Медицинский радиологический научный центр им. А. Ф. Цыба -филиал ФГБУ «НМИЦ радиологии» МЗ РФ, г. Обнинск, Россия Цель: оценка эффективности спинальной анальгезии в комплексе анестезиологического пособия при лапароскопических операциях на толстой кишке в условиях программы ускоренного восстановления� Материал и методы: 60 пациентов, оперируемых на толстой кишке лапароскопическим доступом в рамках программы ускоренного вос-становления, разделены на две группы� В 1-й группе (n = 30) периоперационную анальгезию обеспечивали субарахноидальным введением 10,0−12,5 мг бупивакаина и 200 мкг морфина� Во 2-й группе (n = 30) проводили системную мультимодальную анальгезию (нестероидные противовоспалительные средства, опиоиды)� Результаты. Максимальная интенсивность боли в покое в 1-е сут после операции была 2 (2−3) балла по цифровой рейтинговой шкале в 1-й группе и 5 (4−6) баллов во 2-й группе (p < 0,0001)� Интенсивность боли при первой вертикализации составляла 3 (2−5) балла в 1-й группе и 6 (6−7) баллов во 2-й (p < 0,0001)� Интраоперационное потребление фентанила, частота послеоперационной тошноты, рвоты и потребность в дополнительном обезболивании были значительно ниже в 1-й группе� The objective: to assess the efficiency of spinal analgesia as a part of anaesthesiologic support in laparoscopic colon surgeries within fast track programs� Subjects and methods: 60 patients who had laparoscopic colon surgeries within fast track programs were divided into 2 groups� In Group 1 (n = 30), peri-operative analgesia was provided through intrathecal administration of 10�0-12�5 mg of bupivacaine and 200 mcg of morphine� In Group 2 (n = 30), the systemic multi-modal analgesia was provided (nonsteroidal anti-inflammatory drugs, opioids)� Results. The maximum intensity of pain at rest within 24 hours after surgery was assessed as 2 (2−3) scores as per the digital rating scale in Group 1 and 5 (4−6) scores in Group 2 (p < 0�0001)� The intensity of pain by the first verticalisation made 3 (2−5) scores in Group 1 and 6 (6−7) scores in Group 2 (p < 0�0001)� Intra-operative consumption of phentanyl, frequency of post-operative nausea, vomit and need for extra pain relief were much lower in Group 1� Conclusion

The objective. To assess the effect of spinal analgesia on the oxygen status and the level of myocardial damage markers in patients with colorectal cancer operated by laparoscopic access. Subjects and methods. 60 patients with colorectal cancer operated under general anesthesia with laparoscopic access were divided into two groups. In group 1 (n=30) intraoperative analgesia was performed with fentanyl. In Group 2 (n=30) before the induction of general anesthesia was performed an intrathecal administration of 10.0-12.5 mg of bupivacaine and 200 mcg of morphine. In case of decreasing an MAP 65 mm Hg.V. a continue infusion of noradrenaline was began. The frequency of administration and the average dose of noradrenalin were estimated, as well as the levels of lactate, pH, BE, ScvO2, highly specific cardiac troponin I (hs-cTnI ) and NT-proBNP in the central venous blood. Results. The frequency of noradrenalin administration in group 2 was significantly higher compared to group 1 56.7% versus 26.7% (HR=2.1; 95% CI 0.86-4.16; p=0.036). Noradrenalin dose, the levels of lactate, pH, BE, ScvO2, hs-cTnI and NT-proBNP levels did not differ significantly in both groups at all stages of research. Conclusion. Spinal analgesia increases the frequency of noradrenalin administration but does not affect the oxygen status and the level of myocardial damage markers in patients with colorectal cancer operated by laparoscopic access.

The aim: To assess the effect of COMT G1947A genetic polymorphism (val158met) on the efficacy of spinal analgesia on day 1 after laparoscopic surgery for colorectal cancer.Material and methods. In a pilot study involving 100 patients with colorectal cancer, operated through laparoscopic access, using spinal analgesia (10.0–12.5 mg of bupivacaine + 200 mcg of morphine), the frequency of COMT gene G1947A (val158met) polymorphism, the intensity of pain on day 1 after surgery, the frequency and severity of nausea, vomiting, skin itching, the need for additional analgesia have been assessed.Results. The frequency distribution of alleles val/val (25%), val/met (45%) and met/met (30%) was consisted with Hardy-Weinberg equilibrium (χ2=0.96; P>0.05) and was not significantly different from the healthy donor group. In the groups of patients with various COMT alleles of val158met polymorphism, the studied parameters also did not differ significantly.Conclusion. Study did not find significant link between spinal analgesia efficacy on day 1 after laparoscopic surgery for colorectal cancer and COMT rs4680 G1947A (val158met) polymorphism. Further research to enhance the power of the study is warranted to reach the final conclusions.