Pub Date : 2021-11-25DOI: 10.25284/2519-2078.4(97).2021.248399
A. Ryzhkovskyi, O. Filyk, R. Trokhymovych
Background. Techniques of myofascial blockades are widely used after gynecological surgeries. The aim of study was to compare TAP block and QL block for postoperative analgesia of total abdominal hysterectomies. Materials and methods. We provided the retrospective single-center cohort study and included 51 patients 40-65 years old with complicated symptomatic uterus fibroids, who need total abdominal hysterectomy. Both groups underwent general anesthesia. In addition, in I group it was performed TAP block bilaterally via lateral access; in II group – QL block bilaterally via anterior (transmuscular) access. After surgery both groups` patients received multimodal analgesia with dexketoprofen, paracetamol, nefopam; in case of severe pain - nalbuphine. The stages of the study were 6 hours (h6), 12 hours (h12), 24 hours (h24), 48 hours (h48), 72 hours (h72) after surgery. We made the analysis pain level (with visual analogue scale - VAS), heart rate, mean arterial pressure, daily requirement of nalbuphine, duration of hospitalization. Results and discussion. It was found that the level of pain according to VAS in I group reached its maximum values on the stages h6 and h12 and was 4.8 [3,3; 5.8] points and 5.0 [3.9; 6.4] points, while in II group - 2.5 [2,3; 3.5] points and 2.1 [1.6; 4.1] points, respectively (p <0.05). We found significant differences in heart rate between groups on h12 stage when it was 86 [82; 90] beats / min in I group, and 72 [63; 79] beats / min in II group (p = 0.05). The daily requirement of nalbuphine on h12 stage had the tendency (p = 0.07) to be lower in II group (20.9 ± 1.1 mg / day), compared with the I group I (31.4 ± 2.9 mg / day). The need for nalbuphine use on h24 stage was significantly lower (p <0.05) in II group (5.8 ± 0.8 mg / day), compared with I group (22.5 ± 4.1 mg / day). The duration of hospitalization in I group was 7.8 ± 0.5 days, in II group - 6.2 ± 0.5 days (p>0,05). Conclusion. The use of QL block, compared with TAP block, showed a pain severity decreasing in 2 times (p <0.05), a tendency to reduce the need for nalbuphine use in 2.5 times (p> 0.05), and a tendency to reduce the duration of hospitalization by 1.6 days (p> 0.05).
{"title":"TRANSVERSUS ABDOMINIS PLANE BLOCK OR QUADRATUS LUMBORUM BLOCK FOR POSTOPERATIVE ANALGESIA AFTER TOTAL ABDOMINAL HYSTERECTOMIES: THE RETROSPECTIVE STUDY","authors":"A. Ryzhkovskyi, O. Filyk, R. Trokhymovych","doi":"10.25284/2519-2078.4(97).2021.248399","DOIUrl":"https://doi.org/10.25284/2519-2078.4(97).2021.248399","url":null,"abstract":"Background. Techniques of myofascial blockades are widely used after gynecological surgeries. The aim of study was to compare TAP block and QL block for postoperative analgesia of total abdominal hysterectomies.\u0000Materials and methods. We provided the retrospective single-center cohort study and included 51 patients 40-65 years old with complicated symptomatic uterus fibroids, who need total abdominal hysterectomy. Both groups underwent general anesthesia. In addition, in I group it was performed TAP block bilaterally via lateral access; in II group – QL block bilaterally via anterior (transmuscular) access. After surgery both groups` patients received multimodal analgesia with dexketoprofen, paracetamol, nefopam; in case of severe pain - nalbuphine. The stages of the study were 6 hours (h6), 12 hours (h12), 24 hours (h24), 48 hours (h48), 72 hours (h72) after surgery. We made the analysis pain level (with visual analogue scale - VAS), heart rate, mean arterial pressure, daily requirement of nalbuphine, duration of hospitalization.\u0000Results and discussion. It was found that the level of pain according to VAS in I group reached its maximum values on the stages h6 and h12 and was 4.8 [3,3; 5.8] points and 5.0 [3.9; 6.4] points, while in II group - 2.5 [2,3; 3.5] points and 2.1 [1.6; 4.1] points, respectively (p <0.05). We found significant differences in heart rate between groups on h12 stage when it was 86 [82; 90] beats / min in I group, and 72 [63; 79] beats / min in II group (p = 0.05). The daily requirement of nalbuphine on h12 stage had the tendency (p = 0.07) to be lower in II group (20.9 ± 1.1 mg / day), compared with the I group I (31.4 ± 2.9 mg / day). The need for nalbuphine use on h24 stage was significantly lower (p <0.05) in II group (5.8 ± 0.8 mg / day), compared with I group (22.5 ± 4.1 mg / day). The duration of hospitalization in I group was 7.8 ± 0.5 days, in II group - 6.2 ± 0.5 days (p>0,05).\u0000Conclusion. The use of QL block, compared with TAP block, showed a pain severity decreasing in 2 times (p <0.05), a tendency to reduce the need for nalbuphine use in 2.5 times (p> 0.05), and a tendency to reduce the duration of hospitalization by 1.6 days (p> 0.05).","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84909358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-25DOI: 10.25284/2519-2078.4(97).2021.248391
V. Yevsieieva, Y. Lisun, Y. Zub
Resume. Resuscitation of the obese patient presents a challenge for even the most skilled physician. Changes in anatomy, metabolic, cardiopulmonary reserve, ventilation, circulation, and pharmacokinetics require special consideration. This article focuses on critical components in the resuscitation of the obese patient, namely circulatory resuscitation, defibrillation, approach to the obese airway and mechanical ventilation, pharmacotherapy of cardiovascular drugs. Materials and methods: Electronic databases of Scopus and PubMed were searched using keyword searches Conclusions. Obesity causes important anatomical and physiological changes that affect resuscitation measures. Healthcare professionals should take into account the specifics of cardiopulmonary resuscitation in patients with morbid obesity to increase the effectiveness of resuscitation in this group of patients
