DOI: https://doi.org/10.22141/2224-0586.5.92.2011.143244

Types of multimodal analgesia in surgical treatment of colorectal cancer

Ye.A. Gorkavyi, І.І. Lisnyi

Abstract


Background. The purpose of the research was to study the efficacy and safety of various types of multimodal analgesia in the surgical treatment of colorectal cancer. Materials and methods. The study included 90 patients operated for rectal cancer. The ana­lysis of changes in hemodynamics, stress marker level — blood sugar and pain intensity on the visual analogue scale was carried out in three groups of patients depending on the method of perioperative analgesia. Results. The study found that the application of various types of multimodal analgesia using epidural analgesia (EA) with inhalation and intravenous anesthesia more effectively protects the patient from surgical stress in colorectal cancer as compared to the total intravenous anesthesia, preserves hemodynamic stability, reduces the dose of fentanyl and muscle relaxants. Conclusions. EA with a mixture of local anesthetic with fentanyl, and EA with a local anesthetic with patient-controlled fentanyl analgesia in combination with a pa­renteral non-steroidal anti-inflammatory drug and paracetamol as components of multimodal analgesia is safe for postope­rative use after colorectal surgeries, effectively controls acute postope­rative pain, maintains a stable level of the blood sugar in comparison with postoperative omnopon anesthesia.

Keywords


multimodal analgesia; epidural analgesia; non-steroidal anti-inflammatory drug; paracetamol; surgical stress; postoperative pain

References


World Cancer Research Fund International. — https://www.wcrf.org.

Національний канцер-реєстр. Структура захворюваності та смертності. — 2016. — № 19.

Apfelbaum J.L., Chen C., Mehta S.S., Gan T.J. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged // Anesth. Analg. — 2003. — Vol. 97. — P. 534-540.

Уніфікований клінічний протокол первинної, вторинної (спеціалізованої), третинної (високоспеціалізованої) медичної допомоги та медичної реабілітації, колоректальний рак. Наказ Міністерства охорони здоров’я України, 12.07.2016, № 703.

Kehlet H., Dahl J.B. Anaesthesia, Surgery, and Challenges in Postoperative Recovery // Lancet. — 2003. — 362. — Р. 1921-1928.

White P.F., Kehlet H., Neal J.M., Schricker T., Carr D.B., Carli F.; Fast-Track Surgery Study Group. The role of the ane­sthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care // Anest. Analg. — 2007. — 104. — Р. 1380-1396.

Bundgaard-Nielsen M., Holte K., Secher N.H., Kehlet H. Monitoring of peri-operative fluid administration by individua­lized goal-directed therapy // Acta Anaesthesiologica Scandinavica. — 2007. — 51(3). — Р. 331-340.

Cousins and Bridenbaugh’s. Epidural Neral Blockade // Neural Blockade in Clinical Anesthesia and Pain Medicine. — 1988. — 2nd ed. — Р. 253-360.

Clinical Nutrition 31 (2012) 801-816, Guidelines ERAS (enhanced recovery programmes after surgery), 2012.

Wilmore D.W. From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients // Ann. Surg. — 2002. — 236. — Р. 643-48.

Christopher L.Wu, Seth R. Cohen, Jeffrey M. Richman, Andrew J. Rowlingson, Genevieve E. Courpas et al. Efficacy of postoperative patient- controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis // Anesthesiology. — 103(5). — Р. 1079-88.

Jorgensen H., Wetterslev J., Moiniche S. et al. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdo­minal surgery // Cochrane Database Syst. Rev. — 2000. — 4. — CD 001893.

Holte K., Kehlet H. Epidural analgesia and risk of anastomotic leakage // Reg. Anesth. Pain. Med. — 2001. — 26. — 111.

Kehlet H., Dahl J.B. The value of ”multimodal” or ”ba­lanced analgesia” in postoperative pain treatment // Anesth. Analg. — 1993 Nov. — 77(5). — Р. 1048-56.

Maund E., McDaid C., Rice S., Wright K., Jenkins B., Woolacott N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery // Br. J. Anaesth. — 2011 Mar. — 106(3). — Р. 292-7.




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