Regional Anesthesia and Acute Pain Management

The number of thyroid surgeries is increasing annually. The choice of anesthetic approach influences the speed and quality of postoperative recovery and determines the risk of complications. This review presents data from clinical studies and meta-analyses regarding the impact of various anesthesia methods in thyroid surgery on surgical stress response, hormonal status, and complication risk. The results of the review indicate that the use of regional anesthesia techniques contributes to a reduction in the intensity of postoperative pain, nausea and vomiting, and the incidence of chronic postoperative pain syndrome. Incorporating regional anesthesia techniques into enhanced recovery after surgery protocols for thyroid surgery helps reduce hospital stay duration and treatment costs. A well-studied, simple, and safe technique is the superficial cervical plexus block, while the intermediate cervical plexus block is less studied but considered safe. The deep cervical plexus block is associated with a higher risk of serious complications. Advancements in ultrasound technology in anesthesia have enabled the use of previously inaccessible regional techniques. Potentially beneficial methods for thyroid surgery include pericapsular block and Berry's ligament block. Further research is required to evaluate the efficacy and safety of these methods.

Anton A. Alekseev

Mikhail E. Politov

Аlexei M. Ovechkin

Ekaterina A. Sozonova

Andrey G. Yavorovskiy

Anesthesia for thyroid surgery and the possibility of regional blocks as its component

甲状腺手术的麻醉及其区域阻滞作为其组成部分的可能性

BACKGROUND. Operations on the organs of the anterior surface of the neck (thyroidectomy, carotidectomy, plastic surgery, etc.) are widespread in the Russian Federation. The development of adequate anesthesiological support for these interventions is an urgent task of modern anesthesiology. The introduction of combined regional anesthesia techniques into surgical practice makes it possible to minimize postoperative complications, manifested in the form of severe pain syndrome, postoperative nausea and vomiting. AIM. To conduct a comparative assessment of the effectiveness of combined (general + regional) and only general anesthesia during operations on the thyroid and parathyroid glands. MATERIALS AND METHODS. In a prospective randomized study, 60 patients operated on for thyroid and parathyroid gland diseases were divided into 2 groups: in group 1, general anesthesia was performed in combination with blockade of the internal fascia of the neck and bilateral blockade of the superficial branches of the cervical plexus, as well as the Berry ligament area under ultrasound navigation; patients of group 2 were operated on in conditions of combined general anesthesia. The hemodynamic profile during surgery, plasma cortisol concentration, required doses of fentanyl, intensity of postoperative pain syndrome, need for anesthesia, and recovery time were evaluated. RESULTS. Combined (general + regional) anesthesia was characterized by a decrease in fentanyl consumption compared with the group receiving only general anesthesia (p 0.0001), a decrease in cortisol content in blood plasma 12 hours after extubation (p=0.0439), a reduction in median pain after tracheal extubation 3 and 12 hours after surgery (p=0.0190, p 0.0001), as well as a twofold reduction in the time interval from the end of the operation to the moment of extubation (p=0.0001). The assessment of patients on the Aldreth awakening scale in the group of people who underwent combined anesthesia indicates a higher willingness of patients to be transferred from the operating room to the awakening ward (p=0.0114). CONCLUSION. The study demonstrated the effectiveness and safety of the combined anesthesia technique in thyroid and parathyroid surgery, which provides adequate anesthetic protection for patients.

Anton A. Alekseyev

Alexei M. Ovechkin

Andrey V. Useinov

Anastasia A. Maksimova

The effectiveness of combined anesthesia in comparison with general anesthesia in thyroid and parathyroid surgery: a single-center prospective randomized study