{"title":"FEATURES OF CARDIOPULMONARY RESUSCITATION IN PATIENTS WITH MORBID OBESITY","authors":"V. Yevsieieva, Y. Lisun, Y. Zub","doi":"10.25284/2519-2078.4(97).2021.248391","DOIUrl":"https://doi.org/10.25284/2519-2078.4(97).2021.248391","url":null,"abstract":"Resume. Resuscitation of the obese patient presents a challenge for even the most skilled physician. Changes in anatomy, metabolic, cardiopulmonary reserve, ventilation, circulation, and pharmacokinetics require special consideration. This article focuses on critical components in the resuscitation of the obese patient, namely circulatory resuscitation, defibrillation, approach to the obese airway and mechanical ventilation, pharmacotherapy of cardiovascular drugs.\u0000Materials and methods: Electronic databases of Scopus and PubMed were searched using keyword searches\u0000Conclusions. Obesity causes important anatomical and physiological changes that affect resuscitation measures. Healthcare professionals should take into account the specifics of cardiopulmonary resuscitation in patients with morbid obesity to increase the effectiveness of resuscitation in this group of patients","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79547742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-25DOI: 10.25284/2519-2078.4(97).2021.248396
Y. Semkovych, D. Dmytriiev, Y. Glazov
Introduction. Regional anesthesia in pediatric practice is one of the most valuable and safest tools for perioperative pain management. The advantages of regional anesthesia are early recovery of children, reducing opioid consumption, postoperative pain, respiratory complications, nausea, vomiting, as well as health care costs. The aim of the study was to analyze the data on the effect of the quadratus lumborum block and the transversalis fascia block on the duration and effectiveness of postoperative analgesia and propose a model of combining two blocks with a single injection. Materials and methods. Today there is growing interest in the use of new methods of regional anesthesia, especially the anterior and posterior torso blocks. The quadratus lumborum block and the transversalis fascia block are aimed at providing analgesia over the T7-L1 dermatomes, namely the ilio-inguinal and iliac nerves, which extend from the lateral portion of the psoas major, the lower edge of the 12th rib; however, there is evidence of cranial spread to the T4 – T5 dermatomes, and caudal spread to the L2 – L3 dermatomes. Currently, there are enough publications concerning the quadratus lumborum block and the transversalis fascia block. Results. For adequate perioperative multimodal anesthesia, the authors proposed a combination of the transversalis fascia block and the quadratus lumborum block with a single injection and ultrasound guidance. Conclusions. The advantages of the proposed method include simplicity, less invasiveness, adequate analgesia during surgery, as well as during the postoperative period (exclusion of somatic and visceral components), as evidenced by the assessment on a visual analogue scale (no more than two points). In addition, it significantly reduces the perioperative opioid use.
{"title":"PATIENT-CENTERED ANALGESIA OF THE ANTERIOR ABDOMINAL WALL IN CHILDREN OF DIFFERENT AGES: OWN EXPERIENCE","authors":"Y. Semkovych, D. Dmytriiev, Y. Glazov","doi":"10.25284/2519-2078.4(97).2021.248396","DOIUrl":"https://doi.org/10.25284/2519-2078.4(97).2021.248396","url":null,"abstract":"Introduction. Regional anesthesia in pediatric practice is one of the most valuable and safest tools for perioperative pain management. The advantages of regional anesthesia are early recovery of children, reducing opioid consumption, postoperative pain, respiratory complications, nausea, vomiting, as well as health care costs.\u0000 The aim of the study was to analyze the data on the effect of the quadratus lumborum block and the transversalis fascia block on the duration and effectiveness of postoperative analgesia and propose a model of combining two blocks with a single injection.\u0000Materials and methods. Today there is growing interest in the use of new methods of regional anesthesia, especially the anterior and posterior torso blocks. The quadratus lumborum block and the transversalis fascia block are aimed at providing analgesia over the T7-L1 dermatomes, namely the ilio-inguinal and iliac nerves, which extend from the lateral portion of the psoas major, the lower edge of the 12th rib; however, there is evidence of cranial spread to the T4 – T5 dermatomes, and caudal spread to the L2 – L3 dermatomes. Currently, there are enough publications concerning the quadratus lumborum block and the transversalis fascia block.\u0000Results. For adequate perioperative multimodal anesthesia, the authors proposed a combination of the transversalis fascia block and the quadratus lumborum block with a single injection and ultrasound guidance.\u0000Conclusions. The advantages of the proposed method include simplicity, less invasiveness, adequate analgesia during surgery, as well as during the postoperative period (exclusion of somatic and visceral components), as evidenced by the assessment on a visual analogue scale (no more than two points). In addition, it significantly reduces the perioperative opioid use.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74834638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-25DOI: 10.25284/2519-2078.4(97).2021.248392
R. Sobko, M. Kovalov, O. Dorosh, U. Fesenko
A clinical case of severe bleeding from the wells of extracted teeth in a 9-year-old girl with Glanzman’s thrombasthenia is reported. Literature data on diagnosis and management of such patients are given. The authors emphasize that in the treatment of such patients sometimes it is necessary to make extraordinary decisions that can save the patient’s life. In this case, a direct blood transfusion was performed.
