Place of modern regional anesthesia techniques in the perioperative period. Advantages of long-term epidural analgesia with ropivacaine

Cardiovascular surgeon, Combustiology, Neurosurgeon, Obstetrician-gynecologist, Oncogynecologist, Oncologist, Orthopaedic Trauma, Surgeon, The anesthesiologist and specialist on medical emergency conditions, Urologist
Place of modern regional anesthesia techniques in the perioperative period. Advantages of long-term epidural analgesia with ropivacaine

Summary. The article deals with the use of modern regional analgesia techniques in the perioperative period.

A review of the literature was also conducted, which includes issues of pain control in patients in the perioperative period, characteristics of pain in surgical patients, features of pain relief methods, and certain aspects of the characteristics of local anesthetics.

Based on the review of the literature, it can be concluded that neuraxial anesthesia, as well as blockade of peripheral nerves and plexuses have become an integral part of the modern clinical practice of an anesthesiologist.

Due to a number of advantages, various methods of local and regional anesthesia are gaining acceptance, and the use of extended catheter techniques for central and peripheral blockades is now recognized as a standard technique in the perioperative management of surgical patients. In modern regional anesthesia and analgesia, both in outpatient settings and in surgical hospitals, the effectiveness and safety of local anesthetics are of fundamental importance.

Key words. Analgesia, regional anesthesia, ropivacaine, local anesthetics.

Authors: Dubrov S.O., Dmytriiev D.V.

Literature:

