Pain medicine 2021-08-28T21:50:52+03:00 Oleksandr Marchuk Open Journal Systems <p>"Medicina bolu" is a science-and-practice periodical for medical professionals. The main highlighting issue is pain, but not the only one, because in medicine there are no situations where a phenomenon is strictly isolated. Sign up for a print edition and follow up on the site to keep up with important and useful information.</p> <p>Thematic interests of the journal<br>Fundamental aspects of pain (clinical physiology, pathophysiology, pharmacology).<br>Applied aspects of pain (epidemiology, pain assessment, innovative methods of diagnosis and treatment, clinical pharmacology).<br>Clinical aspects of pain (acute pain, chronic pain, perioperative pain, posthumous pain, neuropathic pain, dysfunctional pain).<br>Clinical and anatomical approach to pain (headache, orofacial pain, neck and back pain, toothache, musculoskeletal pain, myofascial pain, fibromyalgia, visceral pain, pelvic pain, cardialgia, etc.).<br>Interdisciplinary approach to pain (in anesthesiology, in surgery, in pediatrics, neurology, vertebrology, in the clinic of internal diseases, oncology, rheumatology, gerontology, gastroenterology, traumatology and orthopedics, otorhinolaryngology, dentistry, obstetrics, gynecology and urology, in the palliative and hospice medicine).<br>Treatment and rehabilitation of patients suffering from pain (pharmacotherapy, physical rehabilitation, medical rehabilitation, alternative methods of treatment, means of psychological and psychotherapeutic influence, invasive methods of pain relief, organization of pain relief).<br>Separate clinical cases and their clinical examination.</p> Intravenous versus perineural dexmedetomidine in prolongation of analgesia with regional anesthesia: a meta-analysis and systematic review 2021-08-28T21:50:52+03:00 Yan Feng Pan Chang Xiao-Bo Chen Xiao-Lin Yang Yu-Jun Zhang Wen-Sheng Zhang <p><strong>Background and Objective.</strong> It is unclear whether perineural administration offers advantages when compared to intravenous dexmedetomidine in local anesthesia. To compare the efficacy of perineural versus intravenous dexmedetomidine as local anesthetic adjuvant, we conducted the meta analysis and systematic review.</p> <p><strong>Materials and Methods.</strong> Two researchers searched MEDLINE, OVID, PubMed, Embase, Cochrane Central, Web of Science and Wanfang data for randomized controlled trials comparing the effect of intravenous versus perineural dexmedetomidine as local anesthetic adjuvant without any language restrictions.</p> <p><strong>Results.</strong> We identified 14 randomized controlled trials (801 patients). The results revealed that the duration of analgesia (SMD: -1.76, 95 % CI, [-2.7, -0.83] P = 0.000, I2 = 96 %), the duration of sensory block (SMD:- 3.99, 95 % CI, [-5.88, -2.0], P = 0.000, I2 = 97.6 %), the duration of motor block (SMD: -1.6, 95 % CI, [-2.78, -0.41] P = 0.008, I 2 = 95.5 %) were significantly longer in the perineural group, when compared to systematic dexmedetomidine. The onset time of sensory block (SMD: 1.55, 95 % CI, [0.16, 2.94] P = 0.028, I2 = 96.7 %) and the onset time of motor block (SMD: 0.84, 95 % CI, [0.17, 1.5] P = 0.013, I2 = 88.3 %) were shorter in perineural group compared to intrave nous dexmedetomidine. Meanwhile, analgesic consumption in 24 hours (SMD: 0.37, 95 % CI, [0.05, 0.69] P = 0.023, I 2 = 55.6 %) and the incidence of patients of Ramsay Sedation Scale &gt; 3 (RR: 3.8, 95 % CI, [1.45, 9.97] P = 0.000, I 2 = 26.9 %), hypotension (RR: 1.74, 95 % CI, [1.15, 2.65] P= 0.009, I2 = 32.7 %) and bradycardia (RR: 3.71, 95 % CI, [1.27, 10.86] P = 0.017, I2 = 0 %) were lower in perineural dexmedetomidine compared to the intravenous group.</p> <p><strong>Conclusions.</strong> Our meta-analysis generates the evidence that perineural dexmedetomidine is a superior adminstration for prolonging the duration of analgesia. Perineural dexmedetomidine also shows the advantages in duration of sensory block and the onset time of sensory and motor block, when compared to the intravenous administration. Simultaneously, dexmedetomidine as a local anesthetic adjuvant for perineural injection may be much safer than intravenous application because of the lower incidence of patients of Ramsay Sedation Scale &gt; 3 and lower incidence of hypotension and bradycardia.