[Sphenopalatine ganglion stimulation in the treatment of chronic refractory cluster headache. A preliminary multicenter study in Russia]. / Stimulyatsiya krylonebnogo gangliya v lechenii khronicheskoi klasternoi golovnoi boli. Rezul'taty pervogo mul'titsentrovogo opyta v Rossii.

OBJECTIVE: To analyze the results of sphenopalatine ganglion stimulation in treatment of chronic headache. MATERIALS AND METHODS: Medical histories of patients who underwent sphenopalatine ganglion stimulation in 4 clinical centers have been analyzed. The analysis included the type of pain and its characteristics, methods of surgery, CT, MRI, radiography before and after surgery. The follow-up data of patients with implanted pulse generators was collected in an outpatient clinic or by telephone review. RESULTS: The study included 15 patients with chronic refractory headache, including 14 with cluster headache and one female patient with features of trigeminal autonomic cephalgia without a clear definition of the type of pain. Trial stimulation was performed in 10 patients to determine analgesic effect. Among them stimulation was favorable in 7 cases, and 6 of them underwent pulse generator implantation. In total, 11 (73%) patients underwent implantation with a follow-up from 1 to 60 months. Among them only 6 (54%) patients use stimulation, the remaining 5 (46%) cases had device-related complications (migration, infection of system). Cluster headache has a significant improvement in long-term follow-up. CONCLUSIONS: Sphenopalatine ganglion stimulation may have high potential in the treatment of chronic drug-resistant cluster headache. The complication rate demonstrates that operative technique should be improved.

[The effect of various multimodal analgesia regimens during surgical treatment of patients with spinal stenosis on the rate of failed back surgery syndrome]. / Vliianie razlichnykh mul'timodal'nykh skhem analgezii pri khirurgicheskom lechenii patsientov so stenozom pozvonochnogo kanala na chastotu sindroma neudachnoi operatsii na pozvonochnike.

OBJECTIVE: To determine the effect of various methods of perioperative analgesia on the rate of failed back surgery syndrome in patients operated on for spinal stenosis. MATERIAL AND METHODS: A total of 122 patients were operated on for spinal stenosis in 2010-2016. The patients were assigned to groups according to the type of received analgesia: Group K (n=19) underwent analgesia on-demand. Patients in the PMA group (n=21) received preventive multimodal analgesia (PMA) with ketoprofen, paracetamol and morphine. Patients in the PMA+PG (n=20) and PMA+N (n=20) groups additionally received pregabalin and nefopam, respectively. Patients in the PMA+E group (n=22) received continuous epidural analgesia with a combination of ropivacaine and morphine. In patients in the PMA+I group (n=20), the wound was infiltrated with ropivacaine and ketorolac. RESULTS AND CONCLUSION: In Group K, analgesia was not adequate during five postoperative days. Analgesia with PMA resulted in significant pain reduction during three postoperative days compared to Group K. Wound infiltration in addition to PMA was followed by more significant pain relief during six postoperative hours (compared to the PMA group). Administration of pregabalin or nefopam, as well as epidural analgesia, did not improve quality of postoperative analgesia. Five to seven months after the surgery, 66% (57; 75%) of patients had low back and/or leg pain; 41% (32; 50%) of patients had leg pain. Among patients suffering from pain, 32-41% patients had the severe chronic pain syndrome that resulted in sleep disorder, disability and significant deterioration of quality of life. The rate of failed back surgery syndrome did not depend on the perioperative analgesia regimen.

[Prognostic models of the severity of acute dynamic pain on the first postoperative day and the likelihood of chronic postoperative pain in spine surgery]. / Prognosticheskie modeli vyrazhennosti ostroi dinamicheskoi boli v pervye sutki posle operatsii i veroiatnosti vozniknoveniia khronicheskoi posleoperatsionnoi boli v khirurgii pozvonochnika.

