Regional Anesthesia and Acute Pain Management
Peer-review medical journal.
Editor-in-Chief
- Aleksey M. Ovechkin, MD, Dr. Sci. (Med).
SCOPUS Author ID: 7003507291
Journal founders
- Izdatelstvo "Meditsyna"
- Eco-Vector Publishing Group
Publisher
- Eco-Vector Publishing Group
WEB: https://eco-vector.com/
About
The Journal is intended for practicing anesthetists. The aims of the journal are:
- to disseminate information on the modern techniques of regional anesthesia and analgesia used in surgery, modern medications and treatment schemes used to alleviate postoperative pain and...
- to facilitate experience exchange among anesthetists from all over the World.
Types of accepted articles
- reviews
- systematic reviews and metaanalyses
- original research
- clinical case reports and series
- letters to the editor
- short communications
- clinical practice guidelines
Publications
- in English and Russian
- quarterly, 4 issues per year
- continuously in Online First
- with NO Article Processing Charges (APC)
- distribution in hybrid mode - by subscription and/or Open Access
(OA articles with the Creative Commons Attribution 4.0 International License (CC BY-NC-ND 4.0))
Indexation
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Vol 18, No 2 (2024)
Original study articles
New μ1-opioid receptor agonist for emergency pain relief in outpatient clinic: open observational nonrandomized uncontrolled study
Abstract
BACKGROUND: High-intensity pain is a common problem in outpatient practice, and adequate examination and interventional treatment may be complicated. An effective, safe, and fast pain relief method should be established.
AIM: To evaluate the efficacy and safety of the use of the analgesic Tafalgin in the outpatient clinic for relief of intense pain due to various causes and compare the efficacy of different Tafalgin dosages.
MATERIALS AND METHODS: Twenty-two patients with high-intensity pain (≥7 points on a numeric rating scale, NRS) were studied. All patients were administered Tafalgin once subcutaneously; pain relief, duration of the analgesic effect, and side effects were observed. Additionally, the differences in the effectiveness and safety of two different doses (i.e., 4 and 7 mg) were analyzed.
RESULTS: Average pain intensity at rest before the injection was 9±2 points according to NRS, and pain intensity in movement was 9±1. After Tafalgin injection, average pain intensity decreased to 3±3 points on NRS (pain intensity at rest and in movement were the same). The initial analgesic effect onset time was 17±9 minutes and average duration of the effect was 202±75 minutes. Adverse events (AE) occurred in 8 of 22 patients (36%); all AEs were mild, did not require any treatment, and regressed spontaneously. Differences in efficacy of two Tafalgin doses were noted: after the injection, pain intensity decreased to 6±3 and 2±2 points in the 4 (p=0.16) and 7 mg (p <0,001) groups, respectively. No difference was found between the two groups in effect onset time, effect duration, and number of AEs.
CONCLUSION: Tafalgin demonstrated a strong analgesic effect in intense pain relief; the 7 mg dose demonstrated a satisfactory result and should be prefer for most patients suffering high-intensity pain. In therapeutic dosages, Tafalgin is a well-tolerated treatment, and good adherence to medication was noted.
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Potential of modern nonopioid analgesics in the prevention and treatment of pain syndrome in decompressive stabilizing spine surgeries
Abstract
BACKGROUND: Secondary (tumor) lesion of the spine in 80% of cases is accompanied by chronic pain syndrome (CPS). A decrease in opioid subsidies in the postoperative period is important not only to prevent side effects, but also in order to create a reserve when providing palliative care for patients with CP, due to the pathology of the skeletal muscle system.
AIM: To optimize postop analgesia for cancer patients with CPS undergoing decompressive-stabilizing spine surgery.
MATERIALS AND METHODS: We included 52 patients aged 32–76 (average age: 59±10 [95% CI: 56–62]) years, 23 (44.2%) men and 29 (55.8%) women, with physical status according to the classification of patients of the American Society of Anesthesiologists I–III, CPS without therapy were included strong opioids for spinal metastases. Patients were randomized according to the type of postop analgesia: tramadol was used in the control group (group K) (n=15, 28.8%), a combination of diclofenac and orphenadrine in group D (n=18, 34.6%), and ibuprofen in group I (n=19, 36.5%). Postoperative pain intensity deduced using the visual analog scale was determined during extubation, transfer to a bed in the intensive care unit, 1 and 3 hours postop, and 21:00 on the day of surgery and 06:00 on day 2. The effect duration of the analgesic under study, the need for anesthesia on the postop day, and satisfaction with Likert anesthesia 1 hour after administration were evaluated.
RESULTS: Significant differences in the average values of pain intensity at rest at 06:00 on postoperative day 2 between groups D (Me=10) and K (Me=20) were obtained. Satisfaction with pain relief according to Likert scale in the groups was rated “excellent” or “good.” The duration of opioid therapy was significantly lower in the nonopioid groups (six postop days in groups I and D versus seven in group K; p=0.013).
CONCLUSIONS: Postop analgesia methods using nonopioid analgesics are effective and possess opioid-sparing potential.
