PROPHYLAXIS AND LEVELING OF THE PAIN SYNDROME IN SURGERY OF ACUTE PANCREATITIS
DOI:
https://doi.org/10.32782/2786-9067-2025-29-1Keywords:
acute pancreatitis, original schemes of multimodal analgesiaAbstract
The effectiveness of prevention and reduction of pain syndrome was studied in a selected group of patients in GP in the amount of 62 people aged 43 to 67 years. All patients were divided into two groups. In the main group (39) an original method of multimodal analgesia was used based on a combi-nation of the centrally acting analgesic nefopam and the nonsteroidal anti-inflammatory drug diclofenac.In the comparative group (23) traditional analgesics and antispasmodics were used. The method of analgesia using modern co-analgesics and antispasmodics in tablet form (32) was also evaluated in com-parison with conventional methods of analgesia (16). The analgesic effect was assessed using a visual analogue pain scale (in points) and the level of the stress hormone cortisol in the blood.It was found that in the main group of patients, from the 30th minute, there was a decrease in pain inten-sity from 19 ± 1,2 to 11 ± 1,4 points (p < 0,05) with its subsequent complete cessation and a decrease in the level of cortisol in the blood from the second day – 685 ± 24 nmol/L versus 1 041 ± 12 nmol/L (p < 0,01) with subsequent final normalization. In the comparative group, similar dynamics were not observed. When using the regimen with tablet forms of drugs, a decrease in pain intensity from 19 ± 1,2 to 6 ± 1,2 points (p < 0,05) was observed. That is, the proposed methods not only effectively prevented and eliminated pain syndrome and corresponded to modern trends in the development of surgical treatment of patients with acute pancreatitis, in particular the principle of “Fast-track” surgery.
References
Banks P.A., Bollen T.L., Dervenis C. Classification of acute pancreatitis Acute pancreatitis classification Working Group. Gut. 2013. V. 62. № 1. P. 102–111. DOI: 10.1136/gutjnl-2012-302779.
Barreto S.G., Habtezion A., Gukovskaya A., Lugea A., Jeon C., Yadav D., et al. Critical thresholds: key to unlocking the door to the prevention and specific treatments for acute pancreatitis. Gut. 2021. № 70 (1). P. 194–203. DOI: 10.1136/gutjnl-2020-322163.
Chan K.S., Shelat, V.G. Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies. World J. Gastrointest. Surg. 2022. № 14. P. 1179–1197. (CrossRef). DOI: 10.4240/wjgs.v14.i11679.
Carli F., Kehlet H., Baldini G., Steel A., McRae K., Slinger P., Hemmerling T., Salinas F., Neal J.M. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med. 2011. № 36. P. 63–72. DOI: 10.1097/AAP.0b013e31820307f7.
Carter J., Philp S., Arora, V. Early discharge after major gynaecological surgery: advantages of fast track surgery. Open Journal of Obstetrics and Gynecology. 2011. № 1. P. 1–5. DOI: 10.4236/ojog.2011.11001.
Kehlet H., Baldini G., Steel A., McRae K., Slinger P., Hemmerling T., Salinas F., Neal J.M. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med. 2011. № 36. P. 63–72. https://doi.org/10.1097/AAP.0b013e31820307f7.
Kelhet H. Zabat Lecture Surgical stress and postoperative outcome from here to where? Reg. Anaest. Pain Med. 2006. V. 19. P. 47–52.
Leppäniemi A., Tolonen M., Tarasconi A. еt al. WSES guidelines for the management of severe acute pancreatitis. World J. Emerg. Surg. 2019. № 14. P. 27. DOI: 10.1186/s13017-019-0247-0.eCollection2019 ; 10.1097/TA.0000000000002691.
9. Morrison-Rees S., John A., Williams J.G., Brown T.H., Samuel D.G. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology. 2017. № 17 (2). P. 155–65. https://doi.org/10.1016/j.pan.2017.01.005.
Sartelli M., Chichom-Mefire A., Labricciosa F. et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intraabdomina linfections. World Journal of Emergency Surgery. 2017. № 12. P. 29. DOI: 10.1186/s13017-017-0141-6.
Walkowska J., Zielinska N. Tubbs R.S., Podgórski, M., Dłubek-Ruxer J., Olewnik Ł. Diagnosis and Treatment of Acute Pancreatitis. Diagnostics. 2022. № 12. 1974. (CrossRef). DOI: 10.3390/diagnostics12081974.
Wind J., Polle S.W., Fung Kon Jin P.H., Dejong C.H., von Meyenfeldt M.F., Ubbink D.T., Gouma D.J., Bemelman W.A. Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group; Enhanced Recovery after Surgery (ERAS) Group. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006 Jul. № 93 (7). P. 800–9. DOI: 10.1002/bjs.5384.
