Connor M., Samonte A., et al. Lidocaine and the inhibition of postoperative pain in coronary artery bypass patients. J Cardiothorac Vasc Anesth. 1995; 9(5): 541–546. DOI: 10.1016/s1053-0770(05)80138-7
  67. Striebel H., Klettke U. Is intravenous lidocaine infusion suitable for postoperative pain management? Schmerz. 1992; 6(4): 245–250. DOI: 10.1007/BF02527813
  68. Wuethrich P., Romero J., Burkhard F., et al. No benefit from perioperative intravenous lidocaine in laparoscopic renal surgery: a randomised, placebo-controlled study. Eur J Anaesthesiol. 2012; 29: 537–543. DOI: 10.1097/EJA.0b013e328356bad6
  69. Bryson G., Charapov I., Krolczyk G., et al. Intravenous lidocaine does not reduce length of hospital stay following abdominal hysterectomy. Can J Anaesth. 2010; 57: 759–766. DOI: 10.1007/s12630-010-9332-2
  70. McCarthy G., Megalla S., Habib A. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery. A systematic review of randomized controlled trials. Drugs. 2010; 70(9): 1149–1163. DOI: 10.2165/10898560-000000000-00000
  71. Papagiannopoulou P., Argiriadou H., Georgiou M., et al. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg. Endosc. 2003; 17: 1961–1964. DOI: 10.1007/s00464-002-9256-1
  72. Bamigboye A., Hofmeyr G. Local anesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief. Cochrane Database Syst Rev. 2009: CD006954. DOI: 10.1002/14651858.CD006954.pub2
  73. Kehlet H., Andersen L. Local infiltration analgesia in joint replacement: The evidence and recommendations for clinical practice. Acta Anaesthesiol Scand. 2011; 55: 778–784. DOI: 10.1111/j.1399-6576.2011.02429.x
  74. Richman J., Liu S., Courpas G., Wong R., et al. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg. 2006; 102: 248–257. DOI: 10.1213/01.ANE.0000181289.09675.7D
  75. Ballantyne J.C., Carr D.B., deFerranti S., et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg. 1998; 86: 598–612. DOI: 10.1097/00000539-199803000-00032
  76. Joshi G.P., Bonnet F., Shah R., et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg. 2008; 107: 1026–1040. DOI: 10.1213/01.ane.0000333274.63501.ff
  77. Nishimori M., Ballantyne J.C., Low J.H. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. 2006; CD005059. DOI: 10.1002/14651858.CD005059.pub2
  78. Popping D.M., Elia N., Marret E., et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: A meta-analysis. Arch Surg. 2008; 143: 990–999; discussion: 1000. DOI: 10.1001/archsurg.143.10.990
  79. Popping D., Elia N., Van Aken H., et al. Impact of epidural analgesia on mortality and morbidity after surgery: Systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2014; 259: 1056–1067. DOI: 10.1097/SLA.0000000000000237
  80. PROSPECT — Procedure Specific Postoperative Pain Management. URL: www.postoppain.org. DOI: 10.1016/j.bpa.2006.12.001
  81. Rodgers A., Walker N., Schug S., et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. BMJ. 2000; 321: 1–12. DOI: 10.1136/bmj.321.7275.1493