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Optimization of ultrasound navigation techniques for brachial plexus block using proximal subclavian access
Abstract
BACKGROUND: When performing a brachial plexus block in the proximal subclavian region, the scanning plane is located deeper and posterior to the clavicle midpoint. Data on the angle of the ultrasound probe and visualization of the brachial plexus bundles are limited.
AIM: Our aim was to evaluate visualization and positioning of the neurovascular bundle in the infraclavicular region for proximal brachial plexus block..
MATERIALS AND METHODS: Volunteer patients (добровольцах (n=28, median — 43 years)) at the Military Traumatology and Orthopedics Clinic of the Military Medical Academy, named after S.M. Kirov, were studied. Ultrasound navigation was used to evaluate the neurovascular bundle followed by brachial plexus block.
RESULTS: The study showed that the brachial plexus bundle is best visualized at an average sensor angle of between 90° and the maximum that allows visualization of at least one of the elements of the brachial plexus 64.4° (65.7°, 63°) and amounted to 77.5° (77.9°, 76.5°).
CONCLUSION: The optimal angle for performing a brachial plexus block using the proximal subclavian approach is 77.5°. Optimal visualization of the brachial plexus is possible in the angle range from 64.4° to 90°, which enables selecting the safest trajectory of the needle when performing a blockade in this area, considering the anatomical characteristics of the patient. Further studies are required to compare the sensor angles used in actual clinical practice to the angles obtained in this study.
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The effect of opioid-free anesthesia using lidocaine on the level of inflammatory markers in thoracic patients in the intra- and postoperative period: prospective randomized study
Abstract
BACKGROUND: A pressing issue still remains the reduction of opioid analgesic dosages as a part of anesthesiological support, due to the wide range of complications they cause. An alternative to opioids is opioid-free anesthesia, including the use of lidocaine, which can influence the activity of cytokines, which reflects the advisability of its use in order to prevent an increase in the content of inflammatory markers in the postoperative period. In the domestic and foreign scientific literature, the issue of the dependence of the level of inflammatory markers on the use of non-opioid anesthesia in comparison with opioid anesthesia is relatively little studied, especially in the field of thoracic surgery.
AIM: Our aim was to conduct a comparative analysis of the content of cytokines as markers of inflammation during anesthesia using intravenous lidocaine infusion, intravenous fentanyl infusion and a combination of intravenous fentanyl and epidural anesthesia.
MATERIALS AND METHODS: A single-center, prospective, randomized study was conducted among 90 patients with a verified diagnosis of lung cancer who underwent video-assisted thoracoscopic (Vlobectomy. Depending on the method of anesthesia, patients were divided into 3 groups of 30 people: in the 1st group, lidocaine was administered, in the 2nd group, fentanyl was administered, and in the 3rd group, fentanyl was administered in combination with epidural anesthesia. The main result of the study was the assessment of the concentration of cytokines in the blood serum (interleukins - IL-2, IL-6, IL-10, as well as tumor necrosis factor α — TNF-α) using an enzyme-linked immunosorbent assay. An additional outcome was a laboratory assessment of the concentrations of glucose and cortisol in the blood serum (the analysis of these indicators was performed to assess the adequacy of anesthetic management in the intraoperative period). Statistical analysis of the results was carried out using the Python v.3.0 programming language in Jupiter Notebook.
RESULTS: Analysis of IL-6 content showed a significant difference in favor of group 1 already at the end of the operation (H=10.366691, p=0.0056); 1 day after the end of the operation, the difference in the indicator between the groups increased (H=65.603614 , p <0.001) with the lowest value in group 1. The level of TNF-α at the end of the operation did not reflect significant differences between the groups (H=0.578241, p=0.748922), however, after 24 hours, changes made it possible to note positive dynamics also in group 1 (H=12.928289 , p=0.001558). Similar results were recorded for IL-10 [(H=1.325812, p=0.515352) and (H=9.11072, p=0.010511)] and IL-2 [(H=5.185739, p=0.074805) and (H=23.420171, p=0.000008)], respectively.
CONCLUSION: Our results showed that opioid-free anesthesia based on intravenous lidocaine infusion positively correlates with serum concentrations of IL-2, IL-6, IL-10, and TNF-α in patients undergoing thoracic surgery. Serum levels of these cytokines may be indicators of inflammatory responses and may have clinical implications for selecting appropriate anesthesia for patients with lung cancer. In addition, data regarding IL-2 are new and may be associated with tumor progression and the occurrence of distant metastases.
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Comparison of regional blocks performed under ultrasound navigation during thoracoscopic surgical interventions in children with malignant neoplasms: prospective randomized single center study
Abstract
BACKGROUND: Thoracic epidural anesthesia is the gold standard for postoperative analgesia after thoracic surgery; its alternatives include paravertebral block (PVB) and erector spinae plane block (ESPB). However, ESPB has not been evaluated in comparison with intraoperative PVB for effectiveness and speed of recovery in the early postoperative period after thoracoscopic surgery in children with cancer.
AIM: Our aim was to investigate the analgesic effectiveness of erector spinae muscle block compared to thoracic paravertebral block for intra and postoperative analgesia during thoracoscopic surgical interventions in children with thoracic tumors.