甲状腺和甲状旁腺手术中联合麻醉与全身麻醉效果比较：一项单中心前瞻性随机研究

The problem of choosing a method of regional anesthesia for the surgical treatment of clavicle fractures is of great relevance due to a continued growth in possible contraindications for the choice of conventional methods of blocking the upper limb region. Chronic pulmonary dysfunction in patients after COVID-19, an increasing number of patients suffering from severe respiratory failure caused by chronic obstructive lung disease, and the features of injuries to the upper limb area that can impair lung function on the affected side have led to the conclusion that the use of regional anesthetics may pose more risks to patients than benefits. The authors searched for publications in various electronic databases and libraries, including PubMed, MEDLINE, and EMBASE and others. According to the results of the search, 904 literary sources were identified, and this review includes data from 26 studies containing information on 3391 patients who received one or another method of regional anesthesia and analgesia, and 29 other literary sources substantiating the relevance of the work. The review includes articles describing any methods of regional anesthesia used in surgical interventions on the collarbone in adults and children, as well as articles on complications and side effects of regional anesthesia methods used in clavicle surgery.The purpose of the review was to search for methods of regional anesthesia for patients in the surgical treatment of clavicle fractures, based on the analysis of modern literature. A review of the literature has allowed us to better understand the characteristics of traditional methods of regional anesthesia and to learn about new techniques that can improve patient comfort and safety during clavicular surgery.

Artem N. Adamenko

Anna A. Ezhevskaya

Contemporary methods of regional anesthesia in the surgical treatment of clavicle fractures: narrative review

锁骨骨折手术治疗中的区域麻醉当代方法：叙述性综述

Cryoanalgesia is a modern and increasingly popular method of treating acute and chronic pain. This method involves percutaneous injection of a cryoprobe exposed to extremely low temperatures to disrupt nerves. This review is an attempt to summarize and evaluate the available data on the benefits and safety of cryoneurolysis as a method of perioperative analgesia in total knee replacement (TEC), to answer the question whether the perioperative use of cryoanalgesia really contributes to accelerated rehabilitation of patients after TEC. The authors conducted a search for publications in PubMed (Medline) and eLibrary databases.Ru, Google Scholar, Springer Library, Cochrane Library, Wiley Online Library for the period from 2014 to 2024, 15 articles on the use of cryoanalgesia in TEC were found and analyzed. The data obtained were summarized and interpreted. Based on the results of the analysis, the authors of the review concluded that cryoanalgesia is a promising method for providing long-term perioperative pain control as part of multimodal analgesia schemes. Early rehabilitation of the patient after surgery may be a clinically significant indicator in favor of cryoneurolysis. However, the significant risk of systematic error and clinical heterogeneity of the existing literature studying this problem precludes the possibility of reliable quantification of any performance indicators presented in the existing literature. Future research should provide transparent, unbiased reporting on treatment parameters and outcomes to improve scientific reproducibility.

Nikita E. Pinchuk

Aleksey A. Ushakov

Eduard E. Antipin

Maksim P. Yakovenko

Application of cryoanalgesia for accelerated rehabilitation after total knee arthroplasty: review

全膝关节置换术后加速康复的冷冻镇痛应用：综述

BACKGROUND: In the protocols of rapid recovery after surgery, it is recommended to avoid long-term administration and/ or high doses of opioids in order to reduce the severity of their adverse reactions in the postoperative period. In this regard, opioid-sparing anesthesia (OSA) may become a promising approach to the treatment of cancer patients. AIM. To evaluate the effectiveness of multimodal OSA in the scheme "dexmedetomidine+ketamine (in subanesthetic doses)+lidocaine (intravenous infusion)" in pediatric oncosurgery. MATERIALS AND METHODS: A single-center prospective randomized study involved 40 children aged 12 to 18 years. Patients were divided into 2 groups depending on the method of anesthesia: in group I (n=20), combined endotracheal anesthesia with opioids was performed, in group II (n=20) — multimodal OCA based on intravenous infusion of lidocaine, dexmedetomidine and subanesthetic doses of ketamine. The patients underwent extended operations in the head and neck area in the volume of thyroidectomy with fascial-sheath lymph dissection and excision of the central tissue of the neck from 2 sides. RESULTS: With stable intraoperative hemodynamic parameters, the median total intraoperative need for analgesics in group II was: for lidocaine— 351 (289.6; 418.5) mg (which is 1.75mg/kg per hour), for dexmedetomidine— 88.2 (38.5; 119.7) µg, for ketamine — 21.6 (17.4; 27.3mg. In group I, the median total intraoperative need for fentanyl was 273.7 (406; 240.9)µg. In addition, in group I, the median amount required for postoperative analgesia of the synthetic opioid analgesic tramadol was 419 (365.6; 479)mg (which is 7.8mg/kg; p=0.01). In group II, the median amount of lidocaine required for postoperative analgesia (1 mg/kg per hour) turned out to be 1377.3 (735.7; 1894)mg, while additional tramadol administration at a dose of 57.3 (28.5; 107.7)mg was required in only 7(35%) patients. CONCLUSION: Multimodal OSA based on dexmedetomidine, lidocaine, ketamine and sevoflurane is an effective and safe method of anesthesia in children from 12 to 18 years old, which is not inferior to opioid analgesics in the treatment of perioperative pain during surgical interventions on the thyroid and parathyroid glands in cancer patients, and also reduces the number of adverse reactions characteristic of opioids.

