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:

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


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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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:

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


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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:

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


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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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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


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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:

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


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