Relevance. The local anesthetics were used intraperitoneally after some minimally invasive gynecological interventions like a component of postoperative multimodal anesthesia in recent years.   Objective. The aim of  work was to study the effectiveness of intraperitoneal administration  of bupivokain  for the anesthesia of patients after laparoscopic cholecystectomy. Material and methods. 28 patients aged 32-60 years  (16 women, 12 men) were examined. The patients were divided into two groups. In the first group for anesthesia after the operation, was used ketorolac trometamine in dose 0.2 mg/kg intramuscularly each 6 hours. If the patient complained of postoperative pain, which was assessed by Visual-analog scale in 7 points or higher, fentanyl was administered intramuscularly in dose of 0.003 μg/kg. In the second group, besides the components of multimodal anesthesia used in the first group, at the end of the surgical intervention at the drainage tubes were injected 40 ml of 0.125% solution of bupivocaine (50 mg). This injection was repeated throughout the first day each 6 hours. The condition of patients was assessed by a Visual-analog scale after 1, 4, 8, 12 and 24 hours after the finishing of surgery. The average dose of fentanyl in μg/kg used for postoperative anesthesia  first 24 hours after operation was also determined. Results.  We have received a significant reduction in the rates of pain evaluation for Visual-analog scale in patients who used bupivacaine as a component of multimodal anesthesia. One hour after the end of the operation, the pain score for Visual-analog scale was less than the corresponding one in the control group in 1.77 times, after 4 hours – in 1.47, and in 8 hours – in 1.55 times. In all cases, P <0.001. The mean dose of fentanyl used for treatment in the study group was 1.55 times less than that in the control group. There were no significant complications in both groups. A patient in group 1 had nausea, requiring a single dose of ondasetron 2 mg Conclusion. Intraperitoneal administration of bupivocaine had a significant  anesthetic effect after laparoscopic cholecystectomy.

Relevance. The article is devoted to the problem of diagnosis and treatment of intra-abdominal hypertension (IAH) in acute abdominal pathology. Acute surgical diseases and abdominal injuries are accompanied by an increase in intra-abdominal pressure (IAP) in 83.6% of cases, and cause an abdominal compartment syndrome (ACS) in 16.8% of the observations. Objective. This review seeks to improve the results of treatment of patients with acute abdominal pathology by improving the methods of diagnosis, prevention and treatment of IAH. Materials and methods. The results of treatment of 187 patients with acute pathology of abdominal organs, which was accompanied by high IAP, were analyzed. Among the 187 patients, 98 (52.4%) were men, 89 (47.6%) women. The patients were divided into two groups depending on the diagnostic and therapeutic tactics chosen: the comparison group (85 (45.5%) persons) and the main group (102 (54.5%) persons). The treatment of them were carried out in accordance with our harmonized diagnostic and treatment algorithm of the correction of IAH. 149 (79.7%) patients were operated: 82 patients in the main group and 67 persons in comparison group. Our own method for the long-term determination of IAP by measuring it in the bladder was used for long-term diagnostics of IAP. Advanced laparolifting system was used in the complex conservative treatment of patients with acute pancreatitis accompanied by IAH. Methods for predicting the possibility of performing laparoscopic intervention in urgent surgery and postoperative pain after laparoscopic surgery were improved. Results. Implementation of the improved method of measuring IAP through prolonged monitoring of BP allowed to timely select and start the necessary therapeutic tactics, aimed to overcome intra-abdominal hypertension, and to avoid the development of abdominal compartment syndrome (sensitivity of the technique was 95.2%, specificity - 85.7%). The use of our advanced diagnostic and treatment algorithm for the prevention and treatment of IAH allowed to limit the measures to the first level in 67,6% of cases, to the second level - in 22,5% and to avoid the decompression laparostomy. At the same time, the need for such intervention arose in 11.1% of patients who had conservative treatment. Use of the proposed laparolifting system in the complex conservative treatment of IAH of patients with acute pancreatitis allowed to normalize IAP in the vast majority of patients, preventing the occurrence of ACS by reducing the frequency of complications associated with IAH, from 52.9% to 16.7% (p = 0.03 ), as well as overall mortality - from 35.3% to 5.6% (p = 0.03). Implementation into clinical practice the method of predicting the possibility of performing laparoscopic intervention in the conditions of urgent surgery by registering the initial values ​​of IAP, allowed to expand the indications for the implementation of this type of surgery in treatment of acute surgical pathology of the abdominal cavity organs (sensitivity of the technique was 85.7%, specificity - 95.5%). Local use of stereoselective NSAIDs (original dexketoprofen) at the end of the laparoscopic intervention followed by their intramuscular administration has a higher analgesic effect in comparison with other classes of analgesic agents, which is reliably confirmed by pain assessment indicators (visual analogue scales, blood plasma cortisol and external respiration function) (p <0.0001), and has a significantly higher degree of safety (p <0.001). Application of the proposed diagnostic and treatment algorithm in the complex treatment of patients with acute surgical pathology of the abdominal cavity, which is accompanied by IAH, allowed to achieve the intended goal for improving the treatment results of this category of patients by reducing the incidence of systemic complications from 54.1% to 11.8% ( p <0.0001), total mortality from 21.2% to 1.96% (p <0.0001), and postoperative lethality  from 22.4% to 2.4% (p = 0.0001). Conclusions. The method of measuring IAP by prolonged monitoring of BP is effective and practical (sensitivity of the technique was 95.2%, specificity - 85.7%). The use of the laparolifting system in patients with acute pancreatitis accompanied by IAH allowed to reduce the frequency of complications from 52.9% to 16.7% (p = 0.03), and the overall mortality - from 35.3% to 5.6% (p = 0,03). The introduced method of predicting the possibility of performing laparoscopic intervention in urgent surgery demonstrates high sensitivity (85.7%) and specificity (95.5%). The local use of stereoslective NSAIDs at the end of the laparoscopic intervention has a high analgesic effect and has a significantly higher safety degree (p <0.001). The use of the advanced diagnostic and treatment algorithm for treatment of IAH allows to apply only the first level measures in 67,6% of cases, the second level measures in 22,5%, to avoid the implementation of decompression laparostomy and to reduce the incidence of systemic complications from 54,1% to 11,8% (p <0.0001), to reduce total mortality from 21.2% to 1.96% (p <0.0001) and postoperative lethality from 22.4% to 2.4% (p = 0.0001).

Relevance. The local anesthetics were used intraperitoneally after some minimally invasive gynecological interventions like a component of postoperative multimodal anesthesia in recent years.   Objective. The aim of  work was to study the effectiveness of intraperitoneal administration  of bupivokain  for the anesthesia of patients after laparoscopic cholecystectomy. Material and methods. 28 patients aged 32-60 years  (16 women, 12 men) were examined. The patients were divided into two groups. In the first group for anesthesia after the operation, was used ketorolac trometamine in dose 0.2 mg/kg intramuscularly each 6 hours. If the patient complained of postoperative pain, which was assessed by Visual-analog scale in 7 points or higher, fentanyl was administered intramuscularly in dose of 0.003 μg/kg. In the second group, besides the components of multimodal anesthesia used in the first group, at the end of the surgical intervention at the drainage tubes were injected 40 ml of 0.125% solution of bupivocaine (50 mg). This injection was repeated throughout the first day each 6 hours. The condition of patients was assessed by a Visual-analog scale after 1, 4, 8, 12 and 24 hours after the finishing of surgery. The average dose of fentanyl in μg/kg used for postoperative anesthesia  first 24 hours after operation was also determined. Results.  We have received a significant reduction in the rates of pain evaluation for Visual-analog scale in patients who used bupivacaine as a component of multimodal anesthesia. One hour after the end of the operation, the pain score for Visual-analog scale was less than the corresponding one in the control group in 1.77 times, after 4 hours – in 1.47, and in 8 hours – in 1.55 times. In all cases, P <0.001. The mean dose of fentanyl used for treatment in the study group was 1.55 times less than that in the control group. There were no significant complications in both groups. A patient in group 1 had nausea, requiring a single dose of ondasetron 2 mg Conclusion. Intraperitoneal administration of bupivocaine had a significant  anesthetic effect after laparoscopic cholecystectomy.