Alexey Mikhailovich Ovechkin

INTRODUCTION: Organ toxicity of anticancer treatment remains a significant problem in comorbid patients. Xenon has organoprotective properties, but its clinical use during chemotherapy has been insufficiently studied. OBJECTIVE: To assess changes in organ damage markers, as well as the safety and tolerability of inhaled subanesthetic xenon in patients receiving systemic anticancer therapy. MATERIALS AND METHODS: A prospective randomized controlled study was conducted. Forty-four women with breast, ovarian, or uterine corpus cancer were randomized; 41 completed the intervention stage and were analyzed: 20 in the xenon group and 21 in the control group. The xenon group received three 30-minute inhalations of an oxygen-xenon mixture containing 27–34 % xenon on Days 1, 3, and 5 from chemotherapy initiation; controls received oxygen-nitrogen inhalations. The primary outcome was change in high-sensitivity cardiac troponin T from baseline to Day 15. Secondary outcomes included N-terminal pro-B-type natriuretic peptide (NT-proBNP), S100B protein, syndecan-1, echocardiographic parameters, kidney and liver function tests; safety was assessed by adverse events. RESULTS: Change in high-sensitivity cardiac troponin T from baseline to Day 15 was 8.94 [4.50; 13.30] pg/mL in the control group and 1.01 [−0.09; 1.98] pg/mL in the xenon group (p < 0.001). In the baseline-adjusted model, the between-group difference at Day 15 was β = −7.90 (95% CI: −12.85; −2.94; p = 0.003). The adjusted between-group difference in left ventricular ejection fraction change was +4.66 % (95% CI: 2.4; 6.9; p < 0.001). Significant within-group changes in NT-proBNP and S100B were observed in the control group, whereas no significant changes were observed in the xenon group. CONCLUSIONS: Three 30-minute inhalations of an oxygen-xenon mixture containing 27–34 % xenon were well tolerated and were associated with preliminary differences in changes in markers of subclinical organ damage. These findings require confirmation in larger studies with longer follow-up.

INTRODUCTION: Damage to the ligamentous apparatus of the knee joint is a common sports injury in orthopedics. Given the possibility of ambulatory treatment for these patients, perioperative analgesia plays a key role in the success of surgery. OBJECTIVE: To evaluate the effect of adding the iPACK block (infiltration in the interspace between popliteal artery and capsule of the knee) on perioperative analgesia as part of combined anesthesia for arthroscopic cruciate ligament reconstruction (ACLR). MATERIALS AND METHODS: A single-center prospective cohort study with a historical control group. 115 patients who underwent ACLR, were divided into 2 groups: Group 0 (control; n = 58: general anesthesia (GA) + adductor canal block (ACB) + local infiltration anesthesia (LIA), Group 1 (intervention group; n = 57: GA + ACB + LIA + iPACK block). Evaluated: pain intensity on a visual-analog scale (VAS), time to the first requirement of an analgesic, need for opioids, time of verticalization, frequency of rebound pain. RESULTS: Significant differences in pain dynamics were revealed both at rest (χ2 = 17.68; p = 0.013) and in movement (χ2 = 22.68; p = 0.0019) according to VAS among the comparison groups, with a lower score in group 1. The average time to the first analgesic requirement was the longest in the iPACK group. The probability of prescribing trimeperidine in the first 24 hours was significantly lower in the iPACK group (RR 0.112; 95% CI 0.023–0.549; p = 0.007). The average time until verticalization did not differ significantly between the groups. The frequency of rebound pain was 13,5 % in the control and 1.6 % in the iPACK group (RR 0.116; 95% CI 0.013–1.064; p = 0.057). CONCLUSIONS: the addition of the iPACK block to method of combined anesthesia of GA + ACB + LIA significantly reduced the intensity of pain, increased the time to the first requirement for an analgesic, and significantly reduced the need for opioid analgesics in patients undergoing ACLR, demonstrating a favorable safety profile.

INTRODUCTION: Rebound pain developing after the resolution of regional blockade is an adverse effect that increases patients’ need for analgesics and reduces their satisfaction with postoperative pain management. First described in 2007, rebound pain remains a poorly studied phenomenon. OBJECTIVE: To summarize and analyze current literature on the incidence, mechanisms, risk factors, and preventive measures of rebound pain in patients undergoing surgery with regional anesthesia. MATERIALS AND METHODS: This review included publications indexed in PubMed, Google Scholar, and eLibrary (for Russian-language sources) that met the study objectives. RESULTS: The literature analysis revealed an average incidence of rebound pain of 40–50 %, identified risk factors such as young age, female sex, pre-existing pain, and certain types of surgical procedures, and determined the main strategies for its prevention. CONCLUSIONS: Rebound pain represents a significant clinical problem adversely affecting the early postoperative course. Prevention remains the cornerstone of management. The most promising approaches include the use of local anesthetic adjuvants, particularly dexamethasone, and systemic analgesics.