{"title":"BLOOD CORTISOL CONCENTRATION, HEMODYNAMICS AND METABOLISM OF PATIENTS WITH SECONDARY HYPERPARATHYROIDISM, POSSIBILITIES OF PERIOPERATIVE CORRECTION","authors":"R. Sobko, M. Kovalov, O. Dorosh, U. Fesenko","doi":"10.25284/2519-2078.4(97).2021.248392","DOIUrl":"https://doi.org/10.25284/2519-2078.4(97).2021.248392","url":null,"abstract":"A clinical case of severe bleeding from the wells of extracted teeth in a 9-year-old girl with Glanzman’s thrombasthenia is reported. Literature data on diagnosis and management of such patients are given. The authors emphasize that in the treatment of such patients sometimes it is necessary to make extraordinary decisions that can save the patient’s life. In this case, a direct blood transfusion was performed.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78204406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-25DOI: 10.25284/2519-2078.4(97).2021.248389
O. Sorokina, N. Matolinets, S. Dubrov
One of the main problems in the departments of anesthesiology and intensive care is the lack of energy in patients. In order to solve it, parenteral nutrition, which contains fat emulsions is prescribed for critical patients. It is known that fat emulsions consist of essential fatty acids which can have both pro-inflammatory (linoleic acid) and anti-inflammatory (linolenic acid) effects. In order to reduce the impact on the immune system, the use of alternative fat emulsions is recommended, as this may provide better clinical results. The first generation of fat emulsions consisted of soybean oil, but it was proven that this oil can increase the risk of purulentseptic complications. Second-generation fat emulsions contain medium-chain triglycerides, the metabolism of which can lead to acidosis, so their use is limited, especially in patients with diabetes. Third-generation fat emulsions contain olive oil, which reduces the risk of thrombosis, is considered immunoneutral and less sensitive to lipid peroxidation. Fourth-generation fat emulsions contain fish oil, which has anti-inflammatory properties and can reduce the duration of patients staying in critical condition. The most promising is the usage of balanced fats, among which there is a 20% SMOFlipid available in Ukraine. For patients who require parenteral nutrition, fat emulsions are an integral part of it, and for critically ill patients fat emulsions containing fish oil are recommended. However, it is recommended to assess baseline triglycerides prior to administration. Thus, lipids provide the delivery of fatty acids that affect important body processes, including metabolism, immune response, blood clotting. Alternative fat emulsions can be a better source of energy, also showing antioxidant effects and less suppression of immune system.
{"title":"POLY-COMPONENT FAT EMULSIONS IN THE PARENTAL NUTRITION OF PATIENTS IN THE INTENSIVE CARE UNIT","authors":"O. Sorokina, N. Matolinets, S. Dubrov","doi":"10.25284/2519-2078.4(97).2021.248389","DOIUrl":"https://doi.org/10.25284/2519-2078.4(97).2021.248389","url":null,"abstract":"One of the main problems in the departments of anesthesiology and intensive care is the lack of energy in patients. In order to solve it, parenteral nutrition, which contains fat emulsions is prescribed for critical patients. It is known that fat emulsions consist of essential fatty acids which can have both pro-inflammatory (linoleic acid) and anti-inflammatory (linolenic acid) effects. In order to reduce the impact on the immune system, the use of alternative fat emulsions is recommended, as this may provide better clinical results. The first generation of fat emulsions consisted of soybean oil, but it was proven that this oil can increase the risk of purulentseptic complications. Second-generation fat emulsions contain medium-chain triglycerides, the metabolism of which can lead to acidosis, so their use is limited, especially in patients with diabetes. Third-generation fat emulsions contain olive oil, which reduces the risk of thrombosis, is considered immunoneutral and less sensitive to lipid peroxidation. Fourth-generation fat emulsions contain fish oil, which has anti-inflammatory properties and can reduce the duration of patients staying in critical condition.\u0000The most promising is the usage of balanced fats, among which there is a 20% SMOFlipid available in Ukraine. For patients who require parenteral nutrition, fat emulsions are an integral part of it, and for critically ill patients fat emulsions containing fish oil are recommended. However, it is recommended to assess baseline triglycerides prior to administration. Thus, lipids provide the delivery of fatty acids that affect important body processes, including metabolism, immune response, blood clotting. Alternative fat emulsions can be a better source of energy, also showing antioxidant effects and less suppression of immune system.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75322315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-12DOI: 10.35975/apic.v25i5.1620
