THE COMPARISON OF THE EFFECTIVENESS OF THE VARIOUS METHODS OF PAIN MANAGEMENT AFTER ABDOMINAL OPEN SURGERY
DOI:
https://doi.org/10.31379/2411.2616.13.1.2Keywords:
postoperative analgesia, epidural analgesia, bilateral rectus sheath block, lidocain, laparotomyAbstract
Objectives: The goal of the study is comparing the comparison of the effectiveness of various methods of postoperative analgesia. Design, Materials, Methods: the study was included 38 male patients after open abdominal aortic surgery, all of them underwent the standard pre-procedure examination, anesthesia and intensive care (IC). There were 3 comparable groups. The first group included the epidural analgesia by ropivocain. The second group was bilateral rectus sheath blocks by ropivocain. The third one was the intravenous infusion of lidocaine. We evaluated the system of hemodynamic parameters, the data of pupillometry, several scales of analgesia, emotional and neurological status (VAS, Wong-Baker, SF-36, ММSE, HADS), nociceptional index by ANI-monitors. We used non-parametrical criteria such as Mann Whitney U-test, one-sample Wilcoxon test for the statistical analysis. Results. Fluid therapy has been discontinue after 12h in the 2nd group, 1st and 3rd groups – fluid administration was needed of 6-12 ml\kg (p<0,01). Current study show that all method analgesia is effective and associated with decrease VAS pain scores. We found predominantly bradycardia and hypotension in other groups. Two patients from the 1st group got epidural hematomas. Method analgesia did not have a positive impact on length of intensive care unite and of hospital stay (7,1±2,9). Complications had negative effect on length of intensive care unite and of hospital stay ( 23±9 days). Conclusions. Epidural analgesia is «Gold standard», but patients with cardiovascular disease are used antiplatelet and anticoagulant therapy to needed of alternative methods analgesia. All method analgesia is effective and associated with decrease VAS pain scores. Overall, a multimodal analgesic (+Bilateral rectus sheath blocks) approach may be used when treating postoperative pain, as it has few side effects. Bilateral rectus sheath block is simple method. The subjective evaluation of pain syndrome did not match with the objective criteria.
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