This article described the main theses of clinical guidelines of the Russian Federation of Anesthesiologists and Reanimatologists on postoperative pain management. The classification, etiology and pathogenesis of postoperative pain, the basic principles and algorithms for diagnosing pain, and the regional and systemic pharmacotherapy of pain in various fields of surgery are consistently presented. Multimodal analgesia is described in detail as a key concept of a current approach to the treatment of postoperative pain.

Design Presentation of clinical cases and literature analysis. Material and methods Clinical observation of patients with congenital cervical spine and shoulder girdle anomalies operated on with neuromonitoring was performed. Operative treatment of Sprengel's deformity was produced with the use of neuroimaging. Results Surgical treatment resulted in good clinical outcomes without neurological adverse events and good aesthetic and radiological appearance at the descended scapula. Discussion Consideration for intraoperative neuromonitoring should be given to prevent neurological complications at lowering the elevated scapula. Conclusion Review of outcomes showed efficacious application of the most valid methods used to descend the scapula with neuromonitoring. This was supported by clinical and radiological findings of the extent of cranial transposition after appropriate correction and absence of neurological adverse events early postsurgery and at a longterm follow-up. No recurrence of scapular dislocation was observed at a long-term follow-up.

Objective. To assess the efficacy of postoperative continuous intralesional analgesia in patients with tuberculous spondylitis. Material and Methods. Patients (n = 56) with tuberculous spondylitis undergoing radical reconstructive spinal surgery were randomized into two groups depending on the type of post-operative analgesia: standard parenteral analgesia in Group I, and continuous intralesional infusion with local anesthetic in Group II. The amount of administered narcotic and non-narcotic analgesics was evaluated with formalized Analgesic Assessment Scale, postoperative activity -with the Patient Activity Scale, and pain intensity -with the VAS. Side effects of analgesic therapy were registered. Results. Statistical analysis revealed reliable differences in terms of the assessed analgesic amounts, VAS indexes and frequency of side effects between groups. Results in Group I were reliably higher than in Group II. Цель исследования. Оценка эффективности после-операционного обезболивания методом продленной внутрираневой анальгезии у больных туберкулезным спондилитом. Материал и методы. Пациенты (n = 56) с туберкулез-ным спондилитом, перенесшие радикально-реконструк-тивные операции на позвоночнике, путем рандомизации распределены в две группы по характеру послеопера-ционного обезболивания: в первой группе применяли стандартное парентеральное введение анальгетических препаратов, во второй-продленное внутрираневое вве-дение местного анестетика. Объем использованных нар-котических и ненаркотических анальгетиков определяли по формализированной шкале анальгетиков, послеопе-рационную активность -по шкале активности пациен-тов, выраженность болевого синдрома -по ВАШ. Фик-сировали побочные эффекты анальгетической терапии. Результаты. При статистическом анализе в группах вы-явлены достоверные различия оценок по формализован-ной шкале анальгетиков и ВАШ, а также по частоте по-бочных эффектов. В первой группе результаты оказались достоверно больше, чем во второй. Заключение. Исследование демонстрирует эффектив-ность и безопасность применения продленного обезбо-ливания раны инфузией 0,2 % ропивакаина через специ-альный катетер в раннем послеоперационном периоде. Ключевые слова: послеоперационная боль, послеопера-ционное обезболивание, туберкулезный спондилит, ре-конструктивные операции на позвоночнике, продленная анестезия послеоперационной раны.

This review presents the current state of postoperative pain in children. Based on the fundamental studies that have shown the presence of a newborn neurophysiological and neurochemical nociceptive information transmission mechanisms, provides information about the negative impact of pain on the body of the child. Presented neurophysiological aspects of pain perception in children, pain assessment methods, the basic principles of modern post-operative analgesia. Particular attention is given to drugs permitted for use in the Russian Federation. in children

The results of application of new blood-saving techniques in surgeries for scoliosis were compared in 289 patients aged from 9 months to 17 years, and the analysis of their efficiency was performed. The authors have estimated volume and velocity of blood loss, and changes in hemoglobin rate under balanced anesthesia with spinal blockade, clonidine hypotensive anesthesia and acute preoperative isovolemic hemodilution with autoplasma. The highest efficiency of spinal blockade in lumbar surgery is marked. Hemodilution was found more effective in comparison with hypotensive anesthesia in the patients with CDI correction of scoliosis. Clonidine hypotensive anesthesia (the only variant of blood-saving anesthesia used for hemivertebrae extirpation in our study) has appeared inefficient.