R. Durrani, Ali Usman, Amina Batol Gardezi, Maham Abid
Human abilities are often described to be comprising of many synonymous traits including efficiency, proficiency, capability, and competency etc. The researchers include three main pillars of an individual professional or a whole system; e.g., knowledge, skill and attitude. This invited editorial covers the first two of the three, although all the three must interplay to enhance the abilities of healthcare professionals. The need of a balance of both has been emphasized, as without the one, the second will be become useless. Key words: Knowledge; Skill; Ability; Training Citation: Usman A, Gardezi AB, Durrani RS, Abid M. Knowledge and skill. Anaesth. pain intensive care 2021;25(5):_; DOI: 10.35975/apic.v25i5.1620 Received: September 15, 2021, Accepted: September 20, 2021
{"title":"Knowledge and skill","authors":"R. Durrani, Ali Usman, Amina Batol Gardezi, Maham Abid","doi":"10.35975/apic.v25i5.1620","DOIUrl":"https://doi.org/10.35975/apic.v25i5.1620","url":null,"abstract":"Human abilities are often described to be comprising of many synonymous traits including efficiency, proficiency, capability, and competency etc. The researchers include three main pillars of an individual professional or a whole system; e.g., knowledge, skill and attitude. This invited editorial covers the first two of the three, although all the three must interplay to enhance the abilities of healthcare professionals. The need of a balance of both has been emphasized, as without the one, the second will be become useless. \u0000Key words: Knowledge; Skill; Ability; Training \u0000Citation: Usman A, Gardezi AB, Durrani RS, Abid M. Knowledge and skill. Anaesth. pain intensive care 2021;25(5):_; DOI: 10.35975/apic.v25i5.1620 \u0000Received: September 15, 2021, Accepted: September 20, 2021","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44059408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-05DOI: 10.35975/APIC.V25I3.1146
A. Kamali, Narges Anousheh, M. Shokrpour, S. Pazouki
Background & objective: Childbirth is an important phenomenon in the life of the mother and although this experience is the wish of every mother, it also concerns her due to the labor pain and the possible dangers that threaten her. There are several medications for painless delivery, such as epidural analgesia with the help of bupivacaine and ropivacaine. The aim of this study was to compare the efficacy of painless delivery with epidural method by bupivacaine and ropivacaine in women candidates for painless delivery. Methodology: This study is a double blind randomized clinical trial. In this study, patients were randomly divided into two equal groups of bupivacaine and ropivacaine using cubic random method. The demographic data, incidence of cesarean section and mean birth phases were evaluated. Finally, data were analyzed using SPSS 22 software, ANOVA and T-test. Results: A total of 112 patients were enrolled in the study. There was no significant difference between the two groups in terms of mean active phase of labor, mean Apgar score of min 1 and 5, incidence of cesarean section and mothers motor block score, but the mean of the second phase of labor and mean use of delivery helping instruments (such as forceps and vacuum) were lower in the ropivacaine group. Also, the mean score of patients' satisfaction was higher in ropivacaine group. Conclusion: It could be concluded that the combination of ropivacaine and fentanyl versus the combination of bupivacaine and fentanyl was a very suitable combination for controlling labor pain by epidural method, while it did not increase the rate of cesarean section and did not have a negative effect on neonatal Apgar scores of min 1 and 5, it had a significant effect on decreasing the mean of second stage of labor, decreasing the use of delivery helping instruments and increasing patient satisfaction score. Key words: Bupivacaine; Ropivacaine; Epidural analgesia; Painless delivery Citation: Anousheh N, Shokrpour M, Pazouki S, Kamali A. A double blind randomized clinical trial to compare the efficacy of bupivacaine and ropivacaine for painless delivery. Anaesth. pain intensive care 2021;25(3): 274–279. DOI: doi.org/10.35975/apic.v25i3.1146 Received: November 2, 2020, Reviewed: February 22, 2021, Accepted: March 26, 2021
背景与目的:分娩是母亲生命中的一个重要现象，虽然这种经历是每个母亲的愿望，但由于分娩的疼痛和可能威胁到她的危险，分娩也让她感到担忧。有几种无痛分娩药物，如布比卡因和罗哌卡因的硬膜外镇痛。本研究的目的是比较布比卡因和罗哌卡因硬膜外无痛分娩对女性无痛分娩的疗效。方法:本研究为双盲随机临床试验。本研究采用立方随机法将患者随机分为布比卡因和罗哌卡因两组。对人口统计资料、剖宫产发生率和平均产期进行评估。最后，采用SPSS 22软件、方差分析和t检验对数据进行分析。结果:共有112例患者入组。两组在平均产程活跃期、平均Apgar评分min 1分和min 5分、剖宫产发生率和母亲运动阻滞评分方面差异无统计学意义，但罗哌卡因组第二产程平均值和产钳、吸尘等助产器具的平均使用较低。罗哌卡因组患者满意度平均得分较高。结论:由此可见，罗哌卡因联合芬太尼与布比卡因联合芬太尼相比，是一种非常适合硬膜外法控制分娩疼痛的组合，且不增加剖宫产率，对新生儿Apgar分分1分和5分没有负面影响，对降低第二产程平均有显著作用。减少助产器械的使用，提高患者满意度。关键词:布比卡因;Ropivacaine;硬膜外镇痛;引用本文:Anousheh N, Shokrpour M, Pazouki S, Kamali A.一项比较布比卡因和罗哌卡因无痛分娩疗效的双盲随机临床试验。Anaesth。疼痛重症监护2021;25(3):274-279。收稿日期:2020年11月2日，审稿日期:2021年2月22日，接受日期:2021年3月26日