Anastasia A. Tsintsadze

Nune V. Matinyan

Vladimir V. Balandin

Ekaterina I. Belousova

Ekaterina A. Kovaleva

Aleksey S. Slinin

I. A Letyagin

Experience of using multimodal opioid-saving anesthesia in children: single-center prospective randomized study

儿童多模式镇痛麻醉节省阿片类药物使用的经验：单中心前瞻性随机研究

Introduction: Xenon is a noble gas with unique properties that make it an attractive anesthetic agent. In addition to its anesthetic and analgesic effects, xenon has demonstrated organ-protective properties in preclinical studies, suggesting potential therapeutic applications beyond anesthesia. This review aims to systematically evaluate the available clinical evidence on the therapeutic use of xenon, focusing on its effects on various organ systems. Methods: A comprehensive literature search was conducted in medical databases including PubMed, Google Scholar, Cochrane Library, and eLIBRARY.RU. Original clinical studies evaluating the therapeutic use of xenon were included and analyzed. Results: The review identified several areas of potential therapeutic application for xenon: 1. Neuroprotection: Xenon has shown promise in reducing neurological injury and improving outcomes in patients with conditions such as cardiac arrest, traumatic brain injury, and neonatal hypoxic-ischemic encephalopathy. However, the clinical evidence remains limited, and larger randomized controlled trials are ongoing to further evaluate its efficacy. 2. Cardioprotection: Xenon has been found to attenuate myocardial injury and improve cardiac function in patients undergoing cardiac surgery or experiencing cardiac arrest, potentially through its anti-inflammatory and anti-apoptotic effects. 3. Addiction treatment: Inhalation of xenon has been investigated for its potential to alleviate withdrawal symptoms and cravings in patients with opioid and alcohol dependence, with some studies suggesting beneficial effects on cognitive function and mood. 4. Psychiatric applications: Preliminary evidence suggests that xenon may have anxiolytic and antidepressant properties, with potential applications in the treatment of panic disorder and other mood disorders. Conclusion: The available clinical data indicate that xenon may have therapeutic potential beyond its use as an anesthetic agent. However, further well-designed, large-scale studies are needed to establish the efficacy and safety of xenon in various clinical settings and to elucidate the underlying mechanisms of its organ-protective and psychoactive effects.

Mikhail Politov

Elizaveta Zolotova

Sofia Podprugina

Pavel Nogtev

Yulia Agakina

Therapeutic Applications of Xenon (Literature Review).

