Application of principles of multimodal analgesia as the content element of a fast-track surgery program

Objective. To estimate the efficacy of postoperative pain reduction in first days after surgical intervention in acceleration of postoperative restoration in patients and reduction of the stationary treatment duration. Materials and methods. In Sept. 2011 - May 2019 yrs period there were performed 569 elective operative interventions, using principles of a Fast Track Surgery program, including those with application of multimodal analgesia. Depending on the kind of operative intervention the indices of pain impulses were determined in accordance to visual-analogous scale and median duration of stationary treatment. Results. On the first day after laparoscopic cholecystectomy the pain impulsation level have constituted 2.87 ± 0.74, on the second day - 2.01 ± 0.50 (p < 0.001). Median duration of the patients’ stationary stay have constituted 1.72 days. After laparoscopic hernioplasty the results of the pain level investigation were: on the first day - 3.44 ± 0.67, on the second day - 2.06 ± 0.51 (p < 0.001). Median duration of postoperative treatment have constituted 1.43 days. After laparoscopic bariatric interventions on large bowel during the first postoperative day the pain level have constituted 4.24 ± 0.75 and 4.39 ± 0.84 accordingly, on the second day it have reduced to 3.48 ± 0.57 (p < 0.001) and 3.48 ± 0.77 (p < 0.001), on the third day - to 2.79 ± 0.67 (p < 0.001) and 2.84 ± 0.69 (p < 0.001). At the same time a median duration of the patients’ stationary stay have constituted (4.99 ± 0.45) and (4.10 ± 0.60) days, accordingly. Conclusion. Efficacy of reduction of postoperative pain in first days after surgical intervention immediately impacts the speed of restoration of the patients’ organism and duration of stationary treatment.

The method of inhalation analgesia with sevoflurane during spontaneous delivery

Background: The search for methods for protection against delivery and labor pains has led to resumption of studies of non-invasive, safe and effective labor analgesia and inhalational anesthesia that could be used both separately and in combination with other methods. Recent research has demonstrated the highest efficacy of sevoflurane for analgesia of spontaneous delivery.Aim: To develop an optimized and effective method of inhalational analgesia with sevoflurane for spontaneous delivery.Materials and methods: We have performed a prospective study of the efficacy of inhalational sevoflurane for analgesia of spontaneous delivery. Thirty three obstetric patients were given sevoflurane-oxygen mixture according to a specially designed technique. The pain intensity was assessed with a visual analogous scale (VAS), sedation level, with Ramsay scale and Richmond Agitation-Sedation Scale (RASS).Results: The mean duration of inhalational anesthesia was 92.1±28 minutes [60–180']. There were no refusals and no switching to another type of analgesia. After induction of analgesia with Funding sevoflurane, there was a significant decrease of pain intensity by VAS by 34.9% from the baseline level (p = 0.00003); the pain was assessed as “moderate”. This trend was maintained throughout the whole exposure period.Conclusion: The results obtained confirm the possibility to use the proposed method of inhalational analgesia with sevoflurane to ensure effective analgesia in obstetric patients during delivery and labor.

EFFECT OF THE REFLEXOTHERAPY ON THE QUALITY OF LIFE IN PATIENTS WITH CHRONIC TENSION-TYPE HEADACHE

Aim. To estimate the effect of reflexotherapy and standard pharmacological therapy on quality of life in patients with chronic tension-type headache (CTTH).Materials and methods. 95 patients (16 men and 79 women) with CTTH have been taken as the object of research. All patients were divided into two clinical groups. Patients of group 1 received amitriptyline 35-70 mg/day and tolperisone 450 mg/day. Patients of group 2 were assigned to 2-4 courses of injecting reflexotherapy according to the suggested methodology. The intensity of headache was assessed on the basis of scores on the Visual Analogous Scale (VAS). The quality of life was evaluated in all the patients with the aid of the SF-36 survey.Results. In both clinical groups there was decrease in quality of life in all scales except physical function (PF). All patients positively evaluated the results of the treatment. The intensity of pain reduced to 1,7±0,78 points (p<0,05) in the 1st group and 1,65±0,79 (p<0,05) in the 2nd group. As a result of the treatment, quality of life improved significantly in all scales except social function (SF). This index didn't statistically differ in both groups (p>0,05).Conclusion. CTTH significantly affect physical and mental components of patients’ health. The results obtained from the study showed the potential use of injecting reflexotherapy as treatment for CTTH.

The effect of 0.25% levobupivacaine and 0.25% ropivacaine in fascia iliaca block in elderly patients with fracture femur given before positioning for subarachnoid block

Background: Positioning of elderly patients with fracture femur for subarachnoid block (SAB) is a challenging task, both for the patient and anesthesiologist. Severe pain not only adds to the morbidity but also alters the success rate of SAB as appropriate positioning becomes difficult. Fascia iliaca compartment block (FICB) is a simple, rapid, effective and safe method for achieving excellent pain relief. The purpose of this study is to compare the efficacy of 0 .25% of levobupivacaine and 0.25% ropivacaine in FICB on reducing preoperative and postoperative pain and analgesic consumption in lower limb surgery.Methods: 60 elderly patients of ASA class I-III scheduled for elective fracture femur surgery were enrolled in the study and randomly divided into two groups. Group L received 30ml 0.25% levobupivacaine in FICB while Group R received 0.25% ropivacaine in FICB 15min before SAB. Parameters recorded were blood pressure, heart rate, visual analogous scale (VAS), quality of positioning and time to first rescue analgesia. VAS was noted before and after performing FICB and at the time of positioning for subarachnoid block (SAB).Results: The VAS score at different time interval and time to first rescue analgesia were comparable (P >0.05). Quality of positioning was also similar in both the groups (P >0.05).Conclusions: The study demonstrates that levobupivacaine and ropivacaine produce comparable preoperative and postoperative analgesia when used for FICB.