{"title":"A double blind randomized clinical trial to compare the efficacy of bupivacaine and ropivacaine for painless delivery","authors":"A. Kamali, Narges Anousheh, M. Shokrpour, S. Pazouki","doi":"10.35975/APIC.V25I3.1146","DOIUrl":"https://doi.org/10.35975/APIC.V25I3.1146","url":null,"abstract":"Background & objective: Childbirth is an important phenomenon in the life of the mother and although this experience is the wish of every mother, it also concerns her due to the labor pain and the possible dangers that threaten her. There are several medications for painless delivery, such as epidural analgesia with the help of bupivacaine and ropivacaine. The aim of this study was to compare the efficacy of painless delivery with epidural method by bupivacaine and ropivacaine in women candidates for painless delivery. \u0000Methodology: This study is a double blind randomized clinical trial. In this study, patients were randomly divided into two equal groups of bupivacaine and ropivacaine using cubic random method. The demographic data, incidence of cesarean section and mean birth phases were evaluated. Finally, data were analyzed using SPSS 22 software, ANOVA and T-test. \u0000Results: A total of 112 patients were enrolled in the study. There was no significant difference between the two groups in terms of mean active phase of labor, mean Apgar score of min 1 and 5, incidence of cesarean section and mothers motor block score, but the mean of the second phase of labor and mean use of delivery helping instruments (such as forceps and vacuum) were lower in the ropivacaine group. Also, the mean score of patients' satisfaction was higher in ropivacaine group. \u0000Conclusion: It could be concluded that the combination of ropivacaine and fentanyl versus the combination of bupivacaine and fentanyl was a very suitable combination for controlling labor pain by epidural method, while it did not increase the rate of cesarean section and did not have a negative effect on neonatal Apgar scores of min 1 and 5, it had a significant effect on decreasing the mean of second stage of labor, decreasing the use of delivery helping instruments and increasing patient satisfaction score. \u0000Key words: Bupivacaine; Ropivacaine; Epidural analgesia; Painless delivery \u0000Citation: Anousheh N, Shokrpour M, Pazouki S, Kamali A. A double blind randomized clinical trial to compare the efficacy of bupivacaine and ropivacaine for painless delivery. Anaesth. pain intensive care 2021;25(3): 274–279. DOI: doi.org/10.35975/apic.v25i3.1146 \u0000Received: November 2, 2020, Reviewed: February 22, 2021, Accepted: March 26, 2021","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46976285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-30DOI: 10.25284/2519-2078.3(96).2021.242135
M. Pylypenko, B. Mykhaylov
Procedural sedation (PS) is the technique of administering sedatives with or without analgesics to induce a condition in which the patient can tolerate unpleasant procedures while maintaining cardio-respiratory function. Planned PSs are performed with procedures of various invasiveness, painfulness and duration, but by definition, they do not reach the depth of general anesthesia and do not require the use of respiratory support or controlled mechanical ventilation, and even more – muscle relaxants. For effective PS, it is extremely important to establish verbal contact with the patient and achieve a stable emotional state of the patient and carefully explain to him the details of the PS. When choosing the depth of PS, it’s necessary to reach a compromise between the degree of anesthesia and amnesia, on the one hand, and the effectiveness of spontaneous breathing, as well as the possibility of an early recovery of consciousness, on the other. If possible, the problem of pain (when consciousness is partially preserved) or nociceptive stimuli (when the level of consciousness is reduced or absent) is solved separately through the use of local or regional anesthesia. In addition, non-steroidal anti-inflammatory drugs (NSAIDs) and some other drugs with analgesic properties are often used, and opioid analgesics are avoided or used in small or minimal doses. Unlike anesthesia, even deep sedation cannot and should not completely prevent the patient from moving during intense pain / nociceptive stimuli. If necessary, the problem of patient movements is solved not only and not so much by further deepening sedation, but precisely by improving analgesia and/or fixing the patient for the duration of short-term painful manipulations. To achieve these goals, PS is most often used propofol, or its dexmedetomidine or midazolam. This publication focuses on the advantages of using a multimodal approach for prolonged PS, which allows for a significant reduction in the dose of corresponding drugs and rate of complications in comparison with sedation with a single anaesthetic at significantly higher doses.
