IMULTIMODAL ANALGESIA FOR OPEN SURGICAL RECONSTRUCTION OF THE ABDOMINAL AORTA AND ITS BRANCHES
Aim: To provide rationale for alternative methods of epidural anesthesia in the perioperative period for open aortic surgery and their e ectiveness. Materials and methods. Fifty-six patients referred to reconstructive surgical repair of the abdominal aorta were recruited into a randomized prospective study. Patients were randomized into three groups with different method of analgesia through random number generation: Group 1 (n=14) - epidural analgesia with 0.2% ropivacaine 6-12 ml/hour; Group 2 (n=13) - intravenous bolus of 1 mg/kg lidocaine followed by continuous intravenous infusion 0.5-1 mg/kg/hour; Group 3 (n=29) - 0.2% ropivacaine 20 ml for rectus sheath block inserted under ultrasound control before the incision for 30 minutes followed by the placement of catheters before suturing the wound and subsequent injection of 0.2% ropivacaine 10 ml per catheter/4 hours. The standard support was provided to all patients. All interventions were performed by one anesthesiological and surgical team. Hemodynamics, neurological status, adequacy of pain relief using the VAS scale, bispectral index, analgonociception index (ANI monitor), immunobiochemical markers of stress response, the length of stay in the ICU, readmissions, complications, and mortality were compared. Oneway ANOVA and Pearson's χ2 test were used to perform statistical analysis. All data are presented as Me [Q1-Q3], (Min-Max)) and M±SD, (95% CI). Results. The length of the in-hospital stay did not depend on the method of anesthesia. There were no signi cant di erences in the main hemodynamic parameters intraoperatively and on day 1 postoperatively. The levels of pain according to the VAS score at admission to the ICU and on day 1 after surgery were comparable (p=0.613 vs. p=0.189). The amount of intraoperatively administered fentanyl di ered signi cantly between the study groups (p=0.036*) and was higher in patients with rectus sheath block compared with epidural anesthesia (p=0.024). There were no signi cant di erences in the distribution from severe (VAS≥4) to mild (VAS<4) pain after patients' waking up (p=0.155) and on day 2 after surgery (p=0.388). Conclusion. Alternative analgesia methods allows considering the comorbidity pro le of patients and initiating patient-oriented, safe, and e ective treatment of acute pain for open abdominal aortic surgery.