The risk factors for acute pain as well as chronic pain syndrome (CPS) in spine surgery have not been defined to date. PURPOSE: To define the prognostic parameters of acute pain severity and the risk of CPS in patients operated on for spinal diseases and injuries. MATERIAL AND METHODS: The study included 291 patients operated on for degenerative diseases and injuries of the spine at the Sklifosovsky Research Institute of Emergency Medicine in 2010-2016. Sociodemographic and clinical data and the psychological status of patients were evaluated. A mechanical algometer was used to measure the pain threshold (PT) and pain tolerance. The movement pain intensity was assessed by using a visual analog scale (VAS) on the day of surgery. Pain was considered minor at a median score of 0-4 cm and severe at a median score of 5-10 cm. The presence of CPS was assessed during a telephone survey 5-7 months after surgery. RESULTS: The gender, PT, dynamic pain intensity before surgery, and expectation of postoperative pain are risk factors for severe acute postoperative pain. A multinomial logit regression model (Hosmer-Lemeshow test - 4.322; p=0.827) predicts minor dynamic pain on the 1st postoperative day with an accuracy of 70% (95% CI 63-76). The age and dynamic pain intensity on the 1st postoperative are the risk factors for CPS; the multinomial logit regression model (Hosmer-Lemeshow test - 3.1; p=0.928) predicts CPS with an accuracy of 65% (95% CI 59-71) 5-7 months after surgery. CONCLUSION: The developed software in the form of MS Excel calculators provides a particular patient with preoperative assessment of the risk for minor acute dynamic pain on the 1st postoperative day and CPS 5-7 months after surgery.

[Predicting of postoperative pain level and morphine consumption by preoperative pressure pain assessment in patients before elective surgery].

UNLABELLED: The aim of this study was to predict a postoperative pain severity and morphine consumption by preoperative pressure pain assessment. DESIGN: 321 patients scheduled for elective surgery (lumbar discectomy, lumbar spinal fusion, hysterectomy, thoracotomy and total hip replacement) in 2009-2013 were enrolled in retrospective study. Pre-operatively, the pain threshold (PTH) and tolerance (PT) in Newton (N) were measured using the pressure algometry. Post-operatively, the pain scores at rest and during movement at 1st postoperative day (POD) using 10 cm VAS were also recorded Patients could get morphine by PCA device in addition to nonopioid analgesia post-operatively. RESULTS: PTH and PT were respectively 34 (24; 45.6) and 74 (54; 95) N, VAS at 1 POD 2 (1; 3.75) at rest and 4 (2,5; 6.25) cm during movement. Pre-operative PT correlated significantly with pain score during movement in patients at 1 POD (R = -0.124, p = 0.026, n = 320). Logit regression analysis found that pain control adequacy during movement at 1 POD could be predicted with PT (ß = 0.011, Std. Err = 0.004, χ2 = 8.536, p = 0.004, OR = 1.011, 95% CI = 1.004-1.018). Morphine consumption by PCA device in patients was 21.25 (7.5; 38) mg. We found a significant correlation between pre-operative PT and post-operative morphine consumption (R = -0.306, p = 0.0006, n = 122). CONCLUSIONS: Post-operative pain severity during movement at 1st postoperative day can be predicted with the pre-operative pain tolerance using the pressure algometry. There is significant moderate negative correlation between pre- operative pain tolerance and post-operative morphine consumption by PCA device in patients at 1st postoperative day.

[Assessment of pain relief in patients receiving different variants of multimodal analgesia after major gynecological surgery].

The major gynecology surgery generally results in severe postoperative pain. Currently multimodal analgesia concept is widely used for the aim of postoperative pain relief optimization. According to this theory it is worth using the medication with different mechanism in order to increase analgesia qualify, decrease analgesic consumption and avoid adverse reaction. Unfortunately the surveys recently conducted have been pointed out the postoperative analgesia quality is still insufficient despite of using the concept mentioned above. One way to solve the problem is appearing in daily practice nefopam--centrally acting non-opioid analgesic that inhibits reuptake of serotonin, norepinephrine, and dopamine and also mitigates glutamatergic neurotransmission. In this trial we tried to assess the postoperative daily used analgesia quality and potency of preemptive multimodal analgesia model consisted of nefopam, ketoprofen, paracetamol and morphine.