{"title":"JUSTIFICATION FOR THE COMBINED USE OF PROPOFOL AND DEXMEDETOMIDINE IN ELECTIVE PROCEDURAL SEDATION","authors":"M. Pylypenko, B. Mykhaylov","doi":"10.25284/2519-2078.3(96).2021.242135","DOIUrl":"https://doi.org/10.25284/2519-2078.3(96).2021.242135","url":null,"abstract":"Procedural sedation (PS) is the technique of administering sedatives with or without analgesics to induce a condition in which the patient can tolerate unpleasant procedures while maintaining cardio-respiratory function. Planned PSs are performed with procedures of various invasiveness, painfulness and duration, but by definition, they do not reach the depth of general anesthesia and do not require the use of respiratory support or controlled mechanical ventilation, and even more – muscle relaxants. For effective PS, it is extremely important to establish verbal contact with the patient and achieve a stable emotional state of the patient and carefully explain to him the details of the PS. When choosing the depth of PS, it’s necessary to reach a compromise between the degree of anesthesia and amnesia, on the one hand, and the effectiveness of spontaneous breathing, as well as the possibility of an early recovery of consciousness, on the other. If possible, the problem of pain (when consciousness is partially preserved) or nociceptive stimuli (when the level of consciousness is reduced or absent) is solved separately through the use of local or regional anesthesia. In addition, non-steroidal anti-inflammatory drugs (NSAIDs) and some other drugs with analgesic properties are often used, and opioid analgesics are avoided or used in small or minimal doses. Unlike anesthesia, even deep sedation cannot and should not completely prevent the patient from moving during intense pain / nociceptive stimuli. If necessary, the problem of patient movements is solved not only and not so much by further deepening sedation, but precisely by improving analgesia and/or fixing the patient for the duration of short-term painful manipulations. To achieve these goals, PS is most often used propofol, or its dexmedetomidine or midazolam. This publication focuses on the advantages of using a multimodal approach for prolonged PS, which allows for a significant reduction in the dose of corresponding drugs and rate of complications in comparison with sedation with a single anaesthetic at significantly higher doses.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86623597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-30DOI: 10.25284/2519-2078.3(96).2021.242145
Y. Babina, D. V. Dmitriev, O. Nazarchuk, M. Faustova
BACKGROUND. Surgical treatment leads to the development of postoperative pain in 80% of cases. Therefore, prompt and effective pain management is among the key priorities for healthcare professionals. The aim of the study is to determine the CCL2 / MCP-1 level in the blood serum of patients in the postoperative period under different analgesic methods and to assess the relationship between the inflammatory response and the pain response using the Visual Analog Scale (VAS). Materials and methods. We studied 30 pediatric patients with acute surgical abdominal pathologies, aged 8 to 15 years for urgent surgical procedures requiring general anesthesia. The patients were divided into 3 groups according to selected methods of intraoperative anesthesia: the 1 group included 12 patients, who received standard general anesthesia, the 2 group involved 10 patients, who received general anesthesia and infiltration anesthesia of the wound with 0.5% bupivacaine, a local anesthetic, and the 3 group included 8 children, who received general anesthesia and wound infiltration with 0.5% bupivacaine plus adjuvant (dexamethasone – 4 mg). One hour before surgery and in the postoperative period (3 and 12 hours after surgery), the patients were asked to fill in a pain diary assessing the intensity of pain syndrome and its dynamic characteristics using a visual analogue scale (VAS). Investigation to the rate of inflammatory response was assessed by monocytechemoattractant protein-1 (MCP-1). RESULTS. We found out that the plasma CCL2 / MCP-1 level in the patients prior surgery averaged 17.25 ± 7.8 pg / ml; (p <0.05), the baseline plasma CCL2 / MCP-1 levels in the patients of all groups were nearly the same. In patients of the 1st group there was an increase in the level of CCL2 / MCP-1 in the blood plasma (2.3 times) 3 hours after surgery, p <0.05, and 12 hours after surgery, the level of the studied chemokine increased by 6.7 times compared with the results obtained before surgery (p <0,05). Patients in the second group had no increase in inflammatory markers after 3 hours, but after 12 hours after surgery, plasma CCL2 / MCP-1 level significantly increased in 2.2 times compared with the values of the chemokine before surgery (p <0,05). In patients of group 3, the level of CCL2 / MCP-1 in blood plasma did not change statistically at 3 hours and 12 hours after surgery, although on average it decreased quantitatively. In the preoperative period the pain intensity ranked by the VAS scale averaged 7.8 scores and almost did not differ in the all study groups, but in the postoperative period, the degree of pain intensity was quantitatively the lowest in group 3 compared with 1 and 2 study groups. CONCLUSION. The dynamics of plasma CCL2 / MCP-1 levels in the patients reflects the development of the general adaptation syndrome in response to trauma. The CCL2 / MCP-1 level is significantly influenced by the type of anesthesia. The multimodal approach to the pain management is cons