氙的临床应用（文献综述）。

Currently, there are no recommendations for managing pain syndrome in patients with acute destructive pancreatitis. A literature search was conducted using PubMed, Cochrane Controlled Clinical Trials Register, and Google Scholar, without restrictions on language, type, or date of the publication. The analysis revealed several possible options for anesthesia in acute destructive pancreatitis. The most commonly used methods for pain relief include narcotic analgesics and nonsteroidal anti-inflammatory drugs. However, in severe forms of acute pancreatitis, nonsteroidal anti-inflammatory drugs should be used with caution due to the risk of acute kidney injury, while opiates may adversely affect the sphincter of Oddi and contribute to the disease progression due to increased ductal pressure. Epidural analgesia also presents limitations, such as risks of hypotension and incompatibility with anticoagulant or antiplatelet therapy. As alternatives, regional anesthesia techniques (paravertebral block and erector spinae plane block) should be considered. Choosing an optimal analgesia method should take into account several factors: pain intensity, disease severity, etiology of acute destructive pancreatitis, comorbidities, and concurrent use of anticoagulants and antiplatelets. Further research into effectiveness of regional analgesia methods is warranted, as they may address both somatic and visceral components of pain and may prove effective and safe in the most severe cases.

Denis S. Tsvetkov

Denis N. Protsenko

Efim M. Shifman

Possibilities for pain relief in acute pancreatitis: a narrative review

急性胰腺炎疼痛缓解的可能性：一项叙述性综述

Background: Along with increased safety and quality of the early postoperative period, 6.9% of patients who undergo sternotomy experience chronic pain at the surgical site. The significance of this issue is underestimated, with a third of these patients developing a neuropathic component of chronic pain syndrome. Aim: To assess the severity of acute and chronic postoperative pain following sternotomy and to identify predictors of the neuropathic component of chronic pain syndrome. Materials and methods: Out of 115patients who underwent elective coronary artery bypass grafting (CABG) randomized according to method of anesthesia, two study groups were formed based on the results of a telephone survey: a general anesthesia group (GA, n=28) and a combined anesthesia group (CA, n=34). As part of the posthoc analysis, a logistic regression model was built to predict chronic neuropathic pain syndrome based on gender, age, anesthesia method, and factors assessing the severity of the perioperative period and myocardial impairment. Results: Chronic postoperative pain syndrome was identified in 25.8% of patients, with a neuropathic component confirmed in 19.4% of cases. Pain severity at rest in the GA and CA groups was 2.0 (1.0) and 3.0 (3.0) points on a numeric rating scale one hour after extubation, and 2.0 (2.0) and 2.0 (2.0) points by the end of the first postoperative day (p=0.193 and 0.610, respectively). The logistic regression model achieved an AUROC of 0,82 (95% CI 0,68–0,96) with c2(10)=10.62, p=0.39. Conclusions: Neuropathic pain was diagnosed in 19.4% of patients following CABG. The use of regional anesthesia and the severity of acute pain did not impact the development of neuropathic pain syndrome in the long-term period after surgery. The proposed model for predicting the neuropathic component of chronic pain syndrome after CABG requires further improvement.

Konstantin V. Paromov

Dmitriy A. Volkov

Dmitrii A. Svirskii

Andrei V. Lychakov

Vadim A. Salakhov

Mikhail Yu. Kirov

Chronic postoperative pain syndrome and its neuropathic component in long-term period of coronary artery bypass grafting

冠状动脉旁路移植术后长期慢性术后疼痛综合征及其神经病理性成分

Publication Information	Publisher: Eco-Vector LLC，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2021，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

Regional Anesthesia and Acute Pain Management

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Anesthesia for thyroid surgery and the possibility of regional blocks as its component

The effectiveness of combined anesthesia in comparison with general anesthesia in thyroid and parathyroid surgery: a single-center prospective randomized study

Contemporary methods of regional anesthesia in the surgical treatment of clavicle fractures: narrative review

Application of cryoanalgesia for accelerated rehabilitation after total knee arthroplasty: review

Experience of using multimodal opioid-saving anesthesia in children: single-center prospective randomized study

Therapeutic Applications of Xenon (Literature Review).

Experience of using multimodal opioid-saving anesthesia in children: single-center prospective randomized study

Possibilities for pain relief in acute pancreatitis: a narrative review

Chronic postoperative pain syndrome and its neuropathic component in long-term period of coronary artery bypass grafting

Application of cryoanalgesia for accelerated rehabilitation after total knee arthroplasty: review