  1. Gerbershagen H. J. et al. Pain Intensity on the First Day after Surgery: A Prospective Cohort Study Comparing 179 Surgical Procedures. Anesthesiology April 2013, Vol. 118.
  2. Gan    Poorly   controlled   postoperative    pain:    prevalence,    consequences, and prevention. J Pain Res. 2017;10:2287-2298.  DOI:  10.2147/JPR.S144066.
  3. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011 Jun 25;377(9784):2215-25. doi: 10.1016/S0140-6736(11)60245-6.
  4. Elsenbruch S, Icenhour A, Enck P. Visceral pain: a biopsychological perspective. Neuroforum 2017;23:105–10.
  5. KoenenLR, Icenhour A, Forkmann K, et al . Greater fear of visceral pain contributes to differences between visceral and somatic pain in healthy women. Pain 2017;158:1599–608.
  6. Kucera TJ , Boezaart AP. Regional anesthesia does not consistently block ischemic pain: two further cases and a review of the literature. Pain Med 2014;15:316–9.
  7. Kumar N , Thapa D , Gombar S , et al. Analgesic efficacy of pre-operative stellate ganglion block on postoperative pain relief: a randomised controlled trial. Anaesthesia 2014;69:954–660.
  8. GebhartGF, Bielefeldt K. Physiology of visceral pain. Compr Physiol 2016;6:1609–33.
  9. Bisgaard T, Klarskov B, Rosenberg J , et al. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001;90:261–9.
  10. Tolver MA, Rosenberg J, Bisgaard T. Early pain after laparoscopic inguinal hernia repair. A qualitative systematic review. Acta Anaesthesiol Scand 2012;56:549–57.
  11. Sikandar S, Dickenson AH. Visceral pain: the Ins and outs, the ups and downs. Curr Opin Support Palliat Care 2012;6:17–26.
  12. Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., & Griffith, S. (2016). Management of Postoperative Pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ committee on regional anesthesia, executive committee, and administrative council. The Journal of Pain, 17(2), 131-157.
  13. Guidelines on Acute Pain Management, ANZCA, 2013 -anzca.edu.au/getattachment/558316c5-ea93-457c-b51f-d57556b0ffa7/PS41-Guideline-on-acute-pain-management, Acute pain management: scientific evidence, 2020.
  14. Місцеві анестетики: сучасний погляд / Ю. Л. Кучин, М. М. Пилипенко, Ю. І. Налапко , Р. Крегг // Pain Medicine / Медицина Болю , №3 – С. – 7-18.
  15. Hansen TG. Ropivacaine: A pharmacological review. Expert Rev Neurother. 2004;4:781–91. 
  16. McClure JH Br J Anaesth. 1996 Feb; 76(2):300-7.
  17. Amide local anesthetics potently inhibit the human tandem pore domain background K+ channel TASK-2 (KCNK5). Kindler CH, Paul M, Zou H, Liu C, Winegar BD, Gray AT, Yost CS J Pharmacol Exp Ther. 2003 Jul; 306(1):84-92.
  18. A Nav1.7 channel mutation associated with hereditary erythromelalgia contributes to neuronal hyperexcitability and displays reduced lidocaine sensitivity.Sheets PL, Jackson JO 2nd, Waxman SG, Dib-Hajj SD, Cummins TR J Physiol. 2007 Jun 15; 581(Pt 3):1019-31.
  19. Wick EC , Grant MC , Wu CL . Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg 2017;152:691–7.].
  20. Brogi E , Kazan R , Cyr S , et al. Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials. Can J Anesth/J Can Anesth 2016;63:1184–96.
  21. Shi WZ , Miao YL , Yakoob MY , et al. Recovery of gastrointestinal function with thoracic epidural vs. systemic analgesia following gastrointestinal surgery. Acta Anaesthesiol Scand 2014;58:923–32.
  22. Gabriel RA , Ilfeld BM . Use of regional anesthesia for outpatient surgery within the United States: a prevalence study using a nationwide database. Anesth Analg 2018;126:2078–84.
  23. ChinKJ , McDonnell JG ,Carvalho B , et al . Essentials of our current understanding: abdominal wall blocks. Reg Anesth Pain Med 2017;42:133–83.
  24. Helander EM , Webb MP , Kendrick J , et al. Pecs, serratus plane, erector spinae, and paravertebral blocks: a comprehensive review. Best Pract Res Clin Anaesthesiol 2019;33:573–81
  25. Chin KJ , Malhas L , Perlas A . The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med 2017;42:372–6.
  26. Hannig KE , Jessen C , Soni UK , et al. Erector spinae plane block for elective laparoscopic cholecystectomy in the ambulatory surgical setting. Case Rep Anesthesiol 2018;2018:1–6.].
  27. Tran DQ , Boezaart AP , Neal JM . Beyond ultrasound guidance for regional anesthesiology. Reg Anesth Pain Med 2017;42:556–63.
  28. De Lara González SJ , Pomés J , Prats-Galino A . Anatomical description of anaesthetic spread after deep erector spinae block at L-4. Estudio anatómico de la distribución del volumen administrado tras bloqueo en El plano profundo del erector espinal a nivel lumbar. Rev Esp Anestesiol Reanim 2019;66:409–16.
  29. Forero M, Adhikary SD , Lopez H , et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016;41:621–7.
  30. Boezaart AP, et al. Visceral versus somatic pain: an educational review of anatomy and clinical implications Reg Anesth Pain Med 2021;46:629–636.
  31. Blanco R. Quadratus lumborum block for postoperative pain after caesarean section: a randomized controlled trial/ R.Blanco, T.Ansari, E. Girgis// European journal of anesth. – 2015. – №32 (11). – P.812-818.
  32. Дмитрієв Д. В. Обгрунтування застосування схем мультимодальної аналгезії для післяопераційного знеболення у дітей / Д. В. Дмитрієв, Б. В. Залецкий, К. Ю. Дмитрієва // Клінічна хірургія. – 2017. – № 11. – С. 54-56.
  33. Бабіна Ю. М. Антимікробна активність локальних анальгетиків проти збудників ранової інфекції, пов’язаної з наданням медичної допомоги / Ю. М. Бабіна, Д. В. Дмитрієв, О. А. Назарчук // Медицина невідкладних станів. – 2019. – № 2. – С. 162.
  34. Дмитрієв Д. В. Пацієнт-контрольована аналгезія в дитячій хірургії / Д. В. Дмитрієв, А. І. Семененко, Є. О. Глазов, О. О. Калінчук // Медицина невідкладних станів. – 2019. – № 2. – С. 185-186.
  35. Zaric D., Nydahl P., Philipson N et al. // Reg. Anesth. -1996. – V.21.- P.14-25.
  36. Місце ропівакаїну у сучасній регіонарній анестезії / І.І. Лісний, Х.А. Закальська // Клінічна онкологія, 2021, Т. 11, № 1 (41): 1-5.
  37. Zink W., Seif C., Bohl J., Hacke N., Braun P., Sinner B., Graf B. (2003) The acute myotoxic effects of bupivacaine and ropivacaine after continuous peripheral nerve blockades. Anesthesia & Analgesia, 97(4), 1173-1 179.
  38. Xiang B, Yang J, Lei X, Yu J. Adjuvant Sufentanil Decreased the EC50 of Epidural Ropivacaine for Labor Analgesia in Healthy Term Pregnancy. Drug Des Devel Ther. 2021;15:2143-2149
  39. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 209: obstetric analgesia and anesthesia. Obstet Gynecol. 2019;133(3):e208–e225.
25 October, 2022

Authors:

Dmytriev D.V. Dubrov Serhiy Oleksandrovych

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