  82. Chestnut D.H. Efficacy and safety of epidural opioids for postoperative analgesia. Anesthesiology. 2005; 102: 221. DOI: 10.1097/00000542-200501000-00031
  83. Macrae W. Chronic post-surgical pain: 10 years on. Br. J. Anaesth. 2008; 101: 77–86. DOI: 10.1093/bja/aen099
  84. Andreae M., Andreae D. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane Systematic review and meta-analysis. Br. J. Anaesth. 2013; 111: 711–720. DOI: 10.1093/bja/aet213
  85. Mamoun N.F., Lin P., Zimmerman N.M., et al. Intravenous acetaminophen analgesia after cardiac surgery: a randomized, blinded, controlled superiority trial. J Thorac Cardiovasc Surg. 2016; 152: 881–889.e1. DOI: 10.1016/j.jtcvs.2016.04.078
  86. Acharya M., Dunning J. Does the use of non-steroidal anti-inflammatory drugs after cardiac surgery increase the risk of renal failure? Interact Cardio Vasc Thorac Surg. 2010; 11: 461–467. DOI: 10.1510/icvts.2010.239053
  87. Bainbridge D., Cheng D.C., Martin J.E., Novick R. Evidence-Based Perioperative Clinical Outcomes Research Group. NSAID-analgesia, pain control and morbidity in cardiothoracic surgery. Can J Anaesth. 2006; 53: 46–59. DOI: 10.1007/BF03021527
  88. Kulik A., Ruel M., Bourke M.E., et al. Postoperative naproxen after coronary artery bypass surgery: a doubleblin randomized controlled trial. Eur J Cardiothorac Surg. 2004; 26: 694–700. DOI: 10.1016/j.ejcts.2004.07.004
  89. Sousa-Uva M., Head S.J., Milojevic M., et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018; 53(1): 5–33. DOI: 10.1093/ejcts/ezx314
  90. Oliveri L., Jerzewski K., Kulik A. Black box warning: is ketorolac safe for use after cardiac surgery? J Cardiothorac Vasc Anesth. 2014; 28: 274–279. DOI: 10.1053/j.jvca.2013.07.014
  91. Nussmeier N.A., Whelton A.A., Brown M.T., et al. Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. N Engl J Med. 2005; 352: 1081–1091. DOI: 10.1056/NEJMoa050330
  92. Ott E., Nussmeier N.A., Duke P.C., et al. Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2003; 125: 1481–1492. DOI: 10.1016/s0022-5223(03)00125-9
  93. Landoni G., Isella F., Greco M., et al. Benefits and risks of epidural analgesia in cardiac surgery. Br J Anaesth. 2015; 115: 25–32. DOI: 10.1093/bja/aev201
  94. Потиевская В., Гридчик И., Грицан А. и др. Седация пациентов в отделениях реанимации и интенсивной терапии. Клинические рекомендации ФАР от 30 марта 2018 г. Анестезиология и реаниматология. 2018; 63(2): 165–175.[Potievskaya V.I., Gridchik I.E., Grican A.I., et al. Sedaciya pacientov v otdeleniyah reanimacii i intensivnoj terapii. Klinicheskie rekomendacii FAR ot 30 marta 2018 g. Anesteziologiya i reanimatologiya. 2018; 63(2): 165–175 (In Russ)]
  95. Gerbeshagen H., Aduckathil S., Van Wijck A., et al. Pain intensity on the first day after surgery. Anesthesiology, 2013; 118: 934–944. DOI: 10.1097/ALN.0b013e31828866b3
  96. Barreveld A., Correll D., Liu X., et al. Ketamine decreases postoperative pain scores in patients taking opioids for chronic pain: results of a prospective, randomized, double-blind study. Pain Med. 2013; 14(6): 925–934. DOI: 10.1111/pme.12086

