grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-4625Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2025-184-6-14-20grekov-2683Research ArticleВОПРОСЫ ОБЩЕЙ И ЧАСТНОЙ ХИРУРГИИPROBLEMS OF GENERAL AND SPECIAL SURGERYЭффективность инфильтрации местным анестетиком зон троакарных доступов у онкологических пациентов при лапароскопической резекции толстой кишки: результаты одноцентрового пилотного рандомизированного исследованияEfficacy of local anaesthetic trocar site local infiltration in cancer patients undergoing laparoscopic colorectal resection: a single-center pilot randomized controlled trialhttps://orcid.org/0000-0002-8514-5377ЗахаренкоА. А.ZakharenkoA. A.

Захаренко Александр Анатольевич, доктор медицинских наук, профессор, зав. кафедрой онкологии ФПО, руководитель отдела онкохирургии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 

Zakharenko Alexander A., Dr. of Sci. (Med), Professor, Head of the Department of Oncology of the Faculty of Postgraduate Education, Head of the Department Oncological Surgery

6-8, L’va Tolstogo str., Saint Petersburg, 197022 

9516183@mail.ruhttps://orcid.org/0000-0002-9927-5607ТенО. А.TenO. A.

Тен Олег Андреевич, кандидат медицинских наук, доцент кафедры хирургических болезней стоматологического факультета им. проф. А. М. Ганичкина 

AuthorID: 937324 

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 

Ten Oleg A., Cand. of Sci. (Med.), Associate Professor of the Department of Surgical Diseases of the