{"title":"INVESTIGATION OF CCL2/MCP-1 LEVEL IN BLOOD SERUM OF SURGICAL PAEDIATRIC PATIENTS AS MARKER OF ADEQUACY OF PERIOPERATIVE PAIN MANAGEMENT","authors":"Y. Babina, D. V. Dmitriev, O. Nazarchuk, M. Faustova","doi":"10.25284/2519-2078.3(96).2021.242145","DOIUrl":"https://doi.org/10.25284/2519-2078.3(96).2021.242145","url":null,"abstract":"BACKGROUND. Surgical treatment leads to the development of postoperative pain in 80% of cases. Therefore, prompt and effective pain management is among the key priorities for healthcare professionals.\u0000The aim of the study is to determine the CCL2 / MCP-1 level in the blood serum of patients in the postoperative period under different analgesic methods and to assess the relationship between the inflammatory response and the pain response using the Visual Analog Scale (VAS).\u0000Materials and methods. We studied 30 pediatric patients with acute surgical abdominal pathologies, aged 8 to 15 years for urgent surgical procedures requiring general anesthesia. The patients were divided into 3 groups according to selected methods of intraoperative anesthesia: the 1 group included 12 patients, who received standard general anesthesia, the 2 group involved 10 patients, who received general anesthesia and infiltration anesthesia of the wound with 0.5% bupivacaine, a local anesthetic, and the 3 group included 8 children, who received general anesthesia and wound infiltration with 0.5% bupivacaine plus adjuvant (dexamethasone – 4 mg). One hour before surgery and in the postoperative period (3 and 12 hours after surgery), the patients were asked to fill in a pain diary assessing the intensity of pain syndrome and its dynamic characteristics using a visual analogue scale (VAS). Investigation to the rate of inflammatory response was assessed by monocytechemoattractant protein-1 (MCP-1).\u0000RESULTS. We found out that the plasma CCL2 / MCP-1 level in the patients prior surgery averaged 17.25 ± 7.8 pg / ml; (p <0.05), the baseline plasma CCL2 / MCP-1 levels in the patients of all groups were nearly the same. In patients of the 1st group there was an increase in the level of CCL2 / MCP-1 in the blood plasma (2.3 times) 3 hours after surgery, p <0.05, and 12 hours after surgery, the level of the studied chemokine increased by 6.7 times compared with the results obtained before surgery (p <0,05). Patients in the second group had no increase in inflammatory markers after 3 hours, but after 12 hours after surgery, plasma CCL2 / MCP-1 level significantly increased in 2.2 times compared with the values of the chemokine before surgery (p <0,05). In patients of group 3, the level of CCL2 / MCP-1 in blood plasma did not change statistically at 3 hours and 12 hours after surgery, although on average it decreased quantitatively. In the preoperative period the pain intensity ranked by the VAS scale averaged 7.8 scores and almost did not differ in the all study groups, but in the postoperative period, the degree of pain intensity was quantitatively the lowest in group 3 compared with 1 and 2 study groups.\u0000CONCLUSION. The dynamics of plasma CCL2 / MCP-1 levels in the patients reflects the development of the general adaptation syndrome in response to trauma. The CCL2 / MCP-1 level is significantly influenced by the type of anesthesia. The multimodal approach to the pain management is cons","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79120788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-30DOI: 10.25284/2519-2078.3(96).2021.242148
V. Cherniy, A. Denysenko
Secondary hyperparathyroidism (SHPT) affects a majority of patients with chronic kidney disease (CKD) of stage 3 or worse with manifestations of chronic renal failure (CRF) who undergo hemodialysis. Most of them have severe metabolic disorders, metabolic acidosis and a range of disorders associated with hyperparathyroidism and require parathyroid surgery (PTS). Aim of research. To assess the possibilities of metabolic correction in patients with SHPT with PTS, depending on the level of blood cortisol. Materials and methods. The study was carried out in the clinic of SIS «RPC PCM» SAD, Kyiv, Ukraine, was prospective, not randomized. The study group (n=133) included patients with severe SHPT manifestations due to end-stage chronic renal failure due to CKD, who underwent PTS. Patient age: 21-75 years old. Men – 69 (51,9%), women – 64 (48,1%). The degree of preoperative risk of ASA III-IV. Surgical interventions were performed under general anesthesia using the inhalation anesthetic sevoflurane and the narcotic analgesic fentanyl under conditions of low-flow artificial ventilation. The patients underwent a personalized energy monitoring developed and implemented in our clinic, using indirect calorimetry, by determining the index of current metabolism (Metabolic Rate Index, MRI, cal min-1 m2 ), basal metabolism (Basal Metabolic Rate Index, BMRI, cal min-1 m2), target metabolism (Target Metabolic Rate Index) and severity of metabolic disorders (Metabolic Disordes, MD,% = ). The patients were divided into two groups. The first group (I,72) consisted of patients who had reference values of the morning blood cortisol level before the operation – 171,03 and higher (173-374) nmol/L. The second group (II, 61) consisted of patients who had cortisol levels below this limit (91,5-168 nmol/L). In group I, intensive perioperative therapy was standard and aimed at supporting and correcting vital