Olga E. Romanova

Regional anesthesia has gained recognition in recent years as a promising field in anesthesiology, allowing a substantial reduction in perioperative opioid consumption and, consequently, decreasing the incidence of opioid‑related complications. The main limitation of this approach is the relatively short duration of nerve blockade. Considerable attention has been paid to pharmacological methods for prolonging sensory block, which can be achieved using adjuvants – drugs that enhance the effect of local anesthetics. This area is highly popular in contemporary international research. At present, five key groups of adjuvants have been described: α‑adrenergic agonists (epinephrine), α2‑agonists (dexmedetomidine, clonidine), glucocorticoids (dexamethasone), opioid analgesics (morphine, tramadol, fentanyl), and other agents (ketamine, magnesium sulfate, nonsteroidal anti‑inflammatory drugs [NSAIDs], pregabalin). The objective of this review is to analyze and systematize available data on the use of adjuvants for prolongation of regional nerve blocks.

Acute cholecystitis represents a significant problem in contemporary abdominal surgery. The gold standard for treating this pathology is laparoscopic cholecystectomy. Postoperative pain substantially impedes rehabilitation and impairs the quality of patient recovery. Optimization of perioperative anesthesiology strategies remains a priority task for anesthesiologists and surgeons. This narrative review systematically synthesizes data from randomized controlled trials, meta-analyses, and systematic reviews on anesthesiology support for laparoscopic cholecystectomy, with a focus on regional anesthesia techniques. Contemporary studies indicate that peripheral nerve blocks are associated with reduced opioid requirements, accelerated postoperative recovery, and enhanced patient treatment satisfaction. Particular attention is paid to transversus abdominis plane block and erector spinae plane block, which demonstrate the strongest evidence base. Despite the substantial body of accumulated data, the selection of optimal anesthesia methodology remains subject to scientific debate, underscoring the need for additional research of high methodological quality.

Introduction. Regional anesthesia is gaining popularity in anesthesiology. In thoracoabdominal surgery, the ESP block (erector spinae plane block) and TPV block (thoracic paravertebral block) are frequently used. There is evidence of anesthetic penetration into the epidural space, leading to the development of a sympathetic block. We hypothesize that subtransversal administration of the anesthetic provides a more effective analgesic effect due to a greater influence on the sympathetic trunk, splanchnic nerves, and thoracoabdominal nerves with limited diffusion into the epidural space. The objective was to conduct a comparative evaluation of the spread of contrast with anesthetic in the subtransversal space when performing ESP block, TPV block, and subtransvertal method of paravertebral block. Materials and methods. The study was conducted on 30 cadavers: ESP-block group (n = 10), TPV-block group (n = 10), and subtransvertal method of paravertebral block group (n = 10). The procedure was performed at the level of Th7–Th8 under ultrasound guidance through an 18G needle with infusion of 20 ml of 0.2% Ropivacaine solution with contrast at a rate of 5 ml/min. Then, dissection was performed, and the area of dye spread and the degree of diffusion were analyzed. Results. Statistically significant differences were found in the number of involved spinal nerve roots, splanchnic nerves, and the frequency of diffusion into the pleural cavity and internal organs (p < 0.05). The maximum number of involved spinal nerve roots was observed with ESP block (7 segments), and the minimum with TPV block (2 segments). The greatest spread along the splanchnic nerves and diffusion into the internal organs were recorded with the subtransversal method of paravertebral block. The frequency of intercostal vessel damage did not differ statistically (p > 0.05). Conclusion. The subtransversal method of paravertebral block provides the greatest involvement of nerve structures, which allows us to hypothesize its effect on both the sympathetic and parasympathetic nervous systems. Further research is needed to evaluate the effectiveness of the method.

Ventral hernias, or anterior abdominal wall hernias, represent a relevant surgical problem. An important aspect of high-quality recovery of the patient after this surgical intervention is the appropriate selection of anesthetic management and effective pain control. A scientific data search was conducted in medical databases including PubMed, Google Scholar, the Cochrane Library, and eLibrary. This review analyzes data from clinical studies and meta-analyses addressing various anesthetic techniques used in surgery for anterior abdominal wall hernia repair. Particular attention is given to regional anesthesia, which is currently considered a highly promising method for providing effective and safe high-quality analgesia. Current studies demonstrate that the use of regional anesthesia reduces the risk of opioid-related complications and shortens hospital length of stay compared with epidural, spinal, and general anesthesia. The most extensively studied regional anesthesia techniques include the erector spinae plane block and the transversus abdominis plane block. However, the choice of the optimal anesthetic method for ventral hernia repair remains a subject of debate. Further research is required to establish a gold standard in this field.

