Pain therapy to reduce perioperative complications

The incidence rates of adverse events secondary to any operation are a well-known problem in any surgical field. One outstanding example of such adverse events is postoperative pain. Thus, the incidence of acute postoperative pain following any surgical procedure and its treatment are central issues for every surgeon. In the times of Enhanced Recovery After Surgery (ERAS) programs, acute pain therapy became an increasingly well investigated and accepted aspect in almost all surgical subspecialties. However, if it comes to the reduction of postoperative complications, in the actual context of postoperative pain, surgeons tend to focus on the operative process rather than on the perioperative procedures. Undoubtedly, postoperative pain became an important factor with regard to the quality of surgical care: both, the extent and the quality of the surgical procedure and the extent and the quality of the analgesic technique are decisive issues for a successful pain management. There is growing evidence that supports the role of acute pain therapy in reducing postoperative morbidity, and it has been demonstrated that high pain scores postoperatively may contribute to a complicated postoperative course. This overview comprises the current knowledge on the role of acute pain therapy with regard to the occurrence of postoperative complications. Most of the knowledge is derived from studies that primarily focus on the type and quality of postoperative pain therapy in relation to specific surgical procedures and only secondary on complications. As far as existent, data that report on the recovery period after surgery, on the rehabilitation status, on perioperative morbidity, on the development of chronic pain after surgery, and on possible solutions of the latter problem with the institution of transitional pain services will be presented.

Personalization of the use of non-steroidal anti-inflammatory drugs for musculoskeletal diseases. Resolution on the results of the Meeting of Experts of December 13, 2017

The personalization of therapy is one of the innovative approaches gaining an increasingly strong foothold in modern medicine, implying an individual approach to each patient, taking into account the individual characteristics of the patient and the specific clinical case. This same standpoint of personified therapy should be used to plan rational analgesic therapy, the most important component of managing patients with the most common and socially significant diseases, with conditions that have a significant impact on the patient’s quality of life and worsen the course of concomitant diseases. The Meeting of Experts of different specialties such as rheumatologists, neurologists, cardiologists and clinical pharmacologists considered the key aspects of the prescription of NSAIDs, the most widely used class of painkillers, including those used for the relief of musculoskeletal pain. It was noted that when choosing NSAIDs, the practitioner should take into account the diagnosis, the planned duration of analgesic therapy, the intensity of pain, medical history data, the presence of comorbid diseases and risk factors for drug complications. There are different types of NSAIDs, some of which are most useful for urgent acute pain therapy (eg, ketoprofen), while others are most suitable for long-term pain management in chronic diseases (eg, etoricoxib). In any case, the practitioner should take into account the priority of patient safety and pay the utmost attention to the prevention of NSAIDassociated complications, and also keep in mind the duration of the specific drug administration permitted by the patient information leaflet. It was also noted that the launch of a new generic etoricoxib (Kostarox®) expands the possibilities of analgesic therapy for the Russian practitioners.

Association of Single-Nucleotide Polymorhism C3435T in the ABCB1 Gene with Opioid Sensitivity in Treatment of Postoperative Pain

Background: The minimal effective analgesic concentration of opioids required for satisfactory analgesia may differ significantly among the patients. Genetic factors may contribute to the variable response to opioids by affecting their pharmacokinetics or pharmacodynamics. Methods: Ninety nine patients undergoing abdominal surgery with colorectal anastomosis because of colorectal carcinoma were enrolled in the present study. C34535T was genotyped in all subjects and the patients were divided into three groups according to their genotype: CC-wild type homozygous, CT-mutant heterozygous and TT-mutant homozygous. Intravenous fentanyl, patient controlled analgesia was provided postoperatively for pain control in the first 24 hour after surgery. Opioid consumption, pain scores and the adverse side effects were evaluated. Results: Our main result is that the patients in the CC genotype group consumed significantly more fentanyl (375.0 μg ± 43.1) than the patients in the TT group (295.0 μg ± 49.1) and the CT (356.4 μg ± 41.8) group in the treatment of postoperative pain. The patients in the TT group had lower VAS scores at 6h, 12h, 18 h and 24h postoperatively. There were no significant differences in the side effects among the three groups regarding the vomiting and the sedation score. The patients in the TT group had more frequently nausea score 1, than the patients in the other two groups. Conclusion: Our study indicates that the C3435T SNPs of the ABCB1 gene is associated with differences in the opioid sensitivity. The ABCB1 polymorphism may serve as an important genetic predictor to guide the acute pain therapy in postoperative patients.