Varied Anesthesia Depending on Autonomic Tone During Laparoscopic Surgery

P.A. Volkov1,2, V.A. Guryanov1

1 Chair of Anesthesiology and Critical Care, State Federal-Funded Educational Institution of Higher Professional Training, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow

2 Closed Joint Stock Company Medical Rehabilitation Unit «Clinic K+31», Moscow

For correspondence: Pavel Aleksandrovich Volkov — anesthesiologist-resuscitator of Department of anesthesiology and reanimatology, JSC Inter Regional Center «Klinka K+31», Moscow; e-mail: volkovpavel@ymail.com

For citation: Volkov PA, Guryanov VA. Varied Anesthesia Depending on Autonomic Tone During Laparoscopic Surgery. Intensive Care Herald. 2017;2:26–30.


Adequacy of nonspecific perioperative adaptive reactions of the adaptation syndrome, in the first place, depends on the initial state and interaction of the autonomic nervous system. The satisfactory state of the regulation of physiological system, based on the principles of functional synergy and the relative antagonism of its sympathetic and parasympathetic components, can easily be disrupted by unbalanced pharmacological effects during anesthesia. As a result of autonomic dysfunction, regardless of the cause of its development, the initial or iatrogenic, adaptation failure may occur with the development of hemodynamic changes and postoperative complications. Recently, the number of publications by domestic and foreign authors that demonstrate the advantages of intraoperative use of a new selective alpha2-adrenoagonist drug, dexmedetomidine, has significantly increased. Nevertheless, the appointment of a drag with such pronounced effect on the autonomic nervous system, without regard to the initial vegetative status, can lead to catastrophic consequences. We conducted a comparative analysis of the relationship between changes in hemodynamic parameters and vegetative status during balanced anesthesia, where dexmedetomidine was used as part of the analgesia component. It has been shown that cholinolytic premedication and a decrease in the rate of dexmedetomidine administration in patients with parasympatotonia not only allow to avoid a decrease in the cardiac index during the operation, but also are accompanied by a physiologically more beneficial redistribution of blood circulation determinants. In addition, the results of the work indicate an unchanged quality of analgesia in the case of a decrease in the dose of dexmedetomidine in patients with parasympatotonia.

Keywords: autonomic nervous system, dexmedetomidine, multimodal analgesia

Received: 15.01.2017


References

  1. Носырев С.П., Коваленко А.Н. Основания анестезиологии и реаниматологии. М.: Ключ-С, 2014. [Nosyrev P., Kovalenko A.N. Osnovanija anesteziologii i reanimatologii. Moscow: Kljuch-S Publ.; 2014. (In Russ)]
  2. Оболенский С.В., Лебединский К.М., Шавель А.Г. и др. Анестезиологическое обеспечение эндовидеохирургических операций. В кн.: Видеоэндоскопические вмешательства на органах живота, груди и забрюшинного пространства: Под ред. А.Е. Борисова. СПб.: ЭФА, 2002: 25–47. [Obolenskii S.V., Lebedinskii K.M., ShavelA.G. et al. Anesteziologicheskoe obespechenie endovideohirurgicheskih operatsii. In: Borisov A.E. Videojendoskopicheskie vmeshatel’stva na organah zhivota, grudi i zabrjushinnogo prostranstva. St.-Petersburg: EFA; 2002: 25–47. (In Russ)]
  3. Гурьянов В.А. Современная многокомпонентная сбалансированная анестезия: оптимизация оценки операционноа- нестезиологического риска, предоперационной подготовки и компонента аналгезии: Дис. … д-ра мед. наук. М., 2003. [Gurjanov V.A. Sovremennaja mnogokomponentnaja sbalan- sirovannaja anestezija: optimizacija ocenki operacionno-anesteziologicheskogo riska, predoperacionnoj podgotovki i komponenta analgezii [dissertation]. Moscow, (In Russ)]
  4. Piao G., Wu J. Systematic assessment of dexmedetomidine as an anesthetic agent: a meta-analysis of randomized controlled trials. Arch. Med. Sci. 2014; 10(1): 19–24. doi: 5114/ aoms.2014.40730.
  5. Blaudszun G., Lysakowski C., Elia N., Tramer R. Effect of perioperative systemic α2-agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012; 116(6): 312–322. doi: 10.1097/ALN.0b013e31825681cb.
  6. Микаелян К.П. Дифференцированная премедикация и вводная анестезия с учетом вегетативного статуса при операциях на позвоночнике: Автореф. дис. … канд. мед. наук. М., 2013. [Mikaeljan K.P. Differencirovannaja premedikacija i vvodnaja anestezija s uchetom vegetativnogo statusa pri operacijah na pozvonochnike [dissertation]. Moscow, (In Russ)]
  7. Hofman M.A., Swaab D.F. Living by the clock: The circadian pacemaker in older people. Ageing Res. 2006; 5: 33–51. doi: 10.1016/j.arr.2005.07.001.
  8. MacDonald E., Kobilka B.K., Scheinin M. Gene targeting — homing in on alpha2-adrenoceptor-subtype function. Trends Pharmacol. Sci. 1997; 18(6): 211–219.
  9. Overland A.C., Kitto F., Chabot-Dore A.J. et al. Protein kinase C mediates the synergistic interaction between agonists acting at alpha2-adrenergic and delta-opioid receptors in spinal cord. J. Neurosci. 2009; 29(42): 13264–13273. doi: 10.1523/ JNEUROSCI.1907-09.2009.
  10. Карелов А.Е., Лебединский К.М. Анальгетические адъюванты или альтернативные анальгетики? Вестн. анестезиол. и реаниматол. 2013; 6: 72–80. [Karelov A.E., Lebedinskii K.M. Anal’geticheskie ad’juvanty ili alternativnye anal’getiki? anesteziol. i reanimatol. 2013; 6: 72–80. (In Russ)]

