Vol 11, No 2 (2017)

This review presents the current state of postoperative pain in children. Based on the fundamental studies that have shown the presence of a newborn neurophysiological and neurochemical nociceptive information transmission mechanisms, provides information about the negative impact of pain on the body of the child. Presented neurophysiological aspects of pain perception in children, pain assessment methods, the basic principles of modern post-operative analgesia. Particular attention is given to drugs permitted for use in the Russian Federation. in children

Objective. The aim of the work was to assessment the analgesic effect of dexamethasone at peripheral nerve blockades. Material and methods. The study included 166 patients, including 45 children aged from 3 to 16 years of age, randomized into 3 groups. For blockages in peripheral nerves of the 1st group received 0.5% solution ropivacine, in the 2 nd group - 0.5% solution ropivacine and dexamethasone intravenous, 3 rd group - 0.5% solution ropivacine and dexamethasone. Results. Duration period painless adults was 12.8±7.1 h, 22.8±4.8 h and 24,1±6,8 h, children 8.3±1.5 h, 10.4±1.7 h and 20±5 h, respectively. It is shown that the use of dexamethasone protects the patient from nociceptive afferentation in the postoperative period. Possible mechanisms of the analgesic effect of dexamethasone was discussed. Conclusion. Further research is needed to study the mechanism of analgesic action of dexamethasone.

Objective - to estimate frequency of occurrence of critical incidents during epidural anesthesia in gynecological patients with different sensitivity of peripheral chemoreflex. Material and Methods: prospective observational blind study, 54 gynecological patients, elective surgery. The day before the surgery, the sensitivity of peripheral chemoreflex was determined by the duration of an arbitrary threshold apnea in a test with a delayed respiration. According to the duration of the test, the patients were divided into groups: high (group «1») and medium (group «2») sensitivity of peripheral chemoreflex. During the operation and in the early postoperative period, critical incidents were recorded. Results and Conclusion(s). During epidural anesthesia in gynecological patients from intraoperative critical incidents is revealed hypotension. The frequency of occurrence of hypotension was 32.1% in patients of group «1» and 15.4% in patients of group «2». High sensitivity of peripheral chemoreflex in patients during epidural anesthesia is a predictor of unstable hemodynamics, as well as the risk of postoperative nausea and vomiting.

The objective is to study the effect of single-nucleotide polymorphisms (SNPs) of COMT gene on the formation and characteristics of chronic pain, level of anxiety and depression, effectiveness of analgesia in oncological patients. Material and Methods. The study includes 196 patients with oncological pathology. The formation of chronic pain syndrome was estimated in all patients one year after surgery using the assessment of pain intensity by numeric rating scale, pain questionnaire of McGill, PainDetect. Basing on the patients genotyping data the genotypes and haplotypes frequency distribution on SNPs of rs4680, rs740603, rs2097603=rs2070577, rs4633 of COMT gene was estimated. The relationship between different genotypes, haplotypes and chronic pain intensity, severity of ranking index of pain for sensor and affective characteristics on McGill scale, presence of neuropathic component of pain and anxiety was studied in all patients sample. The same analysis was carried out in order to clarify difference in morphine consumption (mg/24h) and severity of adverse side effects such as drowsiness, confusion and hallucinations. Results. It is found that after one year the pain syndrome was developed in 134 patients. It was showed that there is direct relationship between chronic pain intensity, anxiety level and presence of mutant allele on polymorphisms of rs4680 in exon and rs740603 in intron of COMT gene. There was also revealed inverse relationship between morphine requirement and presence of pointed polymorphisms in comparison with the patients who have GG genotype of these markers. Conclusion. The determination of pointed SNPs may be useful for choosing the optimal tactics of analgesia in patients with chronic oncological pain syndrome.

Clinical guideline contained a summary on the management of hip fractures in the elderly. Presents the key positions, the implementation of which is required in the perioperative period. Special attention is given pain relief, prevention of delirium and management of patients in the postoperative period.