Severe chronic pain syndrome with high requirement for opioids is frequently complicated by opioid tolerance, hyperalgesia, and other side effects. Special complications occur during anesthesia for high-injury surgical interventions and in the postoperative period. Perioperative pain management in these patients requires planning, multimodal approach, combination methods, and prevention of complications including specific complications. This article describes a case of successful surgical treatment of pancreatic cancer in a patient with severe chronic pain syndrome, opioid tolerance, and hyperalgesia. Perioperative period was complicated by high requirement for epidural pain management and use of adjuvants, acute strangulating intestinal obstruction on day 6 of the postoperative period. The authors had to differentiate between pain syndrome and abstinence multiple times and encountered the problem of tachyphylaxis to local anesthetics. Due to thought-out and flexible system of combination multimodal pain management, pain syndrome was relieved, and the patient was discharged in satisfactory condition without the need for opioids.
Pancreatic tail cancer has a poor prognosis and may be unresectable at the time of diagnosis, since it is asymptomatic and often has invasion into adjacent organs, and also has a high metastatic potential, where the target organs are the liver, lungs, bones, as well as the parietal and visceral peritoneum, adrenal glands. Radical resection of the pancreas in such cases is impractical. The gold standard of treatment is systemic chemotherapy. We describe the successful resection of locally advanced pancreatic tail cancer with metastases along the peritoneum of the large omentum after 14 courses of chemotherapy according to the mFOLFIRINOX (oxaliplatin 85 mg/m2 intravenously for 120 min, irinotecan 150 mg/m2 intravenously for 90 min, leucovorin 400 mg/m2 intravenously for 120 min, 5-fluorouracil 2400 mg/m2 intravenous infusion for 46 hours, cycle 14 days).
Распространенный перитонит остается одной из актуальных проблем в ургентной хирургии. В связи с этим совершенствование хирургических методов ведения пациентов является важной задачей современной хирургии. В данной статье представлен клинический случай эффективного лечения перитонита, абдоминального сепсиса на фоне несостоятельности илеотрансверзоанастомоза. Пациентке с разлитым фибринозно-гнойным перитонитом выполняли хирургические вмешательства с использованием VAC-системы, тактики damage control.
Aim. To assess the possibility of open spleen-preserving distal subtotal pancreatic resection for tumors of the body and tail of the pancreas.Material and methods. A retrospective comparative analysis of the immediate results of the spleen-preserving interventions in 41 patients was carried out. Mainly benign tumors or tumors with a low malignancy potential of the corpus and (or) the tail of the pancreas were detected. Distal subtotal pancreatectomy with splenectomy was performed in 53 patients with pancreatic tumors of different histogenesis with low malignancy potential (control group).Results. The duration of spleen-preserving distal subtotal pancreatectomy was 12 minutes shorter, compared with the distal subtotal pancreatectomy with splenectomy group (p = 0.180). Significantly lower volume of intraoperative blood loss during spleen-preserving procedure was noted – by 460 ml (p = 0.0001). The level of postoperative complications in the spleen-preserving pancreatectomy group was 15 (37%), while in the group of distal subtotal pancreatectomy with splenectomy was 26 (49%) (p = 0.227), respectively. External pancreatic fistula after spleenpreserving pancreatectomy was noted in 13 (32%) patients, in the other group in 21 (40%; p = 0.429). The duration of hospital stay did not statistically significantly differ in the compared groups and amounted to: 18.6 ± 6.9 and 20.3 ± 5.4 days (p = 0.123), respectively.Conclusion. Open spleen-preserving pancreatectomy is a relatively safe type of surgical treatment for patients with benign tumors and tumors with a low potential for malignancy of the body and/or tail of the pancreas. The surgery is shorter in time, accompanied by a lower level of complications, significantly less intraoperative blood loss, compared with a similar procedure involving splenectomy.
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