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: fincher-75@mail.ru

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


References

  1. Le Huu Nho R., Mege D., Ouaïssi M., Sielezneff I., Sastre B. Incidence and prevention of ventral incisional hernia. J. Visc. Surg. 2012; 149(5): 3–14. DOI: 10.1016/j.jviscsurg.2012.05.004
  2. Hernández-Granados P., López-Cano M., Morales-Conde S., et al. Incisional hernia prevention and use of mesh. A narrative review. Cir Esp. 2018; 96(2): 76–87. DOI: 10.1016/j.ciresp.2018.01.003
  3. Yamamoto M., Takakura Y., Ikeda S., et al. Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: A single-center review. Asian J. Endosc. Surg. 2018; 19. DOI: 10.1111/ases.12466
  4. Parés D., Shamali A., Stefan S., et al. Predictive factors for extraction site hernia after laparoscopic right colectomy.Int. J. Colorectal Dis. 2016; 31(7): 1323–1328. DOI: 10.1007/s00384-016-2610-x
  5. Silecchia G., Campanile F.C., Sanchez L., et al. Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected].Surg Endosc. 2015; 29(9): 2463–84. DOI: 10.1007/s00464-015-4293-8
  6. Хашимов Б.Б., Аутлев К.М., Кручинин Е.В. и др. Частота возникновения грыж передней брюшной стенки у пациентов с морбидным ожирением. Уральский медицинский журнал. 2017; 3: 107–110.
  7. [Hashimov B.B., Autlev K.M., Kruchinin E.V., et al. The incidence of hernia of the anterior abdominal wall in patients with morbid obesity. Uralʼskij medicinskij zhurnal. 2017; 3: 107–110.(In Russ)]
  8. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesthesia and Intensive Care 2007; 35: 616–617.
  9. Белоярцев, Ф.Ф. Компоненты общей анестезии. М.: Медицина, 1997. [Beloyarcev F.F. Components of General Anesthesia. M.: Meditsina,1997.(In Russ)]
  10. Эпштейн С.Л. Периоперационное анестезиологическое обеспечение больных с морбидным ожирением. Регионарная анестезия и лечение острой боли. 2012; 4(3): 5–27.            
  11. [Ehpshtejn S.L. Perioperative anesthetic management of patients with morbid obesity. Regionarnaya anesteziya i lechenie ostroj boli. 2012; 4(3): 5–27.(In Russ)]
  12. Gaston-Johanson F., Albert M., Fagan E., Zimmerman L. Similarities in pain description of four different ethnic-culture groups. J.Pain Symptom Manage.1990; 5(2): 94–100. DOI: //doi.org/10.1016/S0885–3924(05)80022-3
  13. Вейлер Р.В., Мусаева Т.С., Трембач Н.В., Заболотских И.Б. Критические инциденты в течение комбинированной анестезии при обширных абдоминальных операциях у пациентов пожилого и старческого возраста: роль предоперационного уровня бодрствования. Анестезиология и реаниматология. 2016; 61(5). DOI: http://dx.doi.org/10.18821/0201-7563-2016-61-5-352-356
  14. [Vejler R.V., Musaeva T.S., Trembach N.V., Zabolotskih I.B. Critical incidents during combined anesthesia during extensive abdominal operations in patients of elderly and senile age: the role of the preoperative level of wakefulness. Anesteziologiya i reanimatologiya. 2016; 61(5). DOI: http://dx.doi.org/10.18821/0201-7563-2016-61-5-352-356. (In Russ)]
  15. Лихванцев В.В. Критические инциденты при современных методах общей анестезии. Клиническая анестезиология и реаниматология. 2007; (4): 42.
  16. [Lihvancev V.V. Critical incidents with modern methods of general anesthesia. Klinicheskaya anesteziologiya i reanimatologiya. 2007; (4): 42 (In Russ)]
  17. Анисимов М.А., Горобец Е.С., Якушина И.А. Эффективная анестезия при выполнении онкогинекологических операций у пациенток с сопутствующим морбидным ожирением. Вестник анестезиологии и реаниматологии. 2015; 6: 46–52.
  18. [Anisimov M.A., Gorobec E.S., Yakushina I.A. Effective anesthesia when performing oncologic operations in patients with concomitant morbid obesity. Vestnik anesteziologii i reanimatologii. 2015; 6: 46–52. (In Russ)]
  19. Vadivelu N., Mitra S., Narayan D. Recent advances in postoperative pain management. Yale J. Biol. Med. 2010; 83(1): 11–25.