Dexmedetomidine as the Component of Multimodal Analgesia in Vitreoretinal Surgery

V.V. Berlinsky, V.Yu. Maksimov, L.A. Chumakov, S.A. Kozlov

State autonomous healthcare institution of Saratov region, Regional Ophthalmologic Hospital, Saratov 

For correspondence: Berlinsky Vadim Viktorovich — Candidate of Medical Sciences, Head of department of anaesthesiology and intensive care, State autonomous healthcare institution of Saratov region «Regional Ophthalmologic Hospital», Saratov; anaesthetist and expert in resuscitation, Clinical Hospital n.a. S.R. Mirotvortsev of Saratov State Medical University, Saratov; e-mail: berlinsk64@mail.ru

For citation: Berlinsky VV, Maksimov VYu, Chumakov LA, Kozlov SA. Dexmedetomidine as the Component of Multimodal Analgesia in Vitreoretinal Surgery. Intensive Care Herald. 2017;1:28–31.


The study of efficacy and safety of using of the dexmedetomidine related to the group of central agonists of α2-adrenoceptor as the component of multimodal analgesia in vitreoretinal surgery was carried out. For this purpose 2 groups of patients after vitreoretinal surgical interventions were examined prospectively. Evaluation of anesthesia adequacy was performed using the following parameters: depth of sedation level and consciousness depression, which were estimated by means of Richmond Agitation-Sedation Scale. The degree of collaboration with physician was also evaluated. Monitoring of arterial pressure, heart rate, respiratory rate and SpO2 were conducted. Assessment of pain syndrome was performed with use of verbal descriptive scale of pain intraoperatively and at early postoperative period. The perioperative consumption of fentanyl was taken into consideration. Analysis of the results allowed to conclude that the usage of dexmedetomidine reduced perioperative consumption of opioid analgesics and severity of hemodynamic responses, it helped to maintain consciousness at a comfortable level both for patients and operators.

Keywords: dexmedetomidine, multimodal analgesia, agonist α2-adrenoceptor, anesthesia in ophthalmosurgery