</p> 2021-08-28T00:00:00+03:00 Copyright (c) 2021 Anesthetic management for Placenta Accreta 2021-08-28T20:10:53+03:00 Kim En-Din N S Nadyrkhanova R A Tkachenko Yu V Kulichkin F P Nishanova K D Mikirtichev I I Dzhatdaev <p>Дослідження виконані у 82 вагітних і породіль при кесаревому розтині з приводу передлежання плаценти з вростанням на 37–38 тижні. Органозберігаюча операція була виконана за такою методикою: лапаротомія за Джоель Кохен, донний кесарів розтин з залишенням плаценти, перев’язка трьох пар магістральних маткових судин і внутрішніх клубових артерій з обох сторін (поетапна деваскуляризація матки) з подальшим видаленням стінки матки (метропластика) при вростанні плаценти. Операції виконані в умовах спінальної анестезії (Сан) 0,5 % гіпербаричним розчином бупівакаїну. Інфузійна програма будувалася відповідно до рекомендацій з обмежувальної інфузії. Преінфузію проводили збалансованим кристалоїдом Реосорбілакт (10–15 мл/кг) з подальшим введенням на етапах операції збалансованого кристалоїду і компонентів крові за необхідності. Оцінювали гемодинаміку, КОР та електроліти крові. Оцінку крововтрати проводили гравіметричним способом.</p> <p>Дослідження показали, що Сан і Реосорбілакт у програмі малооб’ємної інфузійної терапії зберігають доставку кисню на фізіологічному рівні, стабілізують гемодинамічний профіль і КОР. При вростанні плаценти використання сучасних технологій в анестезіології реаніматології та акушерстві, з мультидисциплінарним підходом, дозволяють реалізувати органозберігаючу тактику у цієї категорії жінок</p> 2021-08-28T00:00:00+03:00 Copyright (c) 2021 Use of hyaluronic acid preparations for treatment of osteoarthritis of major ligaments 2021-08-28T20:10:51+03:00 Oleksiy Kalashnikov Oleksiy Sulyma Taras Osadchuk Volodymyr Zayets Taras Nizalov Roman Kozak Pavlo Chernyak <p>The authors of the article analyzed the experience of domestic and foreign experts in the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major ligaments.</p> <p><strong>Background and Objective.</strong> To analyze the literature sources in order to determine the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major ligaments.</p> <p><strong>Materials and methods.</strong> Articles in specialized scientific journals and collections, Internet resource.</p> <p><strong>Results.</strong> The analysis of literature sources determined the important role of HA preparations in the supplying and functioning of the articular cartilage. Researchers are inclined to believe that the ideal HA preparation should be as close as possible to the physiological HA of the synovial fluid of the joint. The developed domestic drug Arthro-Patch fully corresponds to these parameters.</p> <p><strong>Conclusions.</strong> The use of modern injectable HA preparations is advisable at stages 1–3 of OA. Anti-inflammatory effect of HA preparations makes it possible to reduce the dose and time of administration of non-steroidal anti-inflammatory drugs and, as a consequence, reduce the risk of developing many adverse side effects of NSAIDs. The high level of safety of HA preparations, the absence of serious side effects during their long-term use determine their widespread use in the clinical practice of modern orthopedists.</p> 2021-08-28T00:00:00+03:00 Copyright (c) 2021 Efficiency and safety of use of the extemporal inhalation anesthetic “Sevoflurane Chemoteka” for anesthetic management in abdominal surgery 2021-08-28T21:49:15+03:00 A E Domoratsky M Yu Svintukovsky V Yu Gladkikh Yu A Oleinikova A M Markulin <div> <div>Sevoflurane is the most widely used modern inhalational anesthetic in the world. Sevoflurane is the “gold standard” for anesthetic management now. The article discusses the modern possibilities of using inhalation anesthesia, and the experience of using the domestic inhalational anesthetic “Sevoflurane Chemoteka” by the authors from the point of view of its effectiveness and safety.</div> </div> 2021-08-28T00:00:00+03:00 Copyright (c) 2021 Anesthesia for knee arthroscopy: which nerves should be blocked? 2021-08-28T20:10:47+03:00 Rostislav Chaplynskyy Olha Perepelytsia Yevhen Perepelytsia <p>Nowadays knee arthroscopy is the most common orthopedic procedure. It is used to diagnose and treat various pathological conditions. Usually knee arthroscopy can be performed using spinal anesthesia. The article presents a successful experience of using a combined technique, which consist in a unilateral subarachnoid anesthesia with additional adductor canal block and blocks of the articular branches of the sciatic and obturator nerves.</p> 2021-08-28T00:00:00+03:00 Copyright (c) 2021 Ropivacaine as the drug of choice for regional anesthesia: why so? 2021-08-28T20:10:57+03:00 Dmytro Dmytriiev Yevhen Lisak <p>While writing the article, we analyzed all the studies related to ropivacaine for the first half of 2021, which were published in PubMed. Previous review articles on ropivacaine were also analyzed.</p> <p><strong>Purpose:</strong> collection and analysis of the latest research results on ropivacaine. Assessment of the place of ropivacaine in modern regional anesthesia.</p> 2021-08-28T00:00:00+03:00 Copyright (c) 2021