Long-term Results of Hemorrhoidal Artery Ligation

Aim of this study is to assess the efficacy, safety, and long-term results of doppler-guided hemorrhoidal artery ligation procedure with a 7-year follow-up period for treatment of grade II and III degree hemorrhoidal diseases. The procedure was performed by a specially designed proctoscope to locate and ligate all terminal branches of superior rectal artery. Patients were followed up at postoperative 1st week and 3rd, 12th, and 24th months by physical examination and 7th year by phone questionnaire using Short Form-36. Between November 2006 and May 2007, 50 patients (29 females, mean age = 38.2) underwent this procedure. All patients discharged at operation day and mean return to work was 2.5 days. There were no major complications and mean postoperative Visual Analogous Scale at first week was 1.72. At 24th month, 44 (88%) and 38 (76%) patients at 7th year were symptom free. Doppler-guided hemorrhoidal artery ligation is a safe, effective, and outpatient procedure, which can be the treatment of choice for second- and third-degree hemorrhoidal diseases with satisfactory long-term results.

Evaluation of anesthetic effect of ropivacaine in surgery of chronic periapical lessions

Introduction. Ropivacaine is used in orthopedcs, gyneacology, surgery, ophtamology, whereas experience about its usage in dentistry is still limited. The aim of this research was to compare the anesthetic effect between local anesthetics ropivacaine and bupivacaine, in surgical disposals of chronical periapical lessions in maxilla. Material and methods. The study included the patients that had indications for surgical removal of chronical periapical lessions at one of the frontal teeth of upper jaw. The total total number of examinees was 60, and they were devided in two groups. Ropivacaine chloride (0.75%) was used as a local anesthetic in one group (Naropin? 0,75%; Astra Zeneca), and in the other one bupivacaine chloride (0.5%) (Vexelit? 0,5%; Zdravlje). The autors applied 1,8 ml of block anesthesia for the n. infraorbitalis (intraoral approach) as well as 0,2 ml of the local anesthetic from the palatine side for the final branches of n. nasopalatinus in order to observe the folloving anesthetic parameters. I. Beginning of anesthesia was followed by the appearence of upper lip numbness. II. Pain rating scale according to Sisk was used for the objective measurement of the anesthesia quality. III. The pain intensity during the intervention was measured by visual analogous scale, on which the patient denoted the intensity of pain he had felt during the intervention. IV. Duration of anesthetic effect - it is followed by soft tissues numbness. Results and discussion. After the ropivacaine application anesthesia effect started in 1.57 min. and after the usage of bupivacaine in 1.67 min. The mean duration of soft tissue numbness after the application of ropivacaine was 321 minutes. Bupivacaine had a shorter anesthetic effect - 296.5 minutes. The quality of anesthesia after the usage of ropivacaine was assessed by the surgeons with average mark - 1.76. Interventions in which this anesthetic was used were performed with minimal pain and without additional anesthesia. The quality of anesthesia after the usage of bupivacaine (3.03) was statistically much worse (p<0.01) in comparison to ropivacaine. In visual analogous scale where patients denoted the intensity of pain during the intervention with ropivacaine the marked average value was 30.1 mm while the average value with usage of bupivacaine was 41.7 mm. The patients from the control group, where bupivacaine was used, had much stronger pain, statistically significant (p<0.05) in comparison to the group where ropivacaine was used. Our results show that the quality of anesthesia that was attained with 0,5% bupivacaine was much worse than the quality of anesthesia after the application of 0,75% ropivacaine. Conclusion. Ropivacaine has a potential to replace bupivacaine completely in cases when there is the indication for its usage in oral surgery (longlasting intervention, interventions followed by intensive postoperational pain, nerve blockade).

Comparison of CAD-CAM and hand made sockets for PTB prostheses

The aim of the present study was to compare sockets for below-knee (BK) prostheses made by Computer Aided Design-Computer Aided Manufacture (CAD-CAM) to those made by hand. The patients in the study were provided with two prostheses each, which apart from the sockets, were identical. One socket, was made by the CAD-CAM technique developed at the Bioengineering Centre, Roehampton, University College London and one was made by hand at the OT-Centre, Stockholm, Sweden. The results were based on investigation of eight unilateral below-knee amputees evaluating their own sockets by Visual Analogous Scale with respect to comfort, pressure, and pain. The sockets were evaluated on seven occasions, at two tests, on delivery, after use every second day for six days and every second week for two weeks. All CAD-CAM sockets except one had to be changed once as compared to the hand made of which only two had to be changed. As to comfort it could not be demonstrated that there was any significant difference between the two types of sockets and both types were well accepted by all patients. Differences in pressure and pain were rarely reported. There were obvious differences between the two types of socket with respect to height, width, and inner surface configuration. The authors feel that CAD-CAM will in the near future be an excellent tool for design and manufacture of prosthetic sockets.