Domestic literature sources characterized with a deficiency of data regarding changes specifics in early postoperative recovery period among patients who underwent colon cancer surgery with anesthetic support during the intra- and postoperative stages based on the most common anesthetic algorithms. Such problem exists even though this aspect is a mandatory component of treatment success evaluation in the early observation period. The objective of the study was to improve a comprehensive approach for anesthetic support of patients with colon cancer in the early postoperative period while using the principles of preemptive and preventive analgesia. According to the tested prognostic model, which was characterized by a sufficient level of goodness of fit, it was found that the overall pattern of pain impact on changes within relevant clinical parameters among different age groups and among patients of different sexes in the early postoperative period was statistically similar and characterized by the following trend: increase of NRS scores provoked more pronounced statistically justified deviations in the structure of SBP, DBP and heart rate parameters compare to the norm, and was also associated with longer hospital stay and higher risk of complications development in the form of nausea and vomiting. Therefore, following scheme of anesthetic support, which was based on the implementation of preemptive and preventive principles and elimination of opioid usage, was proposed to increase the effectiveness of postoperative pain control and optimize the components of a comprehensive patient’s condition assessment in the early postoperative period:
- pre-emptive analgesia (before surgical intervention): pregabalin 150 mg per os 12 hours before operation; acetaminophen 1000 mg intravenously (IV) before cutting the skin layer; MgSO4 25% 2500 mg intravenously before cutting the skin layer; dexamethasone 8 mg intravenously before cutting the skin layer; dexketoprofen 50 mg intravenously before cutting the skin layer;
- epidural anesthesia at the level of Th XI-XII by standard method. Epidural infusion consisted of 4 ml 0,25% longocain solution used as a control test-dose, and of 0.125% longocain solution in combination with phentanil 2 mkg/ml on infusomat accounted for 5.5-9.5 ml/hour. Induction component consisted of 1% dyprophol solution IV with 2,0 – 2,5 mg on 1 kg of body mass, and atracurium 0,5-0,6 mg/kg 90 seconds after tracheal intubation. Anesthesia support was provided by 1% dyprophol solution on infusomat with 4-10 mkg/kg/hour. Miorelaxation effect was provided by atracurium use in dose of 0.1 – 0.2 mg/kg.
- preventive analgesia (after completion of operation): nefopam 20 mg/ml with 2.0 ml intramuscularly every 8 hours during first day after operation; acetaminophen 1000 mg IV every 8 hours during first 3 days after operation; dexketoprofen 50 mg IV every 8 hours during first 3 days after operation.
The condition of patients in the early postoperative period, who underwent colon cancer surgery, while implementing various schemes of anesthetic support, was evaluated among three groups to assess clinical effectiveness of proposed non-opioid anesthetic approach:
- I (study group) – non-opioid anesthetic support with the implementation of preemptive and preventive anesthetic measures, consisted of 77 patients aged 57-69 years;
- ІІ (control group) – anesthetic support was provided due to the classical protocols with the use of opioids, consisted of 58 patients aged 54-69 years;
- III (comparison group) – anesthetic support was provided due to the modified scheme with the use of epidural anesthesia, consisted of 54 patients aged 52-71 years.
The feasibility of implementing a non-opioid approach of anesthetic support for patients with a need of colon cancer surgery at the intra- and postoperative periods was substantiated for the first time, and its clinical effectiveness was proved based on the results of comprehensive assessment of SBP, DBP parameters, the frequency of nausea and vomiting development, as well as the duration of in-hospital stay. Additionally, the predictive approach of changes within the postoperative patients’ condition after colon cancer surgery and prognostic evaluation of support specifics considering in-hospital stay with a pronounced need for pain relief was proposed based on the registered parameters of the duration of surgery and registered postoperative pain intensity during the first days after surgery, while also taking into account the use of different approaches for anesthetic support.
