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CLINICAL MEDICINE

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DOI 10.34014/2227-1848-2021-3-97-110

 

EVALUATION OF ACUTE PAIN SYNDROME IN PATIENTS AFTER SEPTOPLASTY AND VARIOUS ANESTHETIC STRATEGIES

I.K. Kalmykov, V.I. Torshin, N.V. Ermakova, A.N. Sinel'nikova, I.V. Kastyro

Peoples' Friendship University of Russia, Moscow, Russia

 

The aim of the study was to evaluate acute pain syndrome in patients after septoplasty and various strategies of general anesthesia.

Materials and Methods. All patients received local infiltration anesthesia with 2 % procaine solution. In group 1 (n=105), a 2 % solution of promedol and 60 mg of ketorolac were used as evening premedication; in group 2 (n=108), fentanyl, propofol, cisatracuria besylate, tranexamic acid, atropine and metoclopramide were used; in group 3 (n=78), atracuria besylate, sodium thiopental, nitrous oxide and halothane were used. In groups 2 and 3, 100 mg of ketoprofen was injected intramuscularly in the evening of the postsurgical day. Anterior tamponade was carried out with foam tampons. The tamponade was removed on the 2nd day in the groups 1 and 2, and in group 3 it was removed one day after the surgery. Pain syndrome was assessed in 1, 3, and 6 hours, 1 and 2 days after surgery using a visual analogue scale (VAS), a verbal “lightning” scale (VLS), and a numeric rating scale (NRS). Pain was also assessed 1 hour after tamponade removal.

Results. At all stages of the examination (except Day 2), the pain syndrome was less pronounced in group 2. A day after surgery, the patients of group 3 had more severe pain if compared with those of other groups.

Conclusion. During septoplasty, the least painful reaction is provoked by the general anesthesia scheme as used in group 3: fentanyl, propofol, cisatracuria besylate, tranexamic acid, atropine and metoclopramide. In case of nasal tamponade after septoplasty, the tampons should be removed on the 2nd day after surgery.

Key words: septoplasty, anesthesia, analogue scales, pain.

Conflict of interest. The authors declare no conflict of interest.

 

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Received February 07, 2021; accepted June 11, 2021.

 

Information about the authors

Kalmykov Ivan Nikolaevich, Postgraduate Student, Chair of Otorhinolaryngology, Peoples' Friendship University of Russia. 117198, Russia, Moscow, M.-Maklay St., 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0001-7253-3576

Torshin Vladimir Ivanovich, Doctor of Science (Biology), Professor, Head of the Chair of Normal Physiology, Peoples' Friendship University of Russia. 117198, Russia, Moscow, M.-Maklay St., 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0002-3950-8296

Ermakova Natal'ya Viktorovna, Doctor of Science (Medicine), Professor, Chair of Normal Physiology, Peoples' Friendship University of Russia. 117198, Russia, Moscow, M.-Maklay St., 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0002-1074-1641

Sinel'nikova Anna Nikolaevna, Candidate of Science (Medicine), Associate Professor, Chair of Normal Physiology, Peoples' Friendship University of Russia. 117198, Russia, Moscow, M.-Maklay St., 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0003-0096-6369

Kastyro Igor' Vladimirovich, Candidate of Science (Medicine), Senior Lecturer, Chair of Normal Physiology, Peoples' Friendship University of Russia. 117198, Russia, Moscow, M.-Maklay St., 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0001-6134-3080

 

For citation

Kalmykov I.K., Torshin V.I., Ermakova N.V., Sinel'nikova A.N., Kastyro I.V. Otsenka ostrogo bolevogo sindroma u patsientov posle septoplastiki pri primenenii razlichnykh taktik anestezii [Evaluation of acute pain syndrome in patients after septoplasty and various anesthetic strategies]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2021; 3: 97–110. DOI: 10.34014/2227-1848-2021-3-97-110 (in Russian).

 

 

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DOI 10.34014/2227-1848-2021-3-97-110

 

ОЦЕНКА ОСТРОГО БОЛЕВОГО СИНДРОМА У ПАЦИЕНТОВ ПОСЛЕ СЕПТОПЛАСТИКИ ПРИ ПРИМЕНЕНИИ РАЗЛИЧНЫХ ТАКТИК АНЕСТЕЗИИ

И.К. Калмыков, В.И. Торшин, Н.В. Ермакова, А.Н. Синельникова, И.В. Кастыро

ФГАОУ ВО «Российский университет дружбы народов», г. Москва, Россия

 

Цель исследования заключалась в оценке острого болевого синдрома у пациентов после септопластики при применении различных тактик общей анестезии.

Материалы и методы. Ко всем пациентам применяли местную инфильтрационную анестезию 2 % раствором прокаина. В 1-й группе (105 чел.) использовали премедикацию 2 % раствором промедола и 60 мг кеторолака вечером, во 2-й группе (108 чел.) – фентанил, пропофол, цисатракурия безилат, транексамовую кислоту, атропин и метоклопрамид, в 3-й группе (78 чел.) – атракурия безилат, тиопентал натрия, закись азота и галотан. Во 2-й и 3-й группах вечером в день операции внутримышечно вводили 100 мг кетопрофена. Переднюю тампонаду осуществляли поролоновыми тампонами в резиновой перчатке. В 1-й и 2-й группах тампонаду удаляли на 2-й день, а в 3-й группе – через сутки после операции. Болевой синдром оценивали через 1, 3 и 6 ч, 1 и 2 сут после операции с помощью визуально-аналоговой шкалы, вербальной шкалы-«молнии», цифровой рейтинговой шкалы. После удаления тампонов боль оценивали через 1 ч.

Результаты. На всех этапах обследования, кроме 2-го дня, болевой синдром был менее выражен во 2-й группе. Через сутки у пациентов 3-й группы боль была выше, чем в остальных.