MATERIALS AND METODS: A prospective, randomized, single-center study was conducted. The sample size was 90 patients (ESPB group, 45; PVB group, 45). Randomization was performed using computer-generated codes applying the hidden envelope method. Patient representatives and the investigators collecting outcome data were informed about the study. Participants were children aged <18 years with malignancy, ASA class I–II, and undergoing thoracoscopic surgery. The patients underwent ultrasound-guided blockades with the administration of local anesthetic at 2 mg/kg (ropivacaine) after general anesthesia induction and before surgical incision. Moreover, both groups received the same standardized pain management protocol during and after surgery. The main outcome was the effectiveness of analgesia, determined by the need for additional intraoperative opioid administration. The secondary outcomes included pain scores at rest and with movement within 24 hours postsurgery, 24-hour analgesic consumption, time to first analgesia, and postoperative complication incidence and severity.
RESULTS: The time (min) required to perform the block was significantly shorter (p <0.05) in the ESPB 5.5 (6; 8.5) group than in the PVB 11 (9; 12) group. No significant difference was found in the intraoperative fentanyl dose between the ESPB and PVB groups, which was 150 (100; 300) µg and 150 (100; 200) µg (p <0.65), respectively. The PVB group had lower VAS scores at 24 hours postoperatively (p <0.001). In the ESPB group, the mean (standard deviation) of total tramadol consumption was 120 (25) mg/day, and in the PVB group, 54 (12) mg/day (p <0.001). Pain scores according to the VAS and Wong–Becker scales during movement were lower in the PVB group at 1, 2, 6,12, and 24 hours postsurgery (p=0.025, 0.015, 0.03, 0.02, and 0.006).
CONCLUSION: In children with thoracic tumors who underwent thoracoscopic surgical interventions, ultrasound-guided PVB was more effective compared to ultrasound-guided ESPB performed in the postoperative period and induced a more pronounced and prolonged postoperative analgesic effect, although it was not inferior in providing intraoperative analgesia regarding opioid consumption. However, ESPB was easier to implement and required less time.
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Reviews
Pain after cesarean section: do we have reliable predictors? Scoping review
Abstract
BACKGROUND: Every year, the number of publications devoted to the study of various tools for predicting the intensity of pain after cesarean section is growing, which necessitated the generalization and systematization of these data.
OBJECTIVE: Our aim was to identify factors contributing to high-intensity pain after cesarean section (CS).
MATERIALS AND METHODS: a scoping review based on the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines was conducted using PubMed, Cochrane Database of Systematic Reviews, and Google Scholar. The search was performed using the following keywords: “predictors” OR “prediction” OR “forecasting” AND “cesarean section” AND “pain”) in Russian and English, last search date November 30, 2022. The inclusion criteria for the review were formulated using the PICOD method: (P) population: postpartum women; (I) intervention: CS surgery; (C) comparison: surgical approach, anesthesia method, psychological status, pain threshold, genetic characteristics; (O) outcomes: pain intensity scores, analgesic requirements; (D) study design: prospective/retrospective cohort studies. Exclusion criteria were as follows: lack of sufficient data or outcome of interest; duplicate publication; chronic pain; publications devoted to pain relief during childbirth or pain after other surgical interventions; lack of full-text version; reviews and meta-analyses. The quality of selected non-randomized cohort studies was assessed using the Newcastle-Ottawa Scale (NOS).
RESULTS: 30 cohort studies were selected, involving 11,063 patients. Most studies were assigned an NOS score of 6 to 8, which was considered good quality. Two groups of factors were identified as predictors of the intensity of postoperative pain: factors associated with the characteristics of the patient (physical status, psychological status, individual pain threshold and pain tolerance, genetic characteristics) and factors associated with the characteristics of the operation and anesthesia.
CONCLUSION: the scoping review allowed us to identify reliable factors predicting high-intensity pain after CS, which should be taken into account when planning anesthesiological care for patients.
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Effect of various anesthesia methods on surgical treatment outcomes in patients with proximal femur fracture: a narrative review
Abstract
Fractures of the proximal femur (FPF) is an unclassified condition that involves fractures of the femoral head and femoral neck and transvertebral, intervertebral, and subvertebral femoral fractures. To date, the number of patients with FPF in Russia is continuously increasing. Most often, patients with FPF have several concomitant diseases that can have a noticeable effect on the choice of anesthesia method. This review aimed to analyze current literature data on the advantages, risks, and contraindications of traditional and novel approaches to anesthesia in surgeries for FPF and assess the impact of these approaches on postoperative outcomes. A search for publications in the electronic databases PubMed and eLibrary was conducted. It revealed 6 324 publications in PubMed and 520 in eLibrary. After selecting publications, 60 studies meeting the inclusion criteria were included in the review. Studies have shown that regional blockades are highly effective; however, the evidence requires additional confirmation. New local anesthesia methods, such as MAC-STILA, can reduce mortality, especially in patients with a burdened medical history. Although the results of the single-center pilot studies of MAC-STILA are promising, multicenter randomized trials are required to test the reproducibility of this approach and evaluate its effectiveness with respect to outcomes that are crucial for the elderly and their family members.
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