signs, according International Standards for a Safe Practice of Anesthesia 2010, WFSA. In group II, patients additionally received intravenous drip of 125-250 mg of prednisolone and further situationally hydrocortisone under the control of energy monitoring indicators. Results. In 45.9% of patients with SHPT and end-stage CKD, glucocorticoid insufficiency and low metabolic rate were diagnosed, which can lead to irreversible changes in organs or the life support system and increase the risks of perioperative complications and death in PTS. Preventive and perioperative administration of glucocorticoids under the control of energy monitoring, restores homeostasis indicators. Patients with normal blood cortisol levels did not have significant metabolic disorders. It was enough for them to follow the standard protocol of perioperative intensive care. Conclusions. Mandatory preoperative monitoring of blood cortisol levels in patients with SHPT against the background of end-stage CKD, who are on programmed hemodialysis, who are planned for PTS, is required in order to achieve a d
继发性甲状旁腺功能亢进(SHPT)影响大多数接受血液透析的3期或更严重的慢性肾病(CKD)患者，表现为慢性肾功能衰竭(CRF)。他们大多有严重的代谢性疾病、代谢性酸中毒和与甲状旁腺功能亢进相关的一系列疾病，需要进行甲状旁腺手术(PTS)。研究目的。评估SHPT合并PTS患者根据血液皮质醇水平进行代谢纠正的可能性。材料和方法。该研究是在乌克兰基辅的SIS«RPC PCM»SAD诊所进行的，是前瞻性的，不是随机的。研究组(n=133)包括CKD引起的终末期慢性肾功能衰竭导致严重SHPT表现的患者，他们接受了PTS治疗。患者年龄:21-75岁。男性69人(51.9%)，女性64人(48.1%)。ASA III-IV术前风险程度。在低流量人工通气条件下，采用吸入性麻醉剂七氟醚和麻醉镇痛药芬太尼全麻进行手术干预。患者接受了在我们诊所开发和实施的个性化能量监测，使用间接量热法，通过确定当前代谢指数(代谢率指数，MRI, cal min-1 m2)，基础代谢(基础代谢率指数，BMRI, cal min-1 m2)，目标代谢(目标代谢率指数)和代谢紊乱严重程度(代谢紊乱，MD，% =)。患者被分为两组。第一组(I,72)术前晨血皮质醇参考值为- 171,03及以上(173-374)nmol/L。第二组(II, 61)包括皮质醇水平低于该限值(91,5-168 nmol/L)的患者。根据2010年国际麻醉安全操作标准(WFSA)，在第一组中，强化围手术期治疗是标准的，旨在支持和纠正生命体征。II组患者在能量监测指标控制下，在静脉滴注强的松125 ~ 250 mg的基础上再静脉滴注氢化可的松。45.9%的SHPT合并终末期CKD患者诊断为糖皮质激素功能不全和低代谢率，可导致器官或生命支持系统发生不可逆的改变，增加PTS围手术期并发症和死亡的风险。在能量监测的控制下，预防和围手术期给予糖皮质激素，恢复体内平衡指标。血液皮质醇水平正常的患者没有明显的代谢紊乱。围手术期重症监护的标准方案就足够了。在终末期CKD背景下，SHPT患者需要进行计划性血液透析，计划进行PTS治疗，为了实现差异化的治疗方法:确定静脉注射糖皮质激素的需要和剂量，需要在术前强制监测血液皮质醇水平。
{"title":"BLOOD CORTISOL CONCENTRATION, HEMODYNAMICS AND METABOLISM OF PATIENTS WITH SECONDARY HYPERPARATHYROIDISM, POSSIBILITIES OF PERIOPERATIVE CORRECTION","authors":"V. Cherniy, A. Denysenko","doi":"10.25284/2519-2078.3(96).2021.242148","DOIUrl":"https://doi.org/10.25284/2519-2078.3(96).2021.242148","url":null,"abstract":"Secondary hyperparathyroidism (SHPT) affects a majority of patients with chronic kidney disease (CKD) of stage 3 or worse with manifestations of chronic renal failure (CRF) who undergo hemodialysis. Most of them have severe metabolic disorders, metabolic acidosis and a range of disorders associated with hyperparathyroidism and require parathyroid surgery (PTS).\u0000Aim of research. To assess the possibilities of metabolic correction in patients with SHPT with PTS, depending on the level of blood cortisol.\u0000Materials and methods. The study was carried out in the clinic of SIS «RPC PCM» SAD, Kyiv, Ukraine, was prospective, not randomized. The study group (n=133) included patients with severe SHPT manifestations due to end-stage chronic renal failure due to CKD, who underwent PTS. Patient age: 21-75 years old. Men – 69 (51,9%), women – 64 (48,1%). The degree of preoperative risk of ASA III-IV. Surgical interventions were performed under general anesthesia using the inhalation anesthetic sevoflurane and the narcotic analgesic fentanyl under conditions of low-flow artificial ventilation. The patients underwent a personalized energy monitoring developed and implemented in our clinic, using indirect calorimetry, by determining the index of current metabolism (Metabolic Rate Index, MRI, cal min-1 m2 ), basal metabolism (Basal Metabolic Rate Index, BMRI, cal min-1 m2), target metabolism (Target Metabolic Rate Index) and severity of metabolic disorders (Metabolic Disordes, MD,% = ). The patients were divided into two groups. The first group (I,72) consisted of patients who had reference values of the morning blood cortisol level before the operation – 171,03 and higher (173-374) nmol/L. The second group (II, 61) consisted of patients who had cortisol levels below this limit (91,5-168 nmol/L). In group I, intensive perioperative therapy was standard and aimed at supporting and correcting vital signs, according International Standards for a Safe Practice of Anesthesia 2010, WFSA. In group II, patients additionally received intravenous drip of 125-250 mg of prednisolone and further situationally hydrocortisone under the control of energy monitoring indicators.\u0000Results. In 45.9% of patients with SHPT and end-stage CKD, glucocorticoid insufficiency and low metabolic rate were diagnosed, which can lead to irreversible changes in organs or the life support system and increase the risks of perioperative complications and death in PTS. Preventive and perioperative administration of glucocorticoids under the control of energy monitoring, restores homeostasis indicators. Patients with normal blood cortisol levels did not have significant metabolic disorders. It was enough for them to follow the standard protocol of perioperative intensive care.\u0000Conclusions. Mandatory preoperative monitoring of blood cortisol levels in patients with SHPT against the background of end-stage CKD, who are on programmed hemodialysis, who are planned for PTS, is required in order to achieve a d","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84185957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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