Comparison of anesthesia and perioperative analgesia in simulty hernioplasty and abdominoplasty in patients with obesity

M.I. Neimark, R.V. Kiselev

Altai State Medical University of the Ministry of Health of Russia, Barnaul

For correspondence: Roman V. Kiselev, Ph.D., Assistant of the Department of Anaesthesiology, Resustitation, Clinical Pharmacology with the course of postgraduate education of the Altai State Medical University of the Ministry of Health of the Russian Federation, Barnaul; e-mail:

For citation: Neimark MI, Kiselev RV. Comparison of anesthesia and perioperative analgesia in simulty hernioplasty and abdominoplasty in patients with obesity. Alexander Saltanov Intensive Care Herald. 2019;1:45–51.

DOI: 10.21320/1818-474X-2019-1-45-51

Justification. Among patients with large postoperative ventral hernias, the most common are patients with varying degrees of obesity. This group of patients presents a certain complexity for anesthesia in connection with a number of anatomical and physiological changes and a high risk of complications in the early postoperative period in connection with which this study was conducted.

Purpose of trial. Study of the influence of various anaesthetic management and perioperative analgesia with simultaneous hernioplasty and abdominoplasty of major postoperative incisional hernia (PIH) in patients with obesity during the perioperative period.

Materials and methods. A randomized trial of 59 patients with a body mass index > 30 kg /m2 was performed. Depending on the type of anesthesia, patients are divided into two groups. In the 1st group (= 30), the operation was performed on low-flow inhalation of desflurane based anaesthesia in combination with prolonged epidural analgesia (PEA) with ropivacaine, in the 2nd group (= 29), the operation was performed on low flow inhalation of desflurane anesthesia based in combination with blockade of transverse abdominal plane (TAP) with 0.5% solution of ropivacaine, in the 3rd group (n = 31) the operation was performed under combined anesthesia based of low flow desflurane and opioids as main perioperative analgesic. The indicators adequacy of anesthesia parameters investigated, central and peripheral hemodynamics were monitored neuromuscular conduction, evaluated the efficacy of recovery after surgery and postoperative analgesia quality, postoperative critical incident were studied.

Results. It was found that surgical intervention in low-flow inhalation desflurane anaesthesia based combined with PEA ropivacaine promotes faster recovery after surgery and effective postoperative analgesia and fewer complications in the early postoperative period, which contributed to significantly shorter hospital lengths of stay for patients in group 1 — 82,5 hours (95% CI 76–93,5) compared with group 2 — 94 hours (95% CI 85,5–113) (p = 0,015). Conclusions. Combined desflurane-based anesthesia in combination with regional methods is an effective method of anesthesia and analgesia in the perioperative period and contributes to faster recovery after surgery and shorter surgical treatment with simultaneous hernio- and abdominoplasty of large (PIH) in obese patients.

Keywords: low-flow anesthesia; prolonged epidural analgesia, postoperative analgesia, obesity, hernioplasty, blockage of the transverse abdominal plane

Received: 29.09.2018


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Estimation of Dexketoprofen Effectiveness for Preemptive Analgesia in Patients with a Fracture of the Hip after Combined Trauma During Femoral Osteosynthesis

O.V. Voennov1, M.V. Karelsky1, A.O. Trofimov1,2, G.V. Kalentev2

1 Nizhny Novgorod State Medical Academy, Russian Federation, Nizhny Novgorod

2 Nizhny Novgorod Regional Clinical Hospital n.a. Semashko, Russian Federation, Nizhny Novgorod

For correspondence: Karelsky Mikhail Viktorovich, post graduate student of the Department of Anaesthesiology and Reanimatology Nizhny Novgorod State Medical Academy, Russian Federation, Nizhny Novgorod; e-mail:

For citation: Voennov OV, Karelsky MV, Trofimov AO, Kalentev GV. Estimation of Dexketoprofen Effectiveness for Preemptive Analgesia in Patients with a Fracture of the Hip after Combined Trauma During Femoral Osteosynthesis. Intensive Care Herald. 2017;4:29–35.

We have studied the effectiveness of dexketoprofen for preemptive analgesia in patients with a fracture of the hip after combined trauma during femoral osteosynthesis. We examined 120 patients of both sex. The patients were divided into 2 groups of 60 people depending on the use of preemptive analgesia. After that the group of 60 persons were divided into groups of 20 patients, depending on the type of anesthesia. Group 1A — inhalation anesthesia (IA). Group 1B — regional anesthesia (RA). Group 1С — total intravenous anesthesia (TIA). Group 2A — inhalation anesthesia (IA) and preemptive analgesia with dexketoprofen. Group 2B — regional anesthesia (RA) and preemptive analgesia with dexketoprofen. Group 2С — total intravenous anesthesia (TIA) and preemptive analgesia with dexketoprofen. All patients were provided with blocked intramedullary femoral osteosynthesis in 3–5 days after the trauma. Postoperative analgesia was provided with tramadol and trimeperidine. The study consisted of the following steps: 1st — before the surgery, 2nd — at the beginning of the operation, 3rd — after the transfer to the hospital ward, 4th — 24 hours after the surgery. We studied pain expression using the visual analog scale, hemodynamics, blood cortisol levels. After using dexketoprofen all patients had a more favorable pain severity dynamics, less blood cortisol levels, less blood pressure and heart rate in the early postoperative period.

Keywords: postoperative pain syndrome, combined trauma, anesthesia, postoperative analgesia, dexketoprofen, preemptive analgesia

Received: 02.08.2017


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