MULTIMODAL MODEL OF ANALGESIA DURING ABDOMINAL SURGERY OF PATIENTS WITH OBESITY
Keywords:
obesity, abdominal surgery, multimodal analgesiaAbstract
Actuality. Obese patients are specially sensitive to sedative and respiratory-depressive effects of opioids. To reduce perioperative opiod burden different multimodal techniques of analgesia are used in bariatric surgery. The aim of the study was to check the efficiency of own multimodal protocol of perioperative anaesthesia/analgesia in patients with obesity, which have had laparotomy. Materials and methods. 54 patients with BMI>30 kg/m2 divided into two groups were included to prospective one-center research. In group 1 (n=30) multimodal model of analgesia was used (sevoflurane inhalation anaeshesia + lidocaine/ bupivacaine epidural analgesia + low doses of ketamine + low doses of clonidine + fentanyl). In group 2 (n=24) total propofol and fentanyl intravenous anaesthesia was made, for postoperative analgesia trimeperidine was used. It was compared: intraoperative hemodynamic stability, time of tracheal extubation after the end of surgery, general intra- and postoperative need of opioids, time of activization of the patients and possibility of enteral nutrition renewal, level of general comfort from the analgetic treatment. Statistical analysis was performed by the program Statistica for Windows version 6.0. Results. Intraoperatively phenylephrine was used more often in patients of group 1 than in group 2 (18 cases to 2 cases appropriately, p<0.05), but fentanyl was less used (0.8 (0.6–0.9) mg to 1.3 (1.1–1.5) mg appropriately, p<0.05). Time of extubation in group of multimodal analgesia was 13 (10–15) min, and in another group — 35 (20–45) min (p<0.05). After surgery patients from group 1 needed less quantity of trimeperidine than patients from group 2 (30 (20–60) mg to 60 (40–80) mg appropriately, p<0.05), they became active earlier and started to eat (24 hours to 48 hours appropriately, p<0.05). In group of multimodal analgesia 100 % of respondents expressed satisfaction from received analgetic treatment on the level “fluentgood”, while in another group 15 (62.5 %) of respondents mentioned the level of comfort as “good-satisfactory”, but three patients (12.5 %) from this group were absolutely unsatisfied by postoperative analgesia (p<0.05). Conclusion. Multimodal combined anesthesia based on sevofluran low-stream anaesthesia, lidocaine thoracic epidural analgesia, intravenous injection of ketamine and clonidine is a safe technology of perioperative analgesia during abdominal surgery of obese patients. It reduces the need of postoperative use of opioids and improves analgetic comfort of patients.
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