Received: 26.01.2017


References

  1. Ashburh M.A., Caplan R.A., Carr D.B. et al. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists task force on acute pain management. 2004; 100(6): 1573–1581.
  2. Овечкин А.М. Седация в интенсивной терапии. Вестник интенсивной терапии. 2009; 1: 21–26. [OvechkinA.M. Sedatsiya v intensivnoy terapii. Vestnik intensivnoy terapii. 2009; 1: 21–26. (In Russ)]
  3. Тахчиди Х.П., Сахнова С.Н., Мясникова В.В. и др. Анестезия в офтальмологии. М.: МИА, 2007. [Takhchidi Kh.P., Sakhnova S.N., Myasnikova V.V. et al. Anesteziya v oftal’mologii. M.: MIA, 2007. (In Russ)]
  4. Sessler C.N., Gosnell M.S., Grap J. et al. The Richmond Agitation-Sedation Scale. Validiti and Realiabiliti in Adult intensive Care Unit Patients. Am. J. Respir. Crit. Care Med. 2002; 166(10): 1338–1344.
  5. Александрович Ю.С., Гордеев В.И. Оценочные и прогностические шкалы в медицине критических состояний. СПб.: Элби-СПб, 2010. [Aleksandrovich Yu.S., Gordeyev V.I. Otsenochnyye i prognosticheskiye shkaly v meditsine kriticheskikh sostoyaniy. Saint-Petersburg: Elbi-SPb, 2010. (In Russ)]
  6. Жданов Г.Г., Харитонова Е.Б. Клофелин как компонент общей и регионарной анестезии. Саратовский научно-медицинский журнал. 2009; 5(1): 115–118. [Zhdanov G.G., Kharitonova E.B. Klofelin kak komponent obshchey i regionarnoy anestezii. Saratovskiy nauchno-meditsinskiy zhurnal. 2009; 5(1): 115–118. (In Russ)]

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


References

  1. Bilotta F., Pietropaoli P., Sanita R. Nefopam and tramadol for the prevention of shivering during neuroaxial anesthesia. Reg. Anesth. Pain. Med. 2002; 27: 380–384.
  2. Delage N., Maaliki H., Beloeil H. Median effective dose (ED50) of nefopam and ketoprofen in postoperative patients. Anesthesiol 2005; 102: 1211–1216.
  3. Fernandez-Sanchez М., Diaz-Trelles R., Groppetti A. Nefopam, an analogue of or-phenadrine, protects against both NMDA receptor-dependent and independent vera-tridine-induced neurotoxicity. Amino Acids. 2002; 23: 31–36.
  4. Girard P., Verniers D., Coppe M.-C. Nefopam and ketoprofen synergy in rodent models of antinociception. Eur. J. Pharm. 2008; 584: 263–271.
  5. Herminghaus A., Wachowiak M., Wilhelm W. Intravenous administration of lidocaine for perioperative analgesia. Rewiew and recommendations for practical usage. Anesthesist. 2011; 60(2): 152–
  6. Herroeder S., Pecher S., Schonherr M.E. et al. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology. 2007; 106: 11–86.
  7. Kehlet H., Dahl J.B. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth. Analg. 1993; 77: 1048–1056.
  8. Kehlet H. Labat Lecture 2005. Surgical stress and postoperative outcome — from here to where? Anesth. Pain Med. 2006; 31: 47–52.
  9. Marret E., Rolin M., Beaussier M., Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br. J. Surg. 2008; 95(11): 1331–1338.
  10. Piper S., Rohm K., Suttner S. A comparison of nefopam and clonidine for the prevention of postanaesthetic shivering: a comparative, double-blind and placebo-controlled dose-ranging study. 2004; 59: 559–564.
  11. Verleye M., Andre N., Heulard I., Gillardin J. Nefopam blocks voltagesensitive sodium channels and modulates glutamatergic transmission in rodents. Brain Res. 2004; 1013: 249–2
  12. Баландин В.В., Горобец Е.С. Послеоперационное обезболивания нефопамом и НПВП у больных, оперированных по поводу опухолей области головы и шеи. Анестезиология и реаниматология. 2014; 1: 40–43.
  13. Баландин В.В., Горобец Е.С. Безопиоидная анестезия, анальгезии и седация в хирургии опухолей головы и шеи. Анестезиология и реаниматология. 2015; 60(6): 39–42.
  14. Овечкин А.М., Свиридов С.В. Послеоперационная боль и обезболивание: современное состояние проблемы. Медицина критических состояний. 2011; 6(37): 20–31.