INPLASY202420001 Intraoperative electroencephalogram patterns as predictors of postoperative delirium: a systematic review and meta-analysis Keywords: Electroencephalography; postoperative delirium…

A-type botulinum toxin blocks presynaptic production of acetylcholine, thereby disrupting neuromuscular transmission, and leading to flaccid muscle paresis. Injection of toxin into the internal anal sphincter is a new, minimally invasive, effective method of treating children with hypertonicity / achalasia of the sphincter, pelvic muscle dyssynergia, stool retention, secondary fecal incontinence from rectal overflow. The effect of A-type botulinum toxin on smooth muscles of hollow organs has not been yet studied.Objective. To analyze the effect of A-type botulinum toxin on the tone of the smooth muscles of the colon in the experiment.Material and methods. The scientists examined 15 laboratory Sprague Dawley rats. The effect of A-type botulinum toxin on the tone of the smooth muscles of the large intestine was assessed by measuring the stress of the intestinal wall and intraluminal pressure.Results. The scientists revealed a decrease in pressure in the rectum on the 10th day after the injection of A-type botulinum toxin into the segment of the descending colon. The indices of the intestinal wall tension did not differ before the administration of A-type botulinum toxin, as well as in 10 and 20 minutes. The tension in the administration area of A-type botulinum toxin decreased by 81% on the 10th day after injection. There was an indirect decrease in smooth muscle tone in the segments of the colon above and below the injection by 49 and 80%, respectively.Conclusion. The decrease in rectal pressure on the 10th day after the administration of A-type botulinum toxin directly depends upon the decrease in the biovoltage of the overlying sections. Further basic research is needed to assess the effect of the toxin on non-targeted smooth muscle.

In the last decade, botulinum toxin type A (BTA) has been used in children with colorectal diseases. There are no published papers on the topic in Russia. Objective. To investigate BTA effectiveness in children with different colorectal problems. Patients and methods. 9 patients from 1.7 to 14 years old (median age 3.5 years) were treated with the new method in the Speransky Children's Hospital (Moscow, Russia). The indications for treatment were various complaints (constipation, fecal pseudo-incontinence, painful defecation, obstructive defecation), anal hypertonia (spasm). We treated children in whom conservative therapy was ineffective. Incobotulinumtoxin A was administered under general anesthesia at a dose of 3–6 U/kg at 4 points along the circumference of the anal canal. Results. The effect of therapy was obtained in 7 out of 9 patients (77.8%). A good and excellent result was recorded in 4 patients (44.4%), mild – in 3 (33.3). There was no effect in two children with genetic pathology and Hirschsprung's disease with colostomy (22.2%). Conclusion. Circumferential chemodenervation with incobotulinumtoxin A of anal sphincters is an effective and safe method of treating children with defecation disorders resistant to routine conservative therapy, but further research is needed to develop patient selection, dose calculation and create guidelines injection technique and its frequency. Key words: dyssynergic defecation, painful defecation, hirschsprung, achalasia, incobotulinumtoxin A, children

BACKGROUND: After the surgical treatment of children for anorectal malformations, spinal pathology, and Hirschsprungs disease, their quality of life is significantly reduced due to fecal incontinence. For patients with persistent defecation disorders, the Bowel Management program is offered. AIM: This study analyzes the Bowel Management program implemented in the clinic. MATERIALS AND METHODS: A prospective analysis of the program used in children after surgical correction of malformations was conducted. The program comprised the following components: lectures for patients/parents, hospitalization, irrigography with water-soluble contrast, teaching patients/parents about cleansing enemas, keeping a bowel movement diary, plain abdominal X-ray, changing the recipe for enema solution, monitoring the effectiveness, and correcting recommendations. RESULTS: A total of 66 children from 1.5 to 17 years old were treated. Three groups were identified: (I) anorectal malformations (n = 26), (II) spinal pathology (n = 30), and (III) Hirschsprungs disease (n = 10). The results were considered satisfactory if the bowel cleansing procedure was painless for the child and did not cause stress reactions; the parents were satisfied with the result of the prescribed program if after the enema a sufficient amount of stool was removed within 45 minutes, there were no episodes of defecation during the day. With the help of the Rome IV revision criteria, fecal incontinence was noted in all cases against the background of stool retention. In 11 (16.7%), there was no fecal incontinence even in cases of prolonged stool retention. A correlation was found between high lesions (in the lumbar spine) in spinal hernias with the absence of fecal incontinence with prolonged stool retention compared with the low sacral localization of the hernia. In group I, 91.7% had spinal cord fixation. In group II, 86.7% had it, and none were present in group III. The effectiveness of the program was 83.3%. CONCLUSION: The Bowel Management is easy to use and effective in 83% of patients. It can be recommended for the rehabilitation of children with defecation disorders, fecal incontinence after surgical correction of congenital malformations (anorectal malformations, spinal pathology and Hirschsprung's disease).

The review discusses sexual dysfunction and fertility problems in patients with anorectal malformations. Fertility problems in patients with rectal and pelvic abnormalities can develop against the background of concomitant genital malformations and after surgical interventions. Boys often have rectovesical or rectoteurethral (prostatic and bulbar) fistulas. In girls, anorectal malformations may be combined with vaginal atresia and uterine abnormalities leading to impossibility of pregnancy in the future. Psychological aspects have a large effect on sexual dysfunction. Poor results, such as fecal and urine incontinence, have direct influences on social adaptation. In assessing long-term results, multicenter studies have found that, at puberty, one-third of women and 10% of men had problems with their sexual function because of low self-esteem and impaired social adjustment. Anorectal malformations are not current problems in pediatric surgery. Patients need an interdisciplinary, personalized approach that includes timely diagnosis and surgical correction of defects, as well as detection and correction of disorders of anatomy of pelvic organs and internal and external genitalia.