Authors
Yakimovich A.I.1, Sizonenko N.А.1, Surov D.A.1, Soloviev I.А.1, Bezmozgin B.G.2, Babkov О.V.2, Sviatnenko A.V.1, 2
1 S.M. Kirov Military Medical Academy, Saint Petersburg
2 Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine, Saint Petersburg
Abstract
Background. At present, adequate relief of postoperative pain using regional analgesia methods is becoming a popular solution in the structure of providing surgical interventions. Multimodal analgesia, which involves the simultaneous use of two or more analgesics with a different route of administration, is gaining increasing popularity. It allows to achieve adequate analgesia with a minimum of side effects, and also, often, to refuse the use of opiates. This approach is actively used in performing planned interventions, but the situation in emergency surgery is diametrically opposite. The aim of this study was a comparative analysis of the results of the application of the principles of multimodal analgesia in the surgical treatment of patients with colorectal cancer complicated by an acute decompensated colonic obstruction.
Materials and methods. The study involved 105 patients with acute obstructive colonic obstruction of tumor origin, included in three groups (34, 36 and 35 people, respectively). Epidural anesthesia and continuous wound infusion were used to relieve pain in patients of the 1st group. In group 2 only epidural anesthesia was used. In group 3 a standard anesthetic pattern was used — non-steroidal anti-inflammatory drugs (NSAIDs) and opioid drugs (on request).
Results. As criteria for a comparative assessment, we studied: the intensity of the pain syndrome, the need for NSAIDs and narcotic analgesics, the terms of verticalization of patients, the terms of restoration of the motor and evacuation function of the gastrointestinal tract (the appearance of noise of intestinal motility, gas and stool discharge, myoelectric activity).
Conclusion.The analysis of the obtained data convincingly demonstrated that a combination of analgesia methods is the most effective approach to solving the problem of pain relief in the postoperative period.
Keywords: colorectal cancer, acute obstructive colonic obstruction, multimodal analgesia, continuous wound infusion.
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