spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.38181/2223-2427-2022-4-5-14spractice-359Research ArticleСтатьиПРЕДОПЕРАЦИОННОЕ ОБЕЗБОЛИВАНИЕ В АНОРЕКТАЛЬНОЙ ХИРУРГИИ: РЕЗУЛЬТАТЫ ПРОСПЕКТИВНОГО, РАНДОМИЗИРОВАННОГО, ДВОЙНОГО СЛЕПОГО, ПЛАЦЕБО-КОНТРОЛИРУЕМОГО ИССЛЕДОВАНИЯPREEMPTIVE ANALGESIA IN ANORECTAL SURGERY: RESULTS OF THE PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALhttps://orcid.org/0000-0003-2330-4229ГармановаТ. Н.GarmanovaT. N.

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

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

Tatyana 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 факультета фундаментальной медицины

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.comКазаченкоЕ. А.KazachenkoE. A.

Казаченко Екатерина Александровна – врач-ординаторII года по специальности общая хирургия, факультет фундаментальной медицины

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

Тел.: 89269721922

II year resident of the Department of Surgery

Leninskie Gory St., 1, 119991, Moscow

Phone: 8-926-972-19-22

https://orcid.org/0000-0002-2768-4305ЛукьяновА. М.LukianovA. M.

Лукьянов Александр Максимович – врач-ординатор II года по специальности общая хирургия, факультет фундаментальной медицины

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

II year resident of the Department of Surgery

Leninskie Gory St., 1, 119991, Moscow

alexmaxl@mail.ruhttps://orcid.org/0000-0002-7055-9008КривоносоваД. А.KrivonosovaD. A.

Кривоносова Дарья Александровна – врач-ординатор I года, факультет фундаментальной медицины

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

I year resident of the Faculty of Medicine

Leninskie Gory St., 1, 119991, Moscow

dachette-2010@mail.ruhttps://orcid.org/0000-0002-6569-7078АгаповМ. А.AgapovM. A.

Агапов Михаил Андреевич – д.м.н., профессор кафедры хирургии, факультет фундаментальной медицины; руководитель научно-образовательного кластера

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

ул. А. Невского, 14, 236041, Калининград

PhD, Professor of the Department of Surgery

Leninskie Gory St., 1, 119991, Moscow

Head of the Scientific and Educational Cluster MEDBIO

236041, A. Nevskogo St., 14, Kaliningrad

getinfo911@mail.ruМосковский государственный университет имени М.В. Ломоносова (МГУ имени М.В. Ломоносова)РоссияLomonosov Moscow State UniversityRussian FederationМосковский государственный университет имени М.В. Ломоносова (МГУ имени М.В. Ломоносова); Федеральное государственное автономное образовательное учреждение высшего образования «Балтийский федеральный университет имени Иммануила Канта»РоссияLomonosov Moscow State University; Immanuel Kant Baltic Federal UniversityRussian Federation20220812202204514Copyright © Гарманова Т.Н., Маркарьян Д.Р., Казаченко Е.А., Лукьянов А.М., Кривоносова Д.А., Агапов М.А., 20222022Гарманова Т.Н., Маркарьян Д.Р., Казаченко Е.А., Лукьянов А.М., Кривоносова Д.А., Агапов М.А.Garmanova T.N., Markaryan D.R., Kazachenko E.A., Lukianov A.M., Krivonosova D.A., 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/359

Цель: Оценить эффективность предоперационной анальгезии кетопрофеном в дозе 100 мг, применяемого перорально за 2 часа до оперативного вмешательства в аноректальной хирургии, в отношении выраженности послеоперационного болевого синдрома.Методы: Проспективное, рандомизированное, двойное слепое, одноцентровое исследование, проведенное на базе хирургического отделения МНОЦ МГУ им. Ломоносова. В исследование включались пациенты c аноректальными заболеваниями ≥18 лет с анестезиологическим риском по ASA I-II, которым планировалось хирургическое лечение в период 09.2020 – 09.2021г. После получения письменного согласия пациенты были рандомизированы в основную (прием 100мг кетопрофена за 2 часа до операции) и в группу плацебо. Главной конечной точкой являлась оценка количества назначенных опиоидных анальгетиков в течение недели после операции. Вторичные конечные точки: выраженность боли в покое и при дефекации, длительность и частота приема анальгетиков, частота повторных госпитализаций, качество жизни, время от операции до возвращения на работу и частота осложнений. Результаты: В исследование включено 134 участника: в основной группе – 68, в контрольной – 66. Послеоперационный болевой синдром был статистически значимо меньше в основной группе на 4, 5, 6 и 7 дни послеоперационного периода (р=0,035; р=0,023; р=0,046 соответственно). Прием опиоидов после операции также был несколько ниже у пациентов основной группы (р=0,174). Показатели частоты побочных эффектов, качество жизни, времени от операции до возвращения к прежнему образу жизни не различались между группами.Заключение: Предоперационная анальгезия является безопасной и эффективной в отношении снижения выраженности послеоперационного болевого синдрома в аноректальной хирургии, позволяет снизить количество пациентов, требующих обезболивание опиоидами, не увеличивает частоту побочных эффектов, связанных с приемом лекарственных препаратов. Предоперационное обезболивание должно быть частью рутинного ведения пациентов в аноректальной хирургии в рамках мультимодальной анальгезии

Aim: To assess the efficiency of preemptive analgesia with Ketoprofen 100 mg 2 hours before procedure per os to decrease postoperative pain. Methods: This prospective, randomized, double-blind study was conducted in the surgical department of the Lomonosov MSU Medical Center. Patients who were diagnosed with anorectal disease without contraindication to perform subarachnoid anesthesia or other somatic diseases and underwent anorectal procedure were included. After signing the consent all participants were randomly divided: the first group got a 100 mg Ketoprofen tablet, the second one got a starch tablet 2 hours before surgery. Following the procedure the primary and secondary outcomes were evaluated: opioid administration intake, the pain at rest and during defecation, duration and frequency of other analgesics intake, readmission rate, life quality, time to return to previous lifestyle, the complications rate. Results: 134 participants were included in the study: 68 in the main group, 66 in the control one. Postoperative pain syndrome was statistically less in the main group on the 4,5,7 days (p=0,035; p=0,023; p=0,046, respectively). Opioid intake after surgery was significantly lower in the main group (p=0.174). The side effects frequency, live quality, time to return to previous lifestyle also didn’t differ in both groups. Conclusion: Preoperative analgesia is safe and effective in reducing postoperative pain in anorectal surgery, reduces the opioid usе, doesn’t increase the ketoprophen side effects frequency. It should be a part of the routine patients’ multimodal management in anorectal surgery.

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