Журнал «Медицина неотложных состояний» 1 (64) 2015

Purpose — to develop a drug preparation of patients before spinal anaesthesia in abdominal surgery.

Materials and methods

Studied 20 volunteers (group C) and 40 patients who were randomization divided into two groups of 20 people each. Group P consisted of patients who performed the operation after premedication. Physical parameters of patients group P: age — 50,6 ± 2,7 years, weight– 83,3 ± 2,9 kg, index of weight– 29,8 ± 1,2 kg/m², physical status — I-IIASA. Group NPconsisted of patients who performed surgery without premedication. Physical parameters of patientsgroupNP: age — 52,8 ± 3,0 years, weight– 81,0 ± 3,5 kg, index of weight– 29,5 ± 1,2 kg/m², physical status — I-II ASA. The control group C– volunteers — members of the hospital. Physical parameters volunteer group K: age — 42,1 ± 2,2 years, weight– 80,2 ± 4,0 kg, index of weight– 28,2 ± 1,2 kg/m², physical status — I-II ASA.

Evaluation of the degree of anxiety and depression volunteers and patients, and therefore, the quality of premedication was performed using a modified questionnaire Zung. Severity of postoperative pain was determined by the numerical pain rating scale from 0 to 10 points after 3, 10, 24 and 48 h after surgery.

The technique was followed by premedication. Melatonin was administered orally at a dose of 6 mg at bedtime and 1 h before surgery and at bedtime on the first postoperative day. 1 g of paracetamol patients were treated orally for 2 h before the intervention and every 8 h for 2 days. Deksketoprofenintravenously administered 50 mg 20 minutes before surgery and every 8 h for 2 days. Nefopam administered intramuscularly at a dose of 20 mg for 40 minutes before surgery. Dexamethasone was administered at a dose of 8 mg intravenously30 minutes before surgery. Ondansetron was administered intravenously at a dose of 8 mg per 5 minutes before surgery.

In the group NP analgesia in the postoperative period was performed similarly to group P. All operations performed routinely. The method of anaesthesia — spinal anaesthesia hyperbaric bupivacaine a dose of 15-20 mg and buprenorphinea dose of 0,12 mg.

Results and discussion

After summing the scores for the questionnaire Zung group P showed result 5,4 ± 0,6 points and 4 (20%) patients complained of insomnia. In the group NP received — 13,4 ± 0,6 points, and 13 (65%) patients reported sleep disturbances. Analysis groupCshowed indicator — 4,7 ± 0,5 points and 2 (10%) volunteers complained of insomnia. Value of the results shows that the degree of anxiety or depressive anxiety in patients, which the planned abdominal surgery without premedication was 2,9 times (p = 0,0001) higher than in volunteers. When comparing the scores of group P with C coefficients was 1,1 (p = 0,232). Based on these data we can conclude about the need for pharmacological correction of emotional status of patients, which is planned surgery. Will be conducted not only appropriate premedication and treatment of sleep disorders and before the operation.

Analysis of hemodynamic highlighted that the group NP was significantly (p = 0,0001), systolic blood pressure was 12.5% higher than in group C. Diastolic blood pressure, averageblood pressure and heart rate were significantly higher in unreliable group NP respectively by 2,6% (p = 0,601), 6,9% (p = 0,066) and 7,2% (p = 0,139). Statistically significant (p = 0,0001), respiratory rate at 21,7% was higher in patients without premedication than volunteers. SpO₂ not significant (p = 0,05) of 1,2% was the best volunteers than in patients of group NP. Analysis of hemodynamic highlighted that the group P were not significant higher systolic blood pressure by 3,1% (p = 0,270) and diastolic blood pressure by 2,9% (p = 0,466) and average blood pressure by 3% (p = 0,365) than in group C. The heart rate was not significant lower in group P by 2,2% (p = 0,537) than in volunteers. Statistically insignificant (p = 0,552) respiratory rate was 3,3% higher in patients with premedication than volunteers. SpO₂ not significant (p = 0,615) at 0,2% was the best volunteers than in patients of group P.

The quality of postoperative analgesic profile in groups P and NP is characterized positively. Need prescribing opioid analgesics additional arose. Although spinal anaesthesia hyperbaric bupivacaine of buprenorphine effective adjuvant analgesia patients during surgery and in the postoperative period, better analgesic profile has been observed in patients of group P. So, after 3 h after surgery in group P level of pain on a scale of pain was 0,10 ± 0,07 points, and the group NP– 0,30 ± 0,11 points (p = 0,120). After 10 h the investigated parameters was significantly (p = 0,0001) was 4,25 times better in group P than in group NP. After 24 h the corresponding period was significantly (p = 0,002) more quality analgesia (in 1,74 times) was in group P patients than in patients of group NP. At 48 h after the operation efficiency of anaesthesia was significantly (p = 0,0001) in 1,70 times and was better in group P than in group NP.

Postoperative nausea and vomiting was observed in 12 patients of group NP (60%). In group P complications were similar in the 2 patients (10%).

Conclusions

1.    The use of melatonin before surgery and nefopam possible to effectively correct psycho-emotional status and sleep disorders in patients.

2.    Deksketoprofen, paracetamol, nefopamom and dexamethasone improved analgesic profile of patients in the postoperative period.

3.    The combination of dexamethasone with ondansetron effectively warned syndrome occurrence of postoperative nausea and vomiting.