This article described the main theses of clinical guidelines of the Russian Federation of Anesthesiologists and Reanimatologists on postoperative pain management. The classification, etiology and pathogenesis of postoperative pain, the basic principles and algorithms for diagnosing pain, and the regional and systemic pharmacotherapy of pain in various fields of surgery are consistently presented. Multimodal analgesia is described in detail as a key concept of a current approach to the treatment of postoperative pain.

Introduction. Despite the advances in modern anesthesiology, it is impossible to guarantee a safe course of anesthesia, and even with planned surgical interventions, there is a risk of death. At present, there is no unanimity in approaches to assessing perioperative risk, and many systems for determining this risk have not been validated in Russia. The question of the contribution of pre-operative factors to the likelihood of an unfavorable outcome also remains open, which requires large multicenter national studies. Objectives. To assessment the predictive value of preoperative factors in determining the risk of death and complications based on the analysis of data obtained during the first year of the STOPRISK study. Materials and methods. An analysis of data on perioperative indices of 3002 patients operated on the abdominal and pelvic organs from 30 centers in 21 cities of Russia participating in the STOPRISK study is presented. Results. The mortality rate in the study was 0.47 %, the rate of postoperative complications was 3.9 %. Most often, an unfavorable outcome developed after upper abdominal and colorectal surgery. Despite the fact that the severity of surgery and the ASA class are independent predictors of an unfavorable outcome, the use of these parameters allows to predict postoperative mortality (AUROC = 0.85) and (with age) postoperative complications (AUROC = 0.77) with limited accuracy. Conclusions. Thus, the probability of an unfavorable outcome can be estimated using factors such as the severity of surgery and the initial physical status, but their predictive value for determining the risk of mortality is clearly insufficient, and even less is their ability to assess the risk of postoperative complications. As shown by literature data, inclusion in model additional risk factors allows to increase the accuracy of the forecast, however, given the peculiarities of the structure of comorbidities and their impact on outcome in the studied population, we need further evaluation of their contribution to perioperative risk. Also, taking into account the peculiarities of the occurrence of some concomitant diseases, further research is required to identify a significant impact on mortality and postoperative complications.

BACKGROUND: Chronic pain is a common problem that exerts a significant impact on individuals and society as a whole. Pain syndrome is one of the most common explanations for patients need for medical care, and it causes major suffering in humans. Thus far, chronic pain lacks a generally accepted terminology and classification. The review aimed to present the current terminology and classification of chronic pain. MATERIALS AND METHODS: Two independent researchers searched for publications for the period of January 2010 to October 2020 in the databases PubMed, MEDLINE, EMBASE, The Cochrane Library, Google Scholar, and the International Association for the Study of Pain. The last search query was performed on October 25, 2020. The search identified 423 studies, and 397 of them were excluded because they described the pathophysiology and treatment of chronic pain syndromes. The remaining 26 publications formed the basis of this review. RESULTS: The review presents the current terminology and classification of chronic pain, which is defined as pain that lasts for 3 months or more after the underlying pathology is cured. The work presents the description of terms such as chronic primary pain, chronic secondary pain, cancer-associated chronic pain, chronic postoperative or post-traumatic pain, chronic neuropathic pain, chronic secondary cephalgia or orofacial pain, chronic secondary visceral pain, and chronic secondary musculoskeletal pain. Additional characteristics of chronic pain, including the intensity of pain, the severity of suffering, and physical dysfunction, are also given. CONCLUSION: The presented modern terminology and classification of chronic pain will contribute not only to the correct formulation of diagnosis established in a patient with chronic pain but also to the implementation of multimodal analgesia, epidemiological studies and, ultimately, the choice of proper strategy for addressing chronic pain by healthcare organizers. The result is also expected to lead to adequate funding for resolving this intricate problem.

According to 2019 data, the incidence of cancer in Russia increases by 1.5% annually, 8.5 million people die from malignant neoplasms. Pain is the most common symptom when diagnosed with a malignant neoplasm. In the final stage of the disease, about 66% of patients experience pain, and in most cases the intensity of pain syndrome is regarded as moderate to severe pain. In the international classification of diseases 11 revisions (μb-11), the diagnosis of chronic pain is supposed to be reflected in a separate section. The aim of the review was to present a modern classification of chronic pain associated with malignancy. The search for publications has been carried out by two independent researchers since 01.2010. until 12.2020. in the databases PubMed, MEDLINE, EMBASE, Cochrane, as well as the International Association for the Study of Pain. The International Association for the Study of Pain has established a special group, which, in close collaboration with WHO representatives, has developed a new classification of chronic pain. Chronic pain caused by malignancy: chronic visceral pain caused by malignancy; chronic bone pain caused by malignancy; chronic neuropathic pain caused by malignancy; other chronic pain caused by malignancy. Chronic pain due to treatment of malignant neoplasm: chronic pain caused by drug treatment of malignant neoplasm Chronic polyneuropathy due to chemotherapy; chronic pain caused by radiation therapy of malignant neoplasm; chronic neuropathy due to radiation therapy; Chronic pain caused by surgical treatment of malignant neoplasm. Other chronic pain caused by treatment of malignant neoplasm. Thus, the inclusion in the MKB-11 of a separate classification of chronic pain associated with malignancy will lead to the correct formulation of the diagnosis, which will contribute to individualized treatment (antitumor therapy, surgery), psychological support, the involvement of algologists (intervention methods of therapy), intensified research on the prevention and treatment of pain syndromes, as well as standardization of chronic assessment of pain.

Background There are scanty data of right ventricular dysfunction markers after major pulmonary resection.Objective To study the changes of plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and its association with pulmonary artery pressure (PAP) as markers of right ventricular dysfunction in patients who underwent bronchoplastic lobectomy or pneumonectomy.Material and Methods The study population consisted of 36 patients aged 40–65 who underwent major  pulmonary resection for lung cancer in 2016–2018. Patients were stratified into two groups according to the type of surgical procedure: bronchoplastic lobectomy, the main group (n = 19), and pneumonectomy, control group (n = 17). They were then analyzed for plasma NT-proBNP concentration, operative time, blood loss, intraoperative fluid administration, intraoperative urine output, and mean PAP level before and after an operation.Results The mean PAP level correlated positively with the plasma NT-proBNP concentration in the pneumonectomy group (Pearson r = 0.916754; p < 0.001). This correlation was no evident in the subset of patients undergoing bronchoplastic lobectomy at the same determination point (Pearson r = 0.234741; p = 0.330).Conclusion The mean PAP increased significantly after pneumonectomy and is closely correlated with plasma  NTproBNP concentration. These findings support the conclusion that bronchoplasty is preferable over pneumonectomy for lung cancer patients.