Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration
Introduction. Thoracic epidural analgesia or thoracic epidural anaesthesia (TEA) and opioid-based intravenous multimodal analgesia (MMA) provide adequate control of perioperative pain, however, comparative data are still to be gathered. Aim. To compare both anesthesia techniques in terms of stress r...
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Bashkir State Medical University
2024-07-01
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| Series: | Креативная хирургия и онкология |
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| Online Access: | https://www.surgonco.ru/jour/article/view/946 |
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| author | A. D. Lifanova A. A. Grazhdankin I. I. Lutfarakhmanov |
| author_facet | A. D. Lifanova A. A. Grazhdankin I. I. Lutfarakhmanov |
| author_sort | A. D. Lifanova |
| collection | DOAJ |
| description | Introduction. Thoracic epidural analgesia or thoracic epidural anaesthesia (TEA) and opioid-based intravenous multimodal analgesia (MMA) provide adequate control of perioperative pain, however, comparative data are still to be gathered. Aim. To compare both anesthesia techniques in terms of stress response during and after robotic-assisted pelvic exenteration (PE). Materials and methods. 112 patients were divided into 2 equal groups A level of serum cortisol was measured at induction of anesthesia and in 2, 24, and 48 hours. The efficacy of analgesia was compared using a 10-point numeric pain scale. Analgesic administration and side effects were reported for 1–3 postoperative days. Results. Cortisol levels increased 2 hours after skin incision in the MMA group and only in 24 hours in the TEA group (p < 0.050). Postoperative cortisol levels were significantly lower in the TEA group (p = 0.001). Numeric pain scores were significantly lower in the TEA group (1.7 [1.0–3.2] vs. 2.7 [2.1–4.2]; 1.9 [1.0–3.3] vs. 3.5 [3.5–5.0]; 3.7 [3.0–4.8] vs. 4.2 [3.7–4.7], respectively; p < 0.050). Patients in the TEA group received less opioid administration (4.3 mg vs. 13.9 mg; 7.0 mg vs. 19.9 mg; 10.9 mg vs. 16.5 mg, respectively; p < 0.050). The two groups of patients were detected with no significant difference in the incidence of respiratory depression. Discussion. According to the study results, perioperative stress response was reduced with TEA being added to the anesthesia protocol. Patients in the TEA group received lower doses of analgesics. Both groups produced similar short-term postoperative outcomes. Conclusion. As compared to opioid-based MMA, TEA provided more effective analgesia and similar side effect profiles. Therefore, TEA appears to be an acceptable method for stress response suppression and pain management in patients undergoing robotic-assisted PE. |
| format | Article |
| id | doaj-art-284a85967bca4d44867a469d92dcd73d |
| institution | DOAJ |
| issn | 2076-3093 2307-0501 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Bashkir State Medical University |
| record_format | Article |
| series | Креативная хирургия и онкология |
| spelling | doaj-art-284a85967bca4d44867a469d92dcd73d2025-08-20T03:19:21ZengBashkir State Medical UniversityКреативная хирургия и онкология2076-30932307-05012024-07-0114210511510.24060/2076-3093-2024-14-2-105-115569Stress Response and Analgesia During and after Robotic-Assisted Pelvic ExenterationA. D. Lifanova0A. A. Grazhdankin1I. I. Lutfarakhmanov2Bashkir State Medical UniversityBashkir State Medical UniversityBashkir State Medical UniversityIntroduction. Thoracic epidural analgesia or thoracic epidural anaesthesia (TEA) and opioid-based intravenous multimodal analgesia (MMA) provide adequate control of perioperative pain, however, comparative data are still to be gathered. Aim. To compare both anesthesia techniques in terms of stress response during and after robotic-assisted pelvic exenteration (PE). Materials and methods. 112 patients were divided into 2 equal groups A level of serum cortisol was measured at induction of anesthesia and in 2, 24, and 48 hours. The efficacy of analgesia was compared using a 10-point numeric pain scale. Analgesic administration and side effects were reported for 1–3 postoperative days. Results. Cortisol levels increased 2 hours after skin incision in the MMA group and only in 24 hours in the TEA group (p < 0.050). Postoperative cortisol levels were significantly lower in the TEA group (p = 0.001). Numeric pain scores were significantly lower in the TEA group (1.7 [1.0–3.2] vs. 2.7 [2.1–4.2]; 1.9 [1.0–3.3] vs. 3.5 [3.5–5.0]; 3.7 [3.0–4.8] vs. 4.2 [3.7–4.7], respectively; p < 0.050). Patients in the TEA group received less opioid administration (4.3 mg vs. 13.9 mg; 7.0 mg vs. 19.9 mg; 10.9 mg vs. 16.5 mg, respectively; p < 0.050). The two groups of patients were detected with no significant difference in the incidence of respiratory depression. Discussion. According to the study results, perioperative stress response was reduced with TEA being added to the anesthesia protocol. Patients in the TEA group received lower doses of analgesics. Both groups produced similar short-term postoperative outcomes. Conclusion. As compared to opioid-based MMA, TEA provided more effective analgesia and similar side effect profiles. Therefore, TEA appears to be an acceptable method for stress response suppression and pain management in patients undergoing robotic-assisted PE.https://www.surgonco.ru/jour/article/view/946pelvic exenterationrobot-assisted surgerystress responsecortisolthoracic epidural analgesiathoracic epidural anesthesiaperioperative periodmultimodal analgesia |
| spellingShingle | A. D. Lifanova A. A. Grazhdankin I. I. Lutfarakhmanov Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration Креативная хирургия и онкология pelvic exenteration robot-assisted surgery stress response cortisol thoracic epidural analgesia thoracic epidural anesthesia perioperative period multimodal analgesia |
| title | Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration |
| title_full | Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration |
| title_fullStr | Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration |
| title_full_unstemmed | Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration |
| title_short | Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration |
| title_sort | stress response and analgesia during and after robotic assisted pelvic exenteration |
| topic | pelvic exenteration robot-assisted surgery stress response cortisol thoracic epidural analgesia thoracic epidural anesthesia perioperative period multimodal analgesia |
| url | https://www.surgonco.ru/jour/article/view/946 |
| work_keys_str_mv | AT adlifanova stressresponseandanalgesiaduringandafterroboticassistedpelvicexenteration AT aagrazhdankin stressresponseandanalgesiaduringandafterroboticassistedpelvicexenteration AT iilutfarakhmanov stressresponseandanalgesiaduringandafterroboticassistedpelvicexenteration |