Evidence-based Medicine’s Point of View on Postoperative Analgesia

A.M. Ovechkin, M.E. Politov

First Moscow Medical State University of I.M. Sechenov, Moscow

For citation: Ovechkin AM, Politov ME. Evidence-based Medicine Point of View on Postoperative Analgesia. Intensive Care Herald. 2016;2:51–60.


The review considers modern approaches to postoperative pain management from the standpoint of evidence-based medicine. Adequate postoperative analgesia, according to foreign literature, does not exceed 50 %. Today the basis for postoperative analgesia is the concept of multimodal analgesia. Data EBM substantiated the combined use of schemes of multimodal analgesia: opioids, non-opioid analgesics (NSAIDs, paracetamol), adjuvant drugs (ketamine, gabapentinoids) and different variants of regional analgesia. From all drug combinations best evidence base has a combination of NSAIDs and paracetamol. In the presence of contraindications to NSAIDs, they may be replaced by a centrally acting analgesic drug — nefopam. The schemes of multimodal analgesia should be built individually for each type of surgical intervention, having regard to the features of post-operative pain syndrome after these interventions, as well as to the individual features of patient.

Keywords: postoperative pain, multimodal analgesia, non-opioid analgesics, regional analgesia

Received: 14.06.2016


References

  1. Benhamou D., Berti M., Brodner G. Postoperative analgesic therapy observational survey (PATHOS): a practice pattern study in 7 central/southern European countries. Pain. 2008; 136: 134–141.
  2. Dolin S., Cashman J., Bland J. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br. J. Anae 2002; 89: 409–423.
  3. Institute of Medicine. Relieving pain in America. USA: National Academies Press, 2011; ISBN-13.9780-0-309-21484-1.
  4. Gan T., Habib A., Miller T. et al. Incidence, patient satisfaction, perception of postsurgical pain: results from a US national survey. Curr. Med. Res. Opin. 2014; 30: 149–160.
  5. Management of Postoperative Pain: A Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain. 2016; 17(2): 131–157.
  6. Acute Pain Management: Scientific Evidence. Australian and New Zeland College of Anaesthetists, 3rd Eds.: P. Macintyre, D. Scott, S. Schug. 2010.
  7. Oderda G., Gan T. Effect of opioid-related adverse events on outcomes in selected surgical patients. J. Pain Palliat. Care Pharmacother. 2013; 27: 62–70.
  8. Nasir D., Howard J., Joshi G., Hill G. A survey of acute pain service structure and function in United States hospitals. Pain Res. Treat. 2011; 2011: 934932.
  9. Laulin J.-P., Maurette P., Rivat C. The role of ketamine in preven ting fentanyl­unduced hyperalgesia and subsequent acute morphine tolerance. Analg. 2002; 94: 1263–1269.
  10. Gottschalk A., Sharma S., Ford J. The role of the perioperative period in recurrence after cancer surgery. Analg. 2010; 110: 1636–1643.
  11. Stubhaug A., Romundstad L., Kaasa T., Breivik H. Methylprednisolone and ketorolac rapidly reduce hyperalgesia around a skin burn injury and increase pressure pain thresholds. Acta Anaesth. Scand. 2007; 51: 1138–1146.
  12. Forrest J., Kamu F., Greer I. Ketorolack, diclofenac and ketoprofen are equally safe for pain relief after major surgery. Brit. Anaesth. 2002; 88: 227–233.
  13. Schjerning Olsen A-M., Fosbol E., Lindhardsen J. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation. 2011; 123: 2226–2235.
  14. S. Food and Drug Administration: Information for Healthcare Professionals: Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Accessed October 30, 2014.
  15. Li Q., Zhang Z., Cai Z. High-dose ketorolac affects adult spinal fusion: A meta-analysis of the effect of periperative nonsteroidal anti-inflammatory drugs on spinal fusion. Spine. 2011; 36: E461–E468.
  16. Dodwell E., Latorre J., Parisini E. et al. NSAID exposure and risk of nonunion: A metaanalysis of case-control and cohort studies. Calcif. Tissue Int. 2010; 87: 193–202.
  17. Mimoz O., Chauvet S., Gregoire N. Nefopam pharmacokinetics in patients with end-stage renal disease. Anesth. Analg. 2010; 111: 1146–1153.
  18. Delage N., Maaliki H., Beloeil H. Median effective dose (ED50) of nefopam and ketoprofen in postoperative patients. Anesthesiol 2005; 102: 1211–1216.
  19. Durrieu G., Oliver P., Bagheri H. Overview of adverse reactions to nefopam: an analysis of French pharmacovigilance database. Clin. Pharmacol. 2007; 21: 555–558.
  20. McCartney C., Sinha A., Katz J. A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Analg. 2004; 98: 1385–1400.
  21. De Kock M. Expanding our horisons: transition of acute postoperative pain to persistent pain and establishment of chronic postsurgical pain service. Anesthesiology. 2009; 111: 461–463.
  22. Lauretti G. Mechanisms of analgesia of Intravenous lidocaine. Rev. Bras. Anestesiol. 2008; 58(3): 280–286.
  23. Cohen S., Mao J. Is the analgesic effect of systemic lidocaine mediated through opioid receptors? Acta Anaesthesiol. Scand. 2003; 47: 910–911.
  24. Nagy I., Woolf C. Lignocaine selectivity reduces C fibreevoked neuronal activity in rat spinal cord in vitro by decreasing N-methyl-D-aspartate and neurokinin receptor-mediated postsynaptic depolarizations; implications for the development of novel centrally acting analgesics. Pain. 1996; 64: 59–70.

