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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Modern Postoperative Pain to the Treatment Approaches in Oncogynecology

I.I. Khusainova1, A.Zh. Bayalieva1,2, M.К. Browne1

1 Kazan State Medical University (KSMU), Kazan

2 Department of Anesthesiology and Reanimatology, disaster medicine KSMU of the Ministry of Health of the Russian Federation

For correspondence: Aynagul Zholdoshevna Bayalieva — Doct. of Med. Sci., Docent, Head of the Department of Anesthesiology and Reanimatology, disaster medicine of KSMU; e-mail:

For citation: Khusainova II, Bayalieva AZh, Browne MК. Modern Postoperative Pain to the Treatment Approaches in Oncogynecology. Intensive Care Herald. 2017;4:13–18.

Effective postoperative analgesia is one of the successful rehabilitation conditions. Mechanisms of postoperative pain have been being studied by now, and more new analgesics and anesthesia techniques are introduced. The range of surgical interventions in oncogynecology is wide: from minimally invasive laparoscopic operations to radical hysterectomies involving healthy tissues and removal of regional lymph nodes. Postoperative pain following radical hysterectomy with an intensity of more than 6 on visual analogue scale (VAS) requires multimodal pain therapy. Inadequate pain management leads to its transformation to a chronic condition, a neuropathic pain, associated with not fully reversible changes in patient’s brain. This article is based on the results of a systematic literature review developed by PROSPECT (cooperation of surgeons and anaesthesiologists in developing guidelines for specific procedures and manipulations). It deals with optimization of pain management highlighting new post-operative care principles.

Keywords: postoperative pain, balanced multimodal analgesia

Received: 09.06.2017


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The Influence of Polymorphism of the Μ-opioid Receptor OPRM1 A118G on the Doses of Narcotic Analgesics in the Early Postoperative Period (Meta-Analysis)

O.A. Makharin, V.M. Genilo

Rostov state medical University, Department of anesthesiology and reanimatology, Rostov-on-don

For correspondence: Oleg A. Makharin — MD, assistant of Department of anesthesiology and reanimatology of Rostov state medical university, Rostov-on-don; e-mail:

For citation: Makharin OA, Genilo VM. The Influence of Polymorphism of the μ-Opioid Receptor OPRM1 A118G on the Doses of Narcotic Analgesics in the Early Postoperative Period (Meta-Analysis). Intensive Care Herald. 2017;3:48–52. 

The aim of the study was the compilation and analysis of available data on the influence of polymorphism of the μ-opioid receptor OPRM1 A118G on the doses of narcotic analgesics in the early postoperative period. Materials and methods. The information was taken from SCO- PUS, MedLine, EMBASE. We analyzed 34 studies. The inclusion criteria in meta-analysis: the original study on this issue. Exclusion criteria: reviews, articles concerning the influence of polymorphism on pain not related to surgical treatment (childbirth, cancer pain, chronic pain), as well as papers in which the authors studied the influence of polymorphism of the μ-opioid receptor OPRM1 A118G on the doses of narcotic analgesics infused in the epidural or intrathecal space. 6 works (1691 patients) were included in the meta-analysis. We analyzed the difference in the need for narcotic analgesics in the first 24 hour. Results. We found that homozygous carriers of A-allele of the μ-opioid receptor OPRM1 needed lower doses of narcotic analgesics compared with heterozygous (fixed effects model; Z = −10,172; p = 0.0001; I2 = 54.1 per cent), and homozygous carriers of G-allele(fixed effects model; Z = −6,543; p = 0.0001; I2= 81,7 %). Conclusion. Polymorphism of the μ-opioid receptor OPRM1 A118G affects the individual need for narcotic analgesics in the early postoperative period.

Keywords: μ-opioid receptor , рolymorphism, postoperative pain, analgesia

Received: 04.03.2017


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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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