Выводы. При проведении септопластики наименьшую болевую реакцию провоцирует схема общей анестезии, примененная в 3-й группе: фентанил, пропофол, цисатракурия безилат, транексамовая кислота, атропин и метоклопрамид. В условиях тампонады носа после септопластики тампоны необходимо удалять на 2-й день после операции.

Ключевые слова: септопластика, анестезия, аналоговые шкалы, боль.

 

Литература

  1. Orhan I., Aydın S., Ormeci T., Yılmaz F. A radiological analysis of inferior turbinate in patients with deviated nasal septum by using computed tomography. Am. J. Rhinol. Allergy. 2014; 28: 68–72.

  2. Andrades P., Cuevas P., Danilla S., Bernales J., Longton C., Borel C., Rodrigo Hernández, Villalobos R. The accuracy of different methods for diagnosing septal deviation in patients undergoing septorhinoplasty: a prospective study. J. Plast. Reconstr. Aesthet. Surg. 2016; 69: 848–855.

  3. Thomas A., Alt J., Gale C., Vijayakumar S., Padia R., Peters M., Champagne T., Meier J.D. Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction. Int. Forum Allergy Rhinol. 2016; 6: 1069–1074.

  4. Rotenberg B.W., Pang K.P. The impact of sinus surgery on sleep outcomes. Int. Forum Allergy Rhinol. 2015; 5: 329–332.

  5. LoSavio P.S., O’Toole T.R. Surgery of the nasal septum and turbinates. In: Batra P.S., Han J.K. (eds.). Practical medical and surgical management of chronic rhinosinusitis. Cham: Springer; 2015: 483–507.

  6. Gillman G. Septoplasty. In: Myers E., Kennedy D. (eds.). Rhinology. Netherlands: Wolters Kluwer, Alphen aan den Rijn; 2016: 7–21.

  7. Ketcham A.S., Han J.K. Complications and management of septoplasty. Otolaryngol. Clin. N. Am. 2010; 43: 897–904.

  8. Dąbrowska‑Bień J., Skarżyński P.H., Gwizdalska I., Łazęcka K., Skarżyńsk H. Complications in septoplasty based on a large group of 5639 patients. European Archives of Oto-Rhino-Laryngology. 2018; 275: 1789–1794.

  9. Stallman J.S., Lobo J.N., Som P.M. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR Am. J. Neuroradiol. 2004; 25 (9): 1613–1618.

  10. Smith K.D., Edwards P.C., Saini T.S., Norton N.S. The prevalence of concha bullosa and nasal septal deviation and their relationship to maxillary sinusitis by volumetric tomography. Int. J. Dent. 2010; 2010.

  11. Bugten V., Nilsen A.H., Thorstensen W.M., Moxness M.H.S., Amundsen M.F., Nordgård S. Quality of life and symptoms before and after nasal septoplasty compared with healthy individuals. BMC Ear, Nose and Throat Disorders. 2016; 16 (1): 13.

  12. Bhattacharyya N. Ambulatory sinus and nasal surgery in the United States: demographics and perioperative outcomes. Laryngoscope. 2010; 120: 635–638.

  13. Пустовит О.М., Наседкин А.Н., Егоров В.И., Исаев В.М., Исаев Э.В., Морозов И.И. Воздействие ультразвуковой кавитации и фотохромотерапии на процесс репарации слизистой оболочки носа после септопластики и подслизистой вазотомии нижних носовых раковин. Голова и шея. 2018; 6 (2): 20–26.

  14. Sommer F., Hoffmann T.K. Septoplasty – a surgical or political challenge? The Lancet. 2019; 394: 276–277. DOI: 10.1016/s0140-6736(19)31241-3.

  15. Van Egmond M.M.H.T., Rovers M.M., Hannink G., Hendriks C.T.M., van Heerbeek N. Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial. Lancet. 2019; 394 (10195): 314–321.

  16. Siegel N.S., Gliklich R.E., Taghizadeh F., Chang Y. Outcomes of septoplasty. Otolaryngol. Head Neck Surg. 2000; 122 (2): 228–232.

  17. Bloom J.D., Kaplan S.E., Bleier B.S., Goldstein S.A. Septoplasty Complications: Avoidance and Management. Otolaryngol. Clin. N. Am. 2009; 42: 463–481.

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Поступила в редакцию 07.02.2021; принята 11.06.2021.

 

Авторский коллектив

Калмыков Иван Николаевич – аспирант кафедры оториноларингологии, ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, г. Москва, ул. М.-Маклая, 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0001-7253-3576

Торшин Владимир Иванович – доктор биологических наук, профессор, заведующий кафедрой нормальной физиологии, ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, г. Москва, ул. М.-Маклая, 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0002-3950-8296

Ермакова Наталья Викторовна – доктор медицинских наук, профессор, профессор кафедры нормальной физиологии, ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, г. Москва, ул. М.-Маклая, 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0002-1074-1641

Синельникова Анна Николаевна – кандидат медицинских наук, доцент кафедры нормальной физиологии, ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, г. Москва, ул. М.-Маклая, 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0003-0096-6369

Кастыро Игорь Владимирович – кандидат медицинских наук, PhD, старший преподаватель кафедры нормальной физиологии, ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, г. Москва, ул. М.-Маклая, 8; e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра., ORCID ID: https://orcid.org/0000-0001-6134-3080

 

Образец цитирования

Калмыков И.К., Торшин В.И., Ермакова Н.В., Синельникова А.Н., Кастыро И.В. Оценка острого болевого синдрома у пациентов после септопластики при применении различных тактик анестезии. Ульяновский медико-биологический журнал. 2021; 3: 97–110. DOI: 10.34014/2227-1848-2021-3-97-110.