Postoperative analgesia in the surgical treatment of non-traumatic subarachnoid hemorrhage

A.Zh. Bayalieva1,2, R.Ja. Shpaner1,2, I.R. Ganeeva1,2

1 Kazan State Medical University, Kazan, Russian Federation

2 Interregional Clinical Diagnostic Center, Kazan, Russian Federation

For correspondence: Bayalieva Aynagul Zholdoshevna, Head of the Department of Anesthesiology and Reanimatology, disaster medicine of KSMU; e-mail: bayalieva1@yandex.ru

For citation: Bayalieva AZh, Shpaner RJa, Ganeeva IR. Postoperative Analgesia in the Surgical Treatment of Non-Traumatic Subarachnoid Hemorrhage. Alexander Saltanov Intensive Care Herald. 2018;1:37–42.

DOI: 10.21320/1818-474X-2018-1-37-42


The aim of the study was evaluation of headache treatment effectiveness in patients with non-traumatic subarachnoid hemorrhage, after surgical clipping of the aneurysm. The study included 105 patients, depending on the multimodal pain control method used, the following groups were formed: I — dexketoprofen or paracetamol; II — gabapentin plus dexketoprofen or paracetamol; III — Transdermal therapeutic system, the active element of which is fentanyl plus dexketoprofen or paracetamol. The drug of the reserve in all three groups was tramadol. The adequacy of the methods was judged by analgesic ability, using the Visual-Analog scale, and by the degree of influence on the level of consciousness, using of the Richmond Agitation-Sedation Scale. When evaluating the effectiveness of the methods, it was found that the combination of gabapentin and dexketoprofen/paracetamol is the most acceptable for this category of patients.

Keywords: postoperative pain, non-traumatic subarachnoid hemorrhage, multimodal analgesia

