Anesthetic management of laparoscopic gynecologic surgeries: a new view
Background. Currently, more than 90 % of all gynecologic surgeries in the world are performed laparoscopically. The advantages of this type of surgery are less trauma, cosmetic effect, the possibility of early activation of patients and reduced hospital stay. Increasingly, such operations are performed under regional anesthesia. The purpose was to compare the postoperative period in patients undergoing laparoscopic gynecologic interventions under general (GA) or regional anesthesia (RA). Materials and methods. A prospective cohort study included 208 patients who underwent laparoscopic conservative myomectomy and removal of the uterus with appendages in the department of operative gynecology with minimally invasive technologies of the Kharkiv Regional Perinatal Center of “Regional Clinical Hospital — Center for Emergency Medical Care and Disaster Medicine” in 2016–2018. The average age of patients was 44.78 ± 8.01 years. Patients were divided into 2 groups: in the first one (n = 103), GA with mechanical ventilation was used, in the second one (n = 105) — combined RA. The clinical status of patients was evaluated based on the results of non-invasive monitoring. The assessment of the pain syndrome was carried out using a visual analog scale (VAS). Various side effects such as nausea and vomiting, shoulder pain, postoperative shivering, headache as well as frequency and type of anesthesia have been analyzed by patients’ surveys. Results. Throughout all postoperative period, pain according to VAS was significantly lower among patients in the RA group. The biggest difference between both groups was observed 3, 6 and 12 hours after surgery (VAS scores in the GA group were 6.4 times higher than those in the RA group). The pain in the shoulders, which often accompanies the early postoperative period of surgeries performed using pneumoperitoneum, was found in 14.6 % of patients from the GA group and in 3.8 % — from the RA group that is significantly lower. The incidence of postoperative nausea and vomiting was significantly higher in the GA group — 20.4 % compared to 5.7 % in the RA group. When comparing methods of analgesia in the postoperative period, it was found that patients in the GA group received narcotic analgesics in average twice, while patients in the RA group received non-steroidal anti-inflammatory drugs 1–2 times per day. Activation of patients in the RA group began after 5 hours, in the group of GA — after 16–18 hours. Already in the first postoperative day, patients of the RA group had active peristalsis and passage of flatus; among GA patients, restoration of bowel activity occurred 2–3 days after surgery. The results of patient satisfaction with treatment on Likert scale (1–5 points) were evaluated 3 months after surgery in terms of recovery, pain severity and return to normal activity. One hundred patients in the GA group and 99 patients of the RA group took part in a telephone survey. The majority of patients in the RA group expressed significantly greater satisfaction with the treatment (4.67 ± 0.41 points) than patients in the GA group (4.15 ± 0.73 points). Conclusions. Combined regional anesthesia is an effective method of pain relief in laparoscopic gynecologic surgeries. Regional anesthesia provides adequate muscle relaxation and appropriate working environment for operators, without compromising general anesthesia and avoiding its unwanted risks. It is this multicomponent technique, according to our research, that it is more effective, safe, more comfortable for patients. We also found that patients operated under RA were generally more satisfied with treatment.
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