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.
The objective of the study is to evaluate the effectiveness of analgesia by infiltration of the skin flap with local anesthetic in children with craniosynostosis after reconstructive surgery.Materials and subjects. 50 children with craniosynostosis, who underwent reconstructive surgery on skull bones, were divided into two groups based on the method of postoperative anesthesia: in Group 1(experimental), the infiltration of the skin flap was used within multimodal anesthesia, while in Group 2, it was standard parenteral use of analgesic drugs. In the postoperative period, pain severity was assessed by FLACC scales, the amount of opioid and non-opioid analgesics consumed was assessed by the formalized Analgesiс Assessment Scale (FSA), and non-invasive hemodynamic monitoring (BP, HR) was performed.Results. The statistical analysis of the results revealed significant differences between groups in the assessment results of FSA and FLACC scales. In Group 1, the level of postoperative pain was significantly lower compared to Group 2. The amount of opioid and non-opioid analgesics consumed was also significantly lower in Group 1.Conclusion. The use of the infiltration of the skin flap as part of multimodal analgesia in children with craniosynostosis, after reconstructive surgery on skull bones significantly reduces the intensity of pain and the amount of opioid analgesics consumed in the postoperative period.
Objective. To test validity of formalized Analgesiс Assessment Scale (AAS) by examining the correlation of its parameters (gradations) with other parameters characterizing pain intensity during the treatment, and to assess the adequacy of conducted analgesia in patients with spinal tuberculosis by taking into account AAS gradations. Material and Methods. The study was performed in a prospective cohort of 15 consecutive patients who underwent similar elective spine surgery for tuberculous spondylitis. Postoperatively, all patients received systemic analgesia with parenteral narcotic and non-narcotic analgesics, depending on pain intensity subjectively assessed by patients using VAS. The protocol for postoperative analgesia included records of pain intensity assessed by VAS, systolic and diastolic blood pressure (BPsist and BPdiast), heart rate, and the AAS gradations of analgesic consumption. Results. An analysis of the correlation between AAS and other variables characterizing pain intensity in the postoperative period showed a strong positive association of AAS with VAS (r = 0,567; P < 0,05) and ADsist (r = 0,340; P < 0,05) variables, which confirms usability of each of these parameters in the assessment of pain intensity. Conclusion. The AAS tested in a pilot study on the cohort of 15 consecutive patients operated for spinal disorders proved its effectiveness in pain intensity assessment, pain therapy, and convenience of analgesics accounting.
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