BACKGROUND: Laparoscopic colorectal surgery is widely used in modern surgical practice and requires optimized anesthetic management. Although the antiemetic effect of propofol-based total intravenous anesthesia (TIVA) is well established, the impact of the anesthesia maintenance technique on postoperative pain, stress response, and gastrointestinal recovery, in the setting of multimodal analgesia with systemic lidocaine infusion, remains less certain and continues to be a subject of debate. AIM: This study aimed to evaluate the effect of propofol-based total intravenous anesthesia compared with desflurane-based inhalational anesthesia on early postoperative outcomes in patients undergoing laparoscopic colorectal surgery. METHODS: A single-center cohort study was conducted in patients undergoing elective laparoscopic colon and rectal resections. To improve group comparability, inverse probability of treatment weighting based on propensity scores was applied. A standardized anesthesia and analgesia protocol was used in all cases (including systemic lidocaine infusion); the groups differed only in the maintenance anesthetic technique: desflurane vs. propofol-based total intravenous anesthesia. The primary outcome was postoperative pain intensity assessed using a visual analog scale (VAS) over 48 hours, as well as cumulative pain intensity expressed as the area under the pain curve (AUC VAS 0–48 h, VAS·h). Secondary outcomes included postoperative nausea and vomiting, analgesic requirements, markers of surgical stress response, recovery of gastrointestinal function, hemodynamic stability, and safety. RESULTS: The effective sample size after weighting was 91.9 patients. The main effect of anesthetic technique on pain intensity over time in the repeated-measures model did not reach statistical significance; however, cumulative pain intensity was significantly lower in the TIVA group compared with the desflurane group (AUC difference −14.2 VAS·h; 95% CI −25.7 to −2.6; p = 0.016). Total intravenous anesthesia was associated with a significant reduction in the incidence of postoperative nausea and vomiting (relative risk 0.32; 95% CI 0.14–0.73; p = 0.007) and a clinically relevant trend toward reduced postoperative opioid analgesic requirements. No differences were observed between groups in endocrine–metabolic stress response, gastrointestinal recovery, intraoperative hypotension, or overall safety profile. CONCLUSION: These findings support the inclusion of propofol-based total intravenous anesthesia in enhanced recovery protocols and highlight the need for further studies to assess long-term outcomes.

Systemic toxicity of local anesthetics is a complex problem requiring an integrated approach to perioperative management of patients with various diseases. These guidelines describe the key aspects of this phenomenon starting with definition of basic terms and ending with description of diagnosis, treatment and emergency care for life-threatening complications. One of the most serious forms of systemic toxicity is cardiotoxicity followed by arrhythmias, impaired myocardial contractility, and even cardiac arrest. In addition, local anesthetics can cause neurotoxicity with seizures, loss of consciousness and other neurological disorders. Importantly, the risk of these complications depends on dose, administration rate and individual characteristics of patients. Regional anesthesia is effective for pain relief. However, it is also associated with certain dangers, such as inadvertent intravenous administration of local anesthetic with systemic toxicity. Early cardiopulmonary resuscitation is necessary for life-threatening complications, such as cardiac or respiratory arrest. Effectiveness of resuscitation measures largely depends on timely nature and correct technique. In case of circulatory arrest, it is recommended to use standard protocols, including chest compression, artificial respiration and defibrillation, as well as etiotropic therapy with fat emulsion as soon as possible. Fat emulsions are one of the promising methods for systemic toxicity of local anesthetics. Fat emulsions are able to bind free anesthetic molecules, reduce their concentration in blood and risk of toxic reactions. This method is particularly effective for cardiotoxic complications. Clinical guidelines contain algorithms for physicians and scales for assessing clinical status of patients. This makes it possible to optimize decision-making process and improve treatment outcomes.

