spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.38181/2223-2427-2021-4-44-52spractice-266Research ArticleСтатьиПРЕДОПЕРАЦИОННОЕ ПРИМЕНЕНИЯ МИКРОНИЗИРОВАННОЙ ФРАКЦИИ ФЛАВОНОИДОВ (ММФ) В СОСТАВЕ СХЕМЫ МУЛЬТИМОДАЛЬНОГО ОБЕЗБОЛИВАНИЯ В ХИРУРГИИ АНОРЕКТАЛЬНОЙ ОБЛАСТИ: ПРОТОКОЛ ПРОСПЕКТИВНОГО, РАНДОМИЗИРОВАННОГО, ПЛАЦЕБО-КОНТРОЛИРУЕМОГО, ДВОЙНОГО-СЛЕПОГО ИССЛЕДОВАНИЯPREOPERATIVE USE OF MICRO-FLAVONOID FRACTION (MMF) AS PART OF A MULTIMODAL ANALGESIA IN ANORECTAL SURGERY: PROSPECTIVE, RANDOMIZED, PLACEBO-CONTROLLED, DOUBLE-BLIND STUDY PROTOCOLhttps://orcid.org/0000-0003-2330-4229ГармановаТ. Н.GarmanovaT. N.

Гарманова Татьяна Николаевна – к.м.н., доцент кафедры хирургии

ул. Ленинские Горы, д. 1, 119991, Москва

Tatiana N. Garmanova – PhD, docent of the Department of Surgery

Leninskie Gory St., 1, 119991, Moscow

tatianagarmanova@gmail.comhttps://orcid.org/0000-0003-2711-2400МаркарьянД. Р.MarkaryanD. R.

Маркарьян Даниил Рафаэлевич – к.м.н., доцент кафедры хирургии

ул. Ленинские Горы, д. 1, 119991, Москва

Daniil R. Markaryan – PhD, docent of the Department of Surgery

Leninskie Gory St., 1, 119991, Moscow

dmarkaryan@gmail.comhttps://orcid.org/0000-0001-6322-7016КазаченкоЕ. А.KazachenkoE. A.

Казаченко Екатерина Александровна – клинический ординатор отделения хирургии №1 медицинского научно-образовательного центра

ул. Ленинские Горы, д. 1, 119991, Москва

Ekaterina A. Kazachenko – Resident of the Department of Surgery №1 of the Medical Research Educational Center

Leninskie Gory St., 1, 119991, Moscow

ekaterina.k.97@mail.ruhttps://orcid.org/0000-0002-2768-4305ЛукьяновА. М.LukianovА. M.

Лукьянов Александр Максимович – клинический ординатор отделения хирургии №1 медицинского научно-образовательного центра

ул. Ленинские Горы, д. 1, 119991, Москва

Alexandr M. Lukianov – Resident of the Department of Surgery №1 of the Medical Research Educational Center

Leninskie Gory St., 1, 119991, Moscow

alexmaxl@mail.ruhttps://orcid.org/0000-0002-6569-7078АгаповМ. А.AgapovM. A.

Агапов Михаил Андреевич – доктор мед. наук, профессор, профессор кафедры хирургии

ул. Ленинские Горы, д. 1, 119991, Москва

Mikhail A. Agapov – PhD, Professor of the Department of Surgery

Leninskie Gory St., 1, 119991, Moscow

getinfo911@mail.ruМосковский государственный университет имени М.В. Ломоносова, факультет фундаментальной медицины (МГУ имени М.В. Ломоносова)РоссияFederal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)Russian Federation202117122021044452Copyright © Гарманова Т.Н., Маркарьян Д.Р., Казаченко Е.А., Лукьянов А.М., Агапов М.А., 20212021Гарманова Т.Н., Маркарьян Д.Р., Казаченко Е.А., Лукьянов А.М., Агапов М.А.Garmanova T.N., Markaryan D.R., Kazachenko E.A., Lukianov А.M., Agapov M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.spractice.ru/jour/article/view/266

Цель: оценить эффективность предоперационного применения МФФ на выраженность болевого синдрома в послеоперационном периоде у пациентов после выполнения оперативных вмешательств на аноректальной области.Материалы и методы: В исследование включаются пациенты с геморроидальной болезнью 2-4 степени, которым планируется хирургическое лечение заболеваний аноректальной области с нарушением целостности слизистой анального канала и/или мышечного каркаса анального канала. Все участники случайным образом делятся на 2 группы: первая получает 1000 мг МФФ (Детралекс ®) per os, начиная за 15 дней до операции (по 72 участника в каждой группе); в течение 3 дней после операции по схеме для лечения острого геморроя и далее в течение 45 дней после операции по 1000 мг в сутки, вторая группа – плацебо. Всем пациентам проводится хирургическое вмешательство, метод обезболивания – спинномозговая анестезия. Затем будет оценена первичная конечная точка: частота назначения наркотических обезболивающих и вторичные конечные точки: выраженность послеоперационного болевого синдрома, количество и длительность приема других лекарственных препаратов, частота повторных госпитализаций, качество жизни, время от операции до возвращения к профессиональной деятельности, частота послеоперационных осложнений, уровень С-реактивного белка.Обсуждение: применение МФФ позволяет добиться уменьшения выраженности клинических проявлений геморроидальной болезни на фоне консервативного лечения. Кроме того, доказана эффективность применения препарата Детралекс® для уменьшения болевого синдрома после проведения оперативного лечения варикозной болезни нижних конечностей. Мы планируем оценить целесообразность применения препаратов группы МФФ в дооперационном периоде у пациентов при проведении хирургического лечения заболеваний аноректальной области с целью уменьшения болевого синдрома и снижения риска послеоперационных осложнений.

Aim: To assess the efficiency of the micro-flavonoid fraction (MMF) administration prior to anorectal surgery with spinal anesthesia on postoperative pain severity reduction.Methods: Patients of our clinic who meet the following inclusion criteria are included: they must be diagnosed with surgical treatment of anorectal diseases. All participants are randomly divided into 2 groups: the first one gets a tablet with 1000 mg MFF (Detralex®), the second one gets a tablet containing starch per os 14 days before surgery (72 participants per arm). Then patients of each group will continue MFF administration for 30 days after surgery. Patients of both arms receive spinal anesthesia and undergo surgery. Following the procedure the primary and secondary outcomes are evaluated: frequency of the opioid drugs intake, the severity of the postoperative pain syndrome, duration and frequency of other drugs intake, readmission rate, overall quality of life, time from the procedure to returning to work and the complications rate, C-reactive protein level.Discussion: the MFF intake allows reducing the severity of the hemorrhoidal disease symptoms during conservative treatment. In addition, the Detralex® efficacy has been proven in postoperative pain reduction for patients diagnosed with varicose veins of the lower extremities. We intend to evaluate the feasibility of the preoperative MFF administration for the postoperative pain reduction and the decrease of the postoperative complications in patients with hemorrhoidal disease.

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The authors declare that there are no conflicts of interest present.