Complex perioperative pain management in the treatment of patients with degenerative lumbar spine diseases
Objective. To analyze the effect of complex perioperative pain management on postoperative pain syndrome and cognitive functions in patients with degenerative lumbar spine diseases. Material and methods. A prospective study included 85 patients with degenerative lumbar spine diseases. Two groups were distinguished. In the control group (n=42), conventional surgical technologies and anesthesia were used. In the main group (n=43), we additionally applied multimodal perioperative analgesia. Comparative analysis included VAS score of pain syndrome and need for pain relief, Montreal Cognitive Assessment Score (MoCA) and Frontal Assessment Battery (FAB) score. Results. Less VAS score and in-hospital need for analgesia were observed in the main group compared to the control group (p<0.001). Twenty-seven patients (62.8%) in the main group did not require painkillers since the 6th postoperative day. According to MoCA and FAB scores, postoperative cognitive functions were significantly better in the main group (p<0.05). Mild-to-moderate cognitive impairment was detected in 29 (69%) and 7 (16.3%) patients in the main and control group, respectively (p=0.007). There was a greater number of adverse effects following anesthesia in the control group (28.6% and 9.3%, respectively, p=0.004). Conclusion. Complex perioperative anesthesia with preoperative administration of ketoprofen, intraoperative injection of dexmedetomidine and postoperative administration of paracetamol and wound edge infiltration with ropivacaine is effective and safe approach. These measures significantly reduce severity of local pain syndrome, incidence of cognitive disorders and risk of adverse anesthesia-induced effects.