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: m.karelsky@mail.ru

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


References

  1. Морган-мл. Д.Э., Михаил М.С. Клиническая анестезиология: кн. 1-я: пер. с англ. М.-СПб.: Бином Невский диалект, [Morgan G.E., Mikhail M.S., Murray M.J. et al. Clinical Anesthe- siology, second edition. New-York: McGraw-Hill, 1996.]
  2. Кобеляцкий Ю.Ю. Роль НПВП в лечении и профилактике хронической боли. Здоровье Украины. 2011; тематический номер: конференция по неврологии, 42–44. [Kobelyatsky Y.Y. The role of NSAIDs in the treatment and prevention of chronic pain. Journal of Health of Ukraine. Thematic issue: Conference on Neurology. 2011; 42–44. (In Russ)]
  3. Чартарян В.М., Вирабян Р.Т., Тевосян А.З. и др. Упреждающая аналгезия в церебральной ангиографии. Медицинский вестник Эребуни. 2008; 3(35): 23–24. [Chartaryan V.M., Virabyan R.T., Tevosyan A.Z. et al. Preemptive analgesia in cerebral angiography. Medical newsletter Erebuni. 2008; 3(35): 23–24. (In Russ)]
  4. Черний В.И., Смирнова Н.Н., Лысак Е.И. Использование нестероидных противовоспалительных средств в упреждающей аналгезии. Хирургия Украины. 2008; 3(27): 058–063. [Cherniy V.I., Smirnova N.N., Lysak E.I. Use of non-steroidal anti-inflammatory drugs in pre-emptive analgesia. Surgery of Ukraine. 2008; 3(27): 058–063. (In Russ)]
  5. Овечкин А.М., Свиридов С.В. Послеоперационная боль и обезболивание: современное состояние проблемы. Медицина неотложных состояний. 2014, 6(61): 147–156. [Ovechkin A.M., Sviridov S.V. Postoperative pain and anesthesia: the current state of the problem. Emergency medicine. 2014; 6(61): 147–156. (In Russ)]
  6. Owen J., Glavin R.J., Shaw N.A. Ibuprofen in the management of postoperative pain. British Journal of Anaesthesia. 1986; 58(12): 1371–1375. doi: 1093/bja/58.12.1371.
  7. Woolf C.J., Chong M.S. Pre-emptive analgesia — Treating Postoperative Pain by Preventing the Establishment of Central Sensitization. Analgesia. 1993; 77(2): 362–379. doi: 10.1213/00000539-199308000-00026.
  8. Овечкин A.M., Решетняк В.К. Использование длительной эпидуральной анальгезии для предупреждения операционного стресс-ответа и послеоперационных болевых синдромов. Боль. 2003; 1: 61–65. [Ovechkin A.M., Reshetnyak V.K. Use of prolonged epidural analgesia to prevent an operational stress response and postoperative pain Pain. 2003; 1: 61–65. (In Russ)]
  9. Светлов В.А., Зайцев А.Ю., Козлов С.П. Сбалансированная анестезия на основе регионарных блокад: стратегия и тактика. Анестезиология и реаниматология. 2006; 4: 4–12. [Svetlov V.A., Zaitsev A.Y., Kozlov S.P. Balanced anesthesia based on regional blockades: strategy and tactics. Anesthesiology and reanimatology. 2006; 4: 4–12. (In Russ)]
  10. Басманов С.Н. Механизмы боли и анальгетики. В кн.: Современные аспекты рационального обезболивания в медицинской практике: практическое руководство. Киев: Морион, 2000: 20–23. [Basmanov S.N. Mechanisms of pain and analgesics. In: Modern aspects of rational anesthesia in medical prac- tice: practical guidance. Kiev: Morion, 2000: 20–23. (In Russ)].
  11. Овечкин А.М. Послеоперационный болевой синдром: кли- нико-патофизиологическое значение и перспективные на- правления терапии. Consilium 2005; 6: 486–490. [Ovechkin A.M. Postoperative pain syndrome: clinico-pathophysiological significance and perspective directions of therapy. Consilium Medicum. 2005; 6: 486–490. (In Russ)]
