Pain medicine 2021-06-06T18:59:28+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> Clinical features and outcomes of new daily persistent headache in patients in China and comparison with medication overuse headache: a double-center retrospective study 2021-06-06T18:59:28+03:00 Huanxian Liu Ye Ran Liang Dang Ruirui Yang Shuping Sun Meichen Zhang Ke Li Chunfu Chen Zhao Dong Shengyuan Yu <p><strong>Background:</strong> This study examined the clinical features and outcomes of NDPH patients and comparison with medication-overuse headache (MOH) in Mainland China.</p> <p><strong>Methods:</strong> This retrospective study observed patients with NDPH and medication-overuse headache (MOH) visiting two outpatient clinics between November 2011 and December 2019. Clinical information was collected and all patients were followed by telephone.</p> <p><strong>Results:</strong> The study recruited 73 NDPH and 638 MOH patients. The NDPH patients included 39 males (39/73, 53.4%) and 34 females (34/73, 46.6%), with an average age of 37.4 years and average headache duration of 10.6 years. Headache-precipitating factors included infection (11/73, 15.1%) and stress (22/73, 30.1%). Compared to MOH patients, NDPH patients had a male predominance (53.4% vs. 22.6%, p&lt;0.001), younger age of CDH onset (26.7±12.3 vs. 41.4±11.3 years, p&lt;0.001), and longer duration of CDH (10.6±11.8 vs. 6.1±6.2 years, p=0.023). In 62 NDPH patients followed up for 31 months, on average, therapeutic responses were more effective in NDPH patients with trigger factors than in those without trigger factors (71.4% vs. 32.4%; p = 0.002); the odds ratio (OR) of an effective outcome was 5.25 (1.73–17.84, p = 0.005).</p> <p><strong>Conclusions:</strong> NDPH is significantly different from MOH, with a male predominance, younger age of CDH onset, and longer duration of CDH. The presence of trigger factors is an independent predictor of better treatment effect in NDPH patients.</p> 2021-04-29T00:00:00+03:00 Copyright (c) 2021 Rationale for analgesia to prevent postoperative hyperalgesia in children, according to the morphological study of skin in the wound 2021-05-24T12:28:02+03:00 Dmytro Dmytriiev Oleksandr Marchuk Olena Kovalchuk <p>In the article, morphological changes of skin in the area of postoperative wound are displayed. It was discovered that continuous infusion of high-dose fentanyl (10–20 mcg/kg/h) for analgesia in the early postoperative period in children operated on for tumors of abdominal cavity can result into opiod-induced hyperalgesia, which is followed by skin morphological changes around the postoperative wound with the development of necrosis in it center with expressed perifocal reactive changes in the form of severe inflammation, and significant violations of microcirculation with the formation of small nerve fibers on day 14. In its turn, using TAP-block and combined spinal-epidural analgesia showed small perineural edema. The fragmentation of nerve fibers was not determined, which indicates the absence of development of postoperative hyperalgesia. Ketamine infusion results into negligible perineural edema and reduction of postoperative hyperalgesia.</p> 2021-04-30T00:00:00+03:00 Copyright (c) 2021 Rationale for preoperative (versus postoperative) administration of meloxicam for acute pain management and assessment of satisfaction in patients with femoroacetabular impingement who underwent hip arthroscopy 2021-05-24T11:59:34+03:00 Yongqing Li Guowei Li Kai Zhang Menglu Jiang Xu Dai Zhenqing Liu Ou Wang <p><strong>Objective:</strong> This study is aimed to compare the analgesic effect and safety of preoperative (versus postoperative) meloxicam administration in femoroacetabular impingement (FAI) patients who underwent hip arthroscopy (HA).</p> <p><strong>Methods:</strong> Totally, 136 FAI patients who scheduled for HA were recruited, then they were randomly assigned to preoperative administration (PREA) group (orally meloxicam 7.5 mg in 12h, 24h before operation, then orally 7.5 mg/d from 12h to Day 7 after operation; N=68) or postoperative administration (POSA) group (orally meloxicam 7.5 mg/d from 12h to Day 7 after operation; N=68) in 1:1 ratio. Furthermore, pain visual analog scale (VAS) score, patient satisfaction score, Harris hip score (HHS) and adverse events were assessed. Besides, the accumulated pethidine consumption for rescuing analgesia was calculated.</p> <p><strong>Results:</strong> Acute pain VAS score at rest (Day1 – Day2) and pain VAS score at motion (Day1 – Day3) were decreased, meanwhile short-term patient satisfaction score (Day1–Day3) was increased in PREA group compared with POSA group; however, these scores in long-term period were of no difference between PREA group and POSA group (Day3–Month3). Furthermore, accumulated pethidine consumption on Day3 and Day7 were attenuated in PREA group compared with POSA group. Additionally, HHS at any assessed time points (Day7–Month3) did not differ between two groups. Besides, no difference in the incidence of adverse events was found between two groups.</p> <p><strong>Conclusions:</strong> Preoperative meloxicam administration displays superior efficacy in short-term pain control, patient satisfaction improvement and attenuated consumption of rescue analgesia over postoperative meloxicam administration in FAI patients who underwent HA.