Received: 27.11.2017


References

  1. Rabinstein A.A., Lanzino G., Wijdicks E.F. Multidisciplinary management and emerging therapeutic strategies in aneurysmal subarachnoid haemorrhage. Lancet Neurol. 2010; 9(5): 504–519. doi: 10.1016/S1474–4422(10)70087–9.
  2. Баялиева А.Ж., Шпанер Р.Я., Ганеева И.Р., Насунов С.Ю. В поисках оптимального лечения головной боли при нетравматическом субарахноидальном кровоизлиянии. Анестезиология иреаниматология. 2017; 2: 149–152. [Bayalieva A.Zh., Shpaner R.Ja., Ganeeva I.R., Nasunov S.Ju. Searching the Optimal Treatment of Headache in Non-traumatic Subarachnoid Hemorrhage. Anaesthesiology and Reanimatology. 2017; 2: 149–152. (In Russ)]
  3. БаялиеваА.Ж., Шпанер Р.Я., Ганеева И.Р. Опыт лечения головной боли при остром нетравматическом субарахноидальном кровоизлиянии и оценка эффективности терапии. Казанский медицинский журнал. 2016; 6: 841–845. [Bayalieva A.Zh., Shpaner R.Ja., Ganeeva I.R. Practice in the treatment of headache in acute Non-traumatic Subarachnoid Hemorrhage and evaluation of the effectiveness of therapy. Kazan medical journal. 2016; 6: 841–845. (In Russ)]
  4. Mahon P., Smith B., Browne J., et al. Effective headache management in the aneurysmal subarachnoid patient: a literature review. British Journal of Neuroscience Nursing. 2012; 8(2): 89–93.
  5. Ганеева И.Р. Лечение головной боли у пациентов с нетравматическим субарахноидальным кровоизлиянием в интенсивной терапии. Регионарная анестезия илечение острой боли. 2017; 3: 164–169. [Ganeeva I.R. Management of headache in patients with non-traumatic subarachnoid hemorrhage. Regional anesthesia and treatment of acute pain. 2017; 3: 164–165. (In Russ)]
  6. Harrison R.A., Field T.S. Post stroke pain: identification, assessment, and therapy. Cerebrovasc. Dis. 2015; 39: 190–201. doi: 10.1159/000375397.
  7. Naess H., Lunde L., Brogger J. The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: the bergen stroke study. Vasc. Health Risk. Manag. 2012; 8: 407–413. doi: 10.2147/VHRM.S32780.
  8. O’Donnell M.J., Diener H.C., Sacco R.L., et al. Chronic pain syndromes after ischemic stroke: PRoFESS trial. Stroke. 2013; 44: 1238–1243. doi: 10.1161/STROKEAHA.111.671008.
  9. Hoang C.L., Salle J.Y., Mandigout S., et al. Physical factors associated with fatigue after stroke: an exploratory study. Top. Stroke Rehabil. 2012; 19: 369–376. doi: 10.1310/tsr1905–369.
  10. Lundström E., Smits A., Terént A., Borg J. Risk factors for stroke-related pain 1 year after first-ever stroke. Eur. J. Neurol. 2009; 16: 188–193. doi: 10.1111/j.1468-1331.2008.02378.x.
  11. Tang W.K., Liang H., Mok V., et al. Is pain associated with suicidality in stroke? Arch.Phys. Med. Rehabil. 2013; 94: 863–866. doi: 10.1016/j.apmr.2012.11.044.
  12. Овечкин А.М., Политов М.Е. Послеоперационное обезболивание с точки зрения доказательной медицины. Вестн. инт. терапии. 2016; 2: 51–60. [Ovechkin A.M., Politov M.E. Postoperative analgesia from evidence based medicine. Vestnik Intensivnoi Terapii. 2016; 2: 51–60. (In Russ)]
  13. Dorhout Mees S.M. MASH-II study group. Magnesium in aneurysmal subarachnoid hemorrhage (MASH II) phase III clinical trial. International Journal of Stroke. 2008; 3(1): 63–65. doi: 10.1111/j.1747-4949.2008.00168.x.
  14. Dorhout Mees S.M., Bertens D., van der Worp H.B.et al. Magnesium and headache after aneurysmal subarachnoid haemorrhage. J. Neurol. Neurosurg. Psychiatry. 2010; 81: 490–493. doi:10.1136/jnnp.2009.181404.
  15. Glisic E.K. Inadequacy of headache management after subarachnoid hemorrhage. American Journal of Critical Care. 2016; 25(2): 136–143. doi:10.4037/ajcc2016486.