A MULTIMODAL METHOD OF TRANSVERSUS ABDOMINIS BLOCKAGE IN COMBINATION WITH NON-STEROID ANTI-INFLAMMATORY DRUGS UNDER ULTRASOUND CONTROL
Actuality. Various multimodal approaches to pain management have been associated with reduced rates of postoperative pain and opioid consumption. Healthcare professionals, patients and their families should be aware of the benefits of opioid-free pain management in postoperative pain management. Under ERAS (Enhanced Recovery After Surgery) protocols, i.e. “enhanced recovery after surgery”, ambulance services may consider existing therapeutic alternatives for the management of acute and long-term pain, which include minimizing perioperative opioid use and establishing adequate opioid prescribing practices.
Aim To improve the quality of postoperative analgesia after general surgical abdominal operations using a new multimodal technique for blocking the transverse space of the abdomen in combination with non-steroidal anti-inflammatory drugs under ultrasound guidance and to study its effectiveness.
Materials and methods of research: We analyzed the results of pain relief in 180 patients who underwent laparoscopic surgery or laparotomy and were divided into three equal (n=60) groups. Patients who underwent a transverse abdominal block using ultrasound navigation were divided into 3 groups.
In the 1st group, a transverse blockade of the abdomen was used with ultrasound navigation and in combination with parenteral administration of the non-steroidal anti-inflammatory drug ketonal 4 times a day, in a volume of 8 ml in the postoperative period. In the 2nd group, a transverse blockade of the abdomen was used with ultrasound navigation and in combination with parenteral administration of the non-steroidal anti-inflammatory drug ketonal 2 times a day, in a volume of 4 ml in the postoperative period, in the first half of the day. In the 3rd group, only a transverse abdominal block was used using ultrasound navigation.
Pain was assessed using a visual analogue scale, as well as in patients and surgeons' satisfaction with pain relief using a Likert scale.
Statistical significance was determined using unpaired two-tailed Student's t-test. Statistical processing of the material was carried out using the software package Statistica v. 7.0.
Results: In the postoperative period, pain sensations were studied on the Likert scales and on the visual analogue scale. In the first group, patient satisfaction with anesthesia was "excellent" in 10 patients (16.67%), which was 15% higher than in the third group (p<0.01) and higher by 6.67% than in the second group (p>0.25). There were no significant differences between the groups for the "very good" rating. There were 2 (3.33%) patients for the “good” rating in the first group, which was 11.67% lower than in the second group by 2 times (p<0.05) and was more than 26.67% lower than in the third group (p<0.001). Estimates "bad" and "very bad" were not noted in all the studied groups. There were no significant differences between the second and third groups in all assessments, despite slightly better results in the second group.
Conclusion: The multimodal technique of blockade of the transverse space of the abdomen in combination with 4-fold administration of ketonal per day under ultrasound control after laparotomy and laparoscopic operations provides reliable pain relief in the postoperative period.
Rinat B. Ashzhanov1, Daulet O. Mamyrov1, Yoshikhiro Noso2,
Marat K. Syzdykbaev1, Olga G. Tashtemirova1, Zhanna U. Kozykenova1,
Nailya M. Urazalina1, Dmitriy V. Terekhov3, Adlet K. Dyusembaev4,
Assem B. Ashzhanova1, Rustam N. Mukatov1, Nursultan M. Mendeshev1,
Igor K. Gavrikov1, Ayan K. Bagenov1, Anton Sheinin5
1 NJSC "Semey Medical University", Semey, Republic of Kazakhstan;
2 Hiroshima International University, Hiroshima, Japan;
3 Rubtsovsk Central District Hospital, Rubtsovsk, Russian Federation;
4 North-Kazakhstan University named after. M.Kozybayeva / North-Kazakhstan Medical College, Petropavlovsk, Republic of Kazakhstan;
5 Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
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Ashzhanov R.B., Mamyrov D.O., Noso Y., Syzdykbaev M.K., Tashtemirova O.G., Kozykenova Zh.U., Urazalina N.M., Terekhov D.V., Dyusembaev A.K., Ashzhanova A.B., Mukatov R.N., Mendeshev N.M., Gavrikov I.K., Bagenov A.K., Sheinin A.A multimodal method of transversus abdominis blockage in combination with non-steroid anti-inflammatory drugs under ultrasound control // Nauka i Zdravookhranenie [Science & Healthcare]. 2023, (Vol.25) 2, pp. 111-119. doi 10.34689/SH.2023.25.2.016Related publications:
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