INFLUENCE OF EPIDURAL ANESTHESIA ON THE QUALITY OF THE PERIOPERATIVE PERIOD IN PATIENTS UNDERGOING TOTAL ABDOMINAL HYSTERECTOMY
DOI:
https://doi.org/10.32782/2411-9164.21.2-10Keywords:
hysterectomy, epidural analgesia, pain, analgesiaAbstract
Introduction. Many pathological conditions lead to the fact that women need a total abdominal hysterectomy. Therefore, improving the quality of the periand postoperative period in such patients is quite important for the positive effect of the treatment. Purpose – to study the effect of epidural analgesia with standard doses of local anesthetics on the quality of the peri- and postoperative period in women undergoing total abdominal hysterectomy. Materials and methods. The results of surgical treatment of 54 women who underwent total abdominal hysterectomy were studied. Patients were divided into 2 groups, depending on the type of anesthesia. The quality of the peri- and postoperative period was assessed by objective (changes in laboratory parameters, doses of anesthetics and analgesics) and subjective (VAS) indicators. The results. Comparing the groups, the following results were obtained: Leukocytes after surgery [16.79±0.93] for 1st group versus [13.65±0.62] for the second group, which is statistically significantly less in the 2nd group p=0.006; on the next day [12.79±0.66]; [11.0±0.44] statistically significantly less in the 2nd group p=0.026; after 3 days [9.75±0.46]; [8.59±0.26], p=0.035 – also a significant decrease. The dose of narcotic analgesic according to the Mann-Whitney test does not statistically differ in the two groups (p=0.135), while the dose of inhalation anesthetic is smaller in group 2 (p=0.009). VAS after awakening [3.9±0.2]; [1.4±0.3] smaller in group 2 p=0.0001; after 3 hours [4.0±0.2]; [2.9±0.3] smaller in group 2 p=0.01; after 6 hours [3.6±0.2]; [3.0±0.2] smaller in group 2 p=0.039; after 9 hours [3.3±0.1]; [2.6±0.2] smaller in group 2 p=0.001; after 12 hours [2.8±0.1]; [2.4±0.1] is smaller in the 2nd group p=0.049. Conclusion. The inclusion of epidural anesthesia as a component of combined anesthesia with inhalation in total abdominal hysterectomy allows to reduce the dose of sevoflurane during anesthesia, and also significantly improves the quality of the postoperative period, especially on the first day. Epidural analgesia promotes accelerated rehabilitation of patients.
References
Hiramatsu, Y. (2019). Basic Standard Procedure of Abdominal Hysterectomy: Part 1. Surg J (N Y). Mar 7;5(Suppl 1): S2–S10. doi: 10.1055/s-0039-1678575.
Beyaz, S.G., Özocak, H., Ergönenç, T., Palabıyık, O., Tuna, A.T., Kaya, B., Erkorkmaz, Ü., & Akdemir, N. (2016). Chronic postsurgical pain and neuropathic symptoms after abdominal hysterectomy: A silent epidemic. Medicine (Baltimore). Aug; 95(33):e4484. doi: 10.1097/MD.0000000000004484.
Lonky, N.M., Mohan, Y., Chiu, V.Y., Park, J., Kivnick, S., Hong, C., Hudson, S.M. (2017). Hysterectomy for benign conditions: Complications relative to surgical approach and other variables that lead to post-operative readmission within 90 days of surgery. Womens Health (Lond). Aug; 13(2):17–26. doi: 10.1177/1745505717714657.
Zheng, Niu, Xiuxiu, Gao, Zeshu, Shi, Tianyu, Liu, Min Wang, Lulu Guo, Dunyi Qi. (2021). Effect of total intravenous anesthesia or inhalation anesthesia on postoperative quality of recovery in patients undergoing total laparoscopic hysterectomy: A randomized controlled trial. doi: 10.1016/j.jclinane..110374.
Kunst, A.M., Wulf, H., Stegemann, B., & Fiehn, A. (2023). Intraoperative guidance of anesthesia: Analgesie Nociception Index (ANI) vs. standard care for hysterectomy under anesthesia with sevoflurane : A randomized controlled simple blinded study on intraoperative opioid consumption, postoperative pain and patient satisfaction. Die Anaesthesiologie, 07 Jun, 72(7):477–487. https://doi.org/10.1007/s00101-023-01288-y.
