Anastasia A. Maksimova

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.

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.

Introduction. The use of various regional blockades as a component of general anesthesia reduces the risk of postoperative complications such as intense pain syndrome, postoperative nausea and vomiting, and postoperative cognitive dysfunction. The study is devoted to the development and description of the technique of regional anesthesia of the anterior surface of the neck during operations on the thyroid and parathyroid glands under ultrasound navigation.The objective was to develop a safe and effective technique of regional anesthesia for operations on the thyroid and parathyroid glands under ultrasound navigation.Materials and methods. The trial involved 60 patients operated on for thyroid and parathyroid gland diseases. All patients were randomized into two groups: group 1 – combined anesthesia: general anesthesia + three-component blockade of the anterior surface of the neck; group 2 – general anesthesia. In group 1, intermediate cervical plexus blockade, pericapsular thyroid blockade, and Berry’s ligament blockade were performed under the control of ultrasound navigation. The patients’ condition was evaluated preoperatively, intraoperatively and in the postoperative period (after 3 and 12 hours) according to the following parameters: hemodynamic variability, pain intensity according to the numerical rating scale, frequency of postoperative nausea/vomiting and postoperative cognitive dysfunction (MOCA, MMSE), terms of postoperative activation of patients, need for prescription of opioid and non-opioid analgesics after surgery.Results. The combination of general anesthesia and the technique of three-component regional neck blockade allowed to limit the use of opioid analgesics: opioid consumption in group 1 was 3.12 [2.68; 3.75] μg/kg, in group 2 – 5.93 [4.48; 7.21] μg/kg (p < 0.0001). A higher rate of cognitive recovery was noted in group 1 compared to patients in group 2 (p = 0.0114). Combined anesthesia provided a long pain-free period after surgery: 12 hours after extubation, patients in group 1 had a very low level of pain according to numerical rating scale – 0 [0; 6.0] mm, patients in group 2 had higher values – 14 [10; 18] mm. The use of regional blockade allowed to reduce ketoprofen consumption in the postoperative period (consumption in group 1 amounted to 1.85 [1.30; 2.02] mg/kg, in group 2 – 3.19 [2.58; 5.97] mg/kg (p = 0.0015)).Conclusion. General anesthesia with three-component regional blockade of the anterior surface of the neck during operations on the thyroid and parathyroid glands under ultrasound navigation is effective and safe technique.

BACKGROUND. Surgeries involving the anterior neck (thyroidectomy, carotidectomy, plastic surgery, etc.) are widespread in Russia. Developing effective anesthesiological strategies for these procedures is a key goal in modern anesthesiology. The introduction of combined regional anesthesia techniques into surgical practice may help to minimize postoperative complications including severe pain syndrome, postoperative nausea, and vomiting. AIM. To compare the effectiveness of combined anesthesia (general + regional) with general anesthesia alone in thyroid and parathyroid gland surgeries. MATERIALS AND METHODS. In a prospective randomized study, 60 patients undergoing thyroid and parathyroid gland surgery were divided into two groups. Group 1 received general anesthesia combined with internal fascia of the neck block, bilateral block of the superficial branches of the cervical plexus, and block of ligament of Berry under ultrasound guidance. Group 2 received only general anesthesia. Hemodynamic profiles, plasma cortisol levels, fentanyl consumption, postoperative pain intensity, need for additional analgesia, and recovery time were evaluated. RESULTS. Compared to the group receiving only general anesthesia, patients receiving combined (general + regional) anesthesia showed a decrease in fentanyl consumption (p 0.0001), lower plasma cortisol levels 12 hours post-extubation (p =0.0439), a reduction in median pain intensity after tracheal extubation 3 and 12 hours after surgery (p =0.0190, p 0.0001), as well as a twofold reduction in time from the end of surgery to extubation (p =0.0001). Additionally, patients in the combined anesthesia group had higher scores on the Aldrete recovery scale, indicating a quicker readiness for transfer to the recovery ward (p =0.0114). CONCLUSION. The study demonstrated the effectiveness and safety of combined anesthesia in thyroid and parathyroid surgery, which provides adequate anesthetic protection for patients.

INTRODUCTION. The Zenker’s diverticulum is a protrusion of the wall of the pharyngeal-esophageal junction from the area of the Killian triangle as a result of persistent spasm of the cricopharyngeal muscle. The prevalence of the disease in Russia is 3 cases per 100 thousand people, in the world 0.01–0.11 %.METHODS AND MATERIALS . At the N. N. Burdenko Faculty Surgery Clinic of the I. M. Sechenov First Moscow State Medical University 2 patients with small diverticulum underwent endoscopic tunnel cricopharyngeal myotomy and 3 patients with large diverticulum underwent video-assisted transaxillary diverticulectomy.RESULTS . Compared with surgical methods for the treatment of Zenker’s diverticulum endoscopic methods have a lower complication rate, but a higher recurrence rate.CONCLUSION. Despite the introduction of new treatment methods, it is advisable to adhere to a differentiated approach to the treatment of Zenker’s diverticulum. Surgical treatment is indicated for patients with a large diverticulum in the absence of contraindications to surgery. Transluminal endoscopic methods, including cricopharyngeal tunnel myotomy, can be considered as a treatment for patients with small-sized Zenker’s diverticulum, as well as patients with large diverticulum who have concomitant diseases and contraindications to traditional surgery.

The OBJECTIVE of this article was to present a clinical demonstration of the successful experience of using minimally invasive surgical treatment of a patient with primary hyperparathyroidism (PHPT) by percutaneous microwave ablation (MWA) of parathyroid adenoma, under ultrasound guidance. This method provides maximum effectiveness with minimal invasiveness, a shorter recovery period after surgery, and a better cosmetic effect. After the minimally invasive intervention, the patient had complaints related to hypocalcemia, which develops practically after any form of radical PHPT treatment. No other complications were observed. Further dynamic observation was carried out by an endocrinologist at the place of residence. The obtained positive results demonstrated a good perspective of PHPT treatment by using MWA.