</p> 2021-04-28T00:00:00+03:00 Copyright (c) 2021 Dexmedetomidine in anaesthesia for laparoscopic surgery for acute cholecystitis 2021-05-24T12:36:36+03:00 O A Halushko V I Mamchich T V Savchuk V V Donets M O Chayka <p><strong>Background.</strong> In laparoscopic cholecystectomy (LCE), general anesthesia has its own characteristics due to the creation of pneumoperitoneum, changes in body position and adsorption of insufflated gas, which causes the occurrence of perioperative complications and requires improvement of anesthesiology programs.</p> <p><strong>Objective:</strong> to determine the efficacy and safety of combined low opioid anesthesia based on dexmedetomidine in complex anesthesia in patients undergoing laparoscopic surgery for acute cholecystitis.</p> <p><strong>Materials and methods.</strong> In total, the study included 163 patients undergoing LCE under general anesthesia. All patients were divided into 3 groups according to the anesthetic care scheme. In Group 1 (n=56), low-opioid anesthesia (dexmedetomidine, lidocaine, fentanyl 1–2 μg/kg/h) and artificial ventilation were performed; Group 2 (n=52): propofol with fentanyl (4–6 μg/kg/h) and artificial ventilation. In Group 3 (n=55): anesthesia with sevoflurane in combination with fentanyl and artificial ventilation.</p> <p><strong>Results.</strong> Hyperdynamic reactions were observed in Group 2 and Group 3 at the beginning of the operation: heart rates and BP values after induction, with intubation in the 3rd, 5th and 7th minute of pneumoperitoneum, were slightly higher in Group 2 and 3 than in Group 1. However, moderate bradycardia was observed in Group 1 more often – in 5 patients (8.92%) than in patients in Group 2 and Group 3 – 2 cases (3.84%) and 2 cases (3.64%), respectively. The total number of injected analgesics during LCE was: in Group 1 – 141.52±23.64 μg, in Group 2 – 426.92±39.41 μg, in Group 3 – 354.75±28.63 μg (p &lt;0.01). Only one patient in Group 1 required ondansetron for the treatment of PONV compared to 5 and 4 in Group 2 and Group 3, respectively (p &lt;0.05). None of the patients in all groups reported “feeling” intraoperative events or “awakening during surgery”.</p> <p><strong>Conclusions.</strong> The use of dexmedetomidine with lidocaine infusion three times reduced the use of opioids in the intraoperative period and to refuse their use in the postoperative period. With the use of low-opioid anesthesia in the postoperative period, the frequency of hypertensive reactions and tachycardia did not increase, but in the postoperative period, these p</p> 2021-04-29T00:00:00+03:00 Copyright (c) 2021 Conversion of epidural analgesia to anesthesia for cesarean section 2021-05-24T09:38:56+03:00 Yevhenii Grizhimalsky Andrii Harha Yevhenii Sulimenko <p>The frequency of cesarean sections is increasing from year to year, and the choice of optimal anesthetic management is important. Regional anaesthesia is the anaesthesia of choice for the cesarean section because it reduces maternal and neonatal risks. If an epidural pain relief of labor is performed, then this epidural catheter can be successfully used for conversion to epidural anaesthesia. The choice of drug for conversion depends on the degree of urgency; the highest rate of onset of anesthesia is shown by lidocaine with adjuvants (fentanyl, sodium bicarbonate). Conversion failure occurs in 0–21% of cases; the main risk factors for conversion failure are inadequate epidural analgesia and patient height. The management of failed conversion depends on the category of urgency and other factors and may include spinal, combined spinal-epidural, or general anesthesia</p> 2021-04-24T00:00:00+03:00 Copyright (c) 2021 The effect of cryotherapy on pain during local and total application 2021-05-24T12:51:45+03:00 J Mašán O Dobrovanov A Čanecký <p><strong>Background:</strong> analgesic effect of total and local cryotherapy in people older than 55 years, in respondents with various diagnoses, most often with degenerative diseases, especially with gonarthrosis, coxarthrosis, spondylosis, osteoarthritis and polyarthrosis.</p> <p><strong>Objective:</strong> the aim of the survey was to process information from the field of total and local cryotherapy and to analyze the information obtained using questionnaires. We process the percentage effect of total and local cryotherapy on the intensity of painful symptoms, feeling, tolerance and satisfaction of respondents after completing ten therapies.</p> <p><strong>Materials and methods:</strong> the group of respondents consisted of 35 men and 65 women aged 55 to 81 years. A total of 100 respondents qualified for the survey. 50% of respondents participated in total cryotherapy and 50% of respondents participated in local cryotherapy.</p> <p><strong>Results:</strong> we processed the results using MS Excel and IBM SPSS. The Modified Laitinen Pain Questionnaire was used. Due to established hypotheses and the nature of the data, we used the Kolmogorov – Smirnov test, the non-parametric Mann – Whitney U-test and the Wilcoxon nonparametric test. The results show that with the help of local and total cryotherapy, the intensity of painful symptoms is lower.</p> <p><strong>Conclusions:</strong> the performed analysis of the data by means of a questionnaire showed that local and total cryotherapy alleviates pain and has an analgesic effect.</p> 2021-04-24T00:00:00+03:00 Copyright (c) 2021