  12. Адашбаев Н.Т., Герасимов Э.М. Операционный стресс и упреждающая аналгезия у больных раком молочной железы. Национальный центр онкологии Кыргызской Республики. [Adashbaev N.T., Gerasimov E.M. Operational stress and anticipatory analgesia in patients with breast cancer. National Center of Oncology of the Kyrgyz Republic. 2011. (In Russ)]
  13. Abstracts 10th World Congress on pain. San Diego, USA. Seattle: IASP Press,
  14. Mauleуn D., Artigas R., Garcia M.L. et al. Preclinical and clinical development of dexketoprofen. Drugs. 1996; 52(Suppl.5): 24–46. doi: 2165/00003495-199600525-00005.
  15. Hanna M.H., Elliot K.M., Stuart-Taylor M.E. et al. Comparative study of analgesic efficacy and morphine-sparing effect of in- tramuscular dexketoprofen trometamol with ketoprofen or placebo after major orthopaedic surgery. British Journal of Clinical Pharmacology. 2003; 55(2): 126–133. doi: 10.1046/j.1365- 2125.2003.01727.x.
  16. Sanchez-Carpena J., Sesma-Sanchez J., Sanchez-Juan C. et al. Comparison of dexketoprofen trometamol and dipyrone in the treatment of renal colic. Clinical Drug Investigation. 2003; 23(3): 193–203. doi: 2165/00044011-200323030-00001.
  17. Побел Е.А. Сравнительное исследование препарата дексалгин и других анальгетиков, применяемых для послеоперационного обезболивания. Поликлиника. 2012; 2: 40–42. [Pobel E.A. Comparative study of dexalgin and other analgesics used for post- operative analgesia. 2012; 2: 40–42. (In Russ)]
  18. Стамов В.И., Светлов В.А., Маячик Р.Б. Упреждает ли упреждающая анальгезия? Анестезиология и реаниматология. 2008; 5: 61–64. [Stamov V.I., Svetlov V.A., Mayachik R.B. Does pre-emptive analgesia prevent? Anesthesiology and 2008; 5: 61–64. (In Russ)]
  19. Higgins M.S., Givogre J.L., Marco A.P. et al. Recovery from outpatient laparoscopic tubal ligation is not improved by preoperative administration of ketorolac or ibuprofen. Anesthesia and Analgesia. 1994; 79(2): 274–280. doi: 10.1213/00000539- 199408000-00012.
  20. Crocker S., Paech M. Preoperative rectal indomethacin for analgesia after laparoscopic sterilization. Anaesthesia and Intensive Care. 1992; 20(3): 337–340.
  21. Edwards N.D., Barclay K., Catling S.J. Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac. Anaesthesia. 1991; 46(12): 1077–1080. doi: 1111/j.1365-2044.1991.tb09930.x.
  22. Souter A.J., Fredman B., Paul F. Controversies in the Perioperative of Use Nonsteroidal Antiinflammatory Drugs. Anesthesia and 1994; 79(6): 1178–1190. doi: 10.1213/00000539- 199412000-00025.
  23. Campbell W.I., Kendrick R. Intravenous diclofenac sodium. Does its administration before operation suppress postoperative pain. 1990; 45(9): 763–766. doi: 10.1111/j.1365- 2044.1990.tb14450.x.
  24. Долгунов А.М., Шуматов А.А., Полежаев А.А. и др. Упреждающая мультимодальная аналгезия кетопрофеном и морфином в торакальной хирургии. Тихоокеанский медицинский журнал. 2003; 3: 59–61. [Dolgunov A.M., Shumatov A.A., Pole- zhaev A.A. et al. Pre-emptive multimodal analgesia with ketoprofen and morphine in thoracic surgery. Pacific Medical Journal. 2003; 3: 59–61. (In Russ)]
  25. Шуматов В.Б., Дунц П.В., Карпеев Г.А. и др. Оптимизация фармакотерапии послеоперационного болевого синдрома. Тихоокеанский медицинский журнал. 2004; 4: 47–48. [Shumatov V.B., Dunts P.V., Karpeev G.A. et al. Optimization of pharmacotherapy of postoperative pain syndrome. Pacific Medical Journal. 2004; 4: 47–48. (In Russ)]