Objective. To compare the effectiveness of spinal anesthesia with combined general anesthesia, including adductor canal block and local infiltration anesthesia, in arthroscopic cruciate ligament surgery. Material and methods. Study design: a single-center, randomized controlled trial performed under conditions of single blindness. 107 patients who underwent arthroscopic cruciate ligament surgery (ACL) using the envelope method were divided into two groups according to the option of the intended anesthetic provision: group 1 — spinal anesthesia (SA) — 54 patients; group 2 — general anesthesia (GA): adductor canal block (ACB) + local infiltration anesthesia (LIA) — 53 patients. Outcome: the primary endpoint of the study was the dynamics of the intensity of postoperative pain, estimated on a 10-centimeter visual analogue scale (VAS) at rest and during movement of the operated limb immediately after surgery and every 4 hours for 1 day. The secondary points of the study were: the time before the first request for anesthesia; the time of verticalization; the need to prescribe opioid analgesics to patients and their total dose on the first day after surgery; the presence of criteria for rebound pain; patient satisfaction with anesthesia; patient satisfaction with postoperative pain relief. Results. More intense pain syndrome in patients at all stages of the study was noted when moving the operated limb in group 1 (CA) — 3.50±0.81 points compared with 1.82±0.92 points in patients in group 2 (OA) (p<0.001). In the SA group, 43 patients (82.7%) needed opioid analgesics in the postoperative period, and 8 of them (18%) required their administration 2 or more times a day. In the GA+ACB+LIA group only 11 patients (22%) needed a single opioid prescription. Among those who received trimeperidine, the total daily dose did not differ between the groups and averaged 40 mg (p=0.130). The time to the first analgesic request was significantly longer in group 2: the median was 380 [300; 480] minutes versus 180 [140; 200] minutes in group 1 (p<0.001). The time of verticalization in the first and second groups was 230 [197.5; 260.0] minutes and 130 [116.25; 158.75] minutes, respectively (p<0.001). The criteria for rebound pain were noted in 80.8% of patients in group 1 and 8% in group 2. Conclusion. The technique of combined anesthesia, which includes not only the blockage of the peripheral nerves of the lower limb, but also the local effect of local anesthetic on the sensory branches of nerves through infiltration anesthesia, can be effectively used in arthroscopic plastic surgery of cruciate ligaments. Further research is needed on the prevention of the phenomenon of rebound pain.

INTRODUCTION: Colorectal cancer ranks as the third most prevalent oncological disease worldwide. While laparoscopic procedures reduce complication rates, postoperative pain management remains a significant challenge. OBJECTIVE: To compare the efficacy and safety of continuous lidocaine infusion and epidural analgesia (EA) in laparoscopic colorectal surgery. MATERIALS AND METHODS: This was a single-center, randomized controlled trial conducted under single-blind conditions (patients blinded). A total of 160 adult patients undergoing elective laparoscopic resections of the colon and/or rectum were enrolled; 154 completed the study protocol and were included in the per-protocol analysis. Patients were randomized into three groups: control (standard anesthesia, n = 53), EA (0.2 % ropivacaine 8–16 mg/h × 48h, n = 51), and lidocaine (1.5 mg/kg bolus followed by 1 mg/kg/h infusion × 48h, n = 50). Outcome measures included pain scores using Visual Analog Scale (VAS), opioid requirements, cortisol and glucose levels, gastrointestinal function recovery, and postoperative nausea and vomiting (PONV) incidence. RESULTS: Immediate postoperative pain intensity was significantly lower in both EA (2.16 ± 0.76) and lidocaine (1.80 ± 0.81) groups compared to control (3.66 ± 0.90; p < 0.001). These differences persisted at 12 hours post-surgery (p < 0.001). Fentanyl consumption was reduced by 283.6 μg in the EA group and by 218.9 μg in the lidocaine group (p < 0.001). Cortisol and glucose levels were significantly lower in both intervention groups (p < 0.05). Gastrointestinal motility and flatus passage recovered more rapidly, particularly in the lidocaine group. PONV incidence was lower in both EA (31.37 %) and lidocaine (34.0 %) groups compared to control (56.6 %, p < 0.05 for EA). No serious adverse events were recorded. СONCLUSIONS: Both techniques demonstrated comparable efficacy in pain reduction, opioid-sparing effects, stress response attenuation, and accelerated gastrointestinal recovery. Continuous lidocaine infusion may serve as a less invasive alternative to epidural analgesia in laparoscopic colorectal surgery.

Introduction. Widespread thyroid gland (TG) diseases highlight the need to improve surgical treatment. Regional anesthesia (RA) is effective to improve perioperative outcomes, reduce morbidity, enhance analgesia and accelerate recovery. However, safety of intermediate cervical plexus block (ICPB), pericapsular block (PCB), and Berry ligament block (BLB) remains insufficiently studied. Objective. To evaluate the safety of RA techniques in TG and parathyroid gland (PTG) region through research of local anesthetic spread in fascial and interfascial cervical spaces. Material and methods. The study was conducted on 35 cadavers. We injected the dyed local anesthetic into fascial spaces under ultrasound guidance and simulated ICPB, PCB and BLB. For ICPB and PCB, 5-mL, 10-mL and 15-mL volumes were tested, while 2-mL and 5-mL were used for BLB. Diffusion of anesthetic to nearby neural structures (vagus nerve, phrenic nerve, sympathetic trunk and recurrent laryngeal nerve) was analyzed. Results. In case of ICPB, local anesthetic volumes up to 10 mL were safe without nerve staining. Injection of 15 mL was followed by vagus nerve staining in 3 cases and phrenic nerve staining in 2 cases. Statistical analysis confirmed that anesthetic volume <10 mL reduced the risk of nerve involvement during ICPB. In case of PCB, volumes <10 mL ensured adequate anesthetic distribution around TG without nerve involvement. Injection of 15 mL was followed by vagus nerve staining in 1 case. BLB with any volumes was followed by staining of recurrent laryngeal nerve due to anatomical proximity of Berry ligament. Conclusion. RA in thyroid surgery, particularly ICPB and PCB, is safe in case of anesthetic volume <10 mL. BLB inherently involves recurrent laryngeal nerve that requires careful technique and minimization of complications. Ultrasound guidance is essential for safe blocks. Further clinical studies with larger samples are necessary to validate these findings.

Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute the foundation of contemporary perioperative pain management regimens. However, their use is often limited by a broad range of serious adverse effects and contraindications. This review, based on an analysis of the scientific sources, aims to evaluate the analgesic efficacy and safety of nefopam, a centrally acting non-opioid analgesic, as an alternative to NSAIDs in perioperative pain management regimens. A search of medical databases, including PubMed (MEDLINE), the Cochrane Library, and eLibrary (RSCI), was conducted from July 1 to December 30, 2024. Nefopam has demonstrated consistent analgesic and opioid-sparing effects in laparoscopic surgery, spinal surgery, cardiac surgery, and transplantation, as well as in patients in intensive care units. Additional beneficial effects include prevention and treatment of postoperative shivering and reduction of discomfort and pain associated with urinary catheterization. The most commonly reported adverse effects of nefopam include excessive sweating, tachycardia following intravenous administration, and dry mouth. Overall, nefopam appears to have a more favorable safety profile compared with NSAIDs.

Perioperative management of patients receiving anticoagulants and antiplatelet agents is a complex task that requires a balance between the risk of thromboembolic complications and the risk of bleeding. Due to the increasing number of patients taking antithrombotic drugs, the relevance of developing modern recommendations for their perioperative management increases. Particular attention is paid to patients with comorbidities such as atrial fibrillation, ischemic stroke, myocardial infarction and coronary stenting. The article presents the guidelines of the Federation of Anesthesiologists and Reanimatologists and the National Association of Specialists in Thrombosis, Clinical Hemostasis and Hemorheology for the management of patients receiving anticoagulants and antiplatelet agents, revised in 2025. The guidelines for the perioperative management of patients receiving anticoagulants and antiplatelet agents have been updated, taking into account modern concepts of the risks of thromboembolism and bleeding. Particular attention focused to risk stratification, interruption and resumption of antithrombotic therapy, and the safety of regional anesthesia during anticoagulant therapy. The recommendations use data from modern studies, meta-analyses, and clinical trials on the perioperative management of patients receiving anticoagulants and antiplatelet agents. Various methods of thromboprophylaxis are considered, including the use of low molecular weight heparins, fondaparinux, and other anticoagulants. Particular attention is paid to risk stratification using the Caprini, HAS-BLED, and CHA2DS2-VASc scales. Recommendations are proposed for interruption and resumption of antithrombotic therapy depending on the risk of thromboembolism and bleeding. Criteria for the quality of compliance with recommendations, as well as algorithms for patient management during elective and emergency surgeries, are developed. The guidelines provide clinicians with practical tools to manage perioperative risk in patients receiving anticoagulants and antiplatelet agents. An important aspect is the individual approach to each patient, taking into account their clinical situation and risks.