spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.38181/2223-2427-2023-2-2spractice-399Research ArticleХИРУРГИЯSURGERYРезультаты предоперационного применения микронизированной очищенной флавоноидной фракции в составе схемы мультимодального обезболивания в хирургии аноректальной области: проспективное, рандомизированное, плацебо-контролируемое, двойное слепое исследованиеResults of preoperative application of micronised purified flavonoid fraction as part of a multimodal analgesic regimen in anorectal surgery: a prospective, randomised, placebo-controlled, double-blind studyhttps://orcid.org/0000-0003-2330-4229ГармановаТ. Н.GarmanovaT. N.

Татьяна Николаевна Гарманова, кандидат медицинских наук, доцент кафедры хирургии

119991, Москва, ул. Ленинские Горы, 1

Dr. Tatiana N. Garmanova, Associate professor, Department of Surgery

1 Leninskie Gory, Moscow, 119991

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

Даниил Рафаэлевич Маркарьян, кандидат медицинских наук, заведующий отделением абдоминальной и торакальной онкологии

119991, Москва, ул. Ленинские Горы, 1

Daniil R. Markaryan, Head of the Department of Abdominal and Thoracal Oncology, Medical Research Educational Centre

1 Leninskie Gory, Moscow, 119991

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

Екатерина Александровна Казаченко, клинический ординатор

119991, Москва, ул. Ленинские Горы, 1

Ekaterina A. Kazachenko, Resident Physician

1 Leninskie Gory, Moscow, 119991

ekaterina.k.97@mail.ruhttps://orcid.org/0000-0003-3541-5663ИщенкоР. В.IshchenkoR. V.

Роман Викторович Ищенко, доктор медицинских наук, заведующий кафедрой хирургии

119991, Москва, ул. Ленинские Горы, 1

Roman V. Ishchenko, Head of the Department of Surgery

1 Leninskie Gory, Moscow, 119991

ishenkorv@rambler.ruhttps://orcid.org/0000-0002-2768-4305ЛукьяновА. М.LukyanovA. M.

Александр Максимович Лукьянов, клинический ординатор

119991, Москва, ул. Ленинские Горы, 1

Alexander M. Lukyanov, Resident Physician

1 Leninskie Gory, Moscow, 119991

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

Дарья Александровна Кривоносова, клинический ординатор

119991, Москва, ул. Ленинские Горы, 1

Daria A. Krivonosova, Resident Physician

1 Leninskie Gory, Moscow, 119991

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

Михаил Андреевич Агапов, доктор медицинских наук, руководитель образовательно-научного кластера «Медбио»

236041, Калининград, ул. А. Невского, 14

Mikhail A. Agapov, Head of the MEDBIO Research and Educational Cluster

14 A. Nevskogo St, Kaliningrad, 236041

getinfo911@mail.ruМосковский государственный университет имени М. В. ЛомоносоваРоссияLomonosov Moscow State UniversityRussian FederationБалтийский федеральный университет имени Иммануила КантаРоссияImmanuel Kant Baltic Federal UniversityRussian Federation202302082023021935Copyright © Гарманова Т.Н., Маркарьян Д.Р., Казаченко Е.А., Ищенко Р.В., Лукьянов А.М., Кривоносова Д.А., Агапов М.А., 20232023Гарманова Т.Н., Маркарьян Д.Р., Казаченко Е.А., Ищенко Р.В., Лукьянов А.М., Кривоносова Д.А., Агапов М.А.Garmanova T.N., Markaryan D.R., Kazachenko E.A., Ishchenko R.V., Lukyanov 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/399

Цель — оценить эффективность периоперационного применения микронизированной очищенной флавоноидной фракции (МОФФ) на выраженность боли в послеоперационном периоде у пациентов после оперативного лечения геморроидальной болезни.

Материалы и методы

Материалы и методы. В клиническое проспективное исследование были включены пациенты, которым планировалось выполнение открытой геморроидэктомии. Все участники случайным образом были разделены на две группы: первая получала 1000 мг МОФФ за 15 дней до операции; в течение 7 дней после операции по схеме для лечения острого геморроя и далее по 1000 мг в сутки до 30 дня после операции, вторая группа — плацебо по указанной схеме. Главной конечной точкой являлась частота назначения наркотических обезболивающих в течение недели после операции.

Результаты

Результаты. В исследование было включено 182 пациента: в основной группе — 102, в контрольной — 82. Послеоперационный болевой синдром в покое и при дефекации был статистически значимо меньше в экспериментальной группе на 6—9-е дни после вмешательства (р ≤ 0,05). Прием опиоидов и других НПВС после операции не отличался в обеих группах (р = 0,717 и р = 0,564 соответственно). Показатели частоты побочных эффектов, времени от операции до возвращения к прежнему образу жизни не достигли значимой разницы между группами. Трудность при уходе за собой, тревога и беспокойство, наличие боли и дискомфорта, наличие остаточных жалоб были достоверно выше в контрольной группе.

Заключение

Заключение. Применение МОФФ в рамках периоперационной анальгезии является безопасным и эффективным в отношении снижения выраженности послеоперационного болевого синдрома в аноректальной хирургии. Применение МОФФ должно быть частью рутинного ведения пациентов в аноректальной хирургии в рамках мультимодальной анальгезии.

This study aims to assess the efficiency of micronised purified flavonoid fraction (MPFF) administration prior to open haemorrhoidectomy on postoperative pain severity reduction.

Methods

Methods. The prospective clinical study involved patients with haemorrhoidal disease. Participants were randomly divided into two groups: the first one received 1000 mg of MPFF (Detralex®) 15 days before surgery, seven days after surgery, according to the acute haemorrhoid treatment scheme, and 1000 mg per day until 30 days after surgery; the second one received a placebo. The primary endpoint was the frequency of opioid intake.

Results

Results. The study included 182 participants (102 and 82 in the experimental and control group, respectively). Postoperative pain at rest and during defecation was significantly lower in the experimental group on days 6—9 postoperatively (p < 0.05). The use of opioids and other NSAIDs after surgery did not differ between groups. There was no significant difference between groups in side effects frequency and time to return to the usual lifestyle. As for the quality of life, the control group had significantly higher levels of self-care difficulty, anxiety and lingering pain/discomfort, being more likely to suffer from other persistent complaints.

Conclusion

Conclusion. The preoperative administration of MPFF as analgesia has demonstrated safety and efficacy, effectively reducing postoperative pain in anorectal surgery while avoiding an increase in side effects. Hence, it is recommended for routine implementation in patient care as an essential component of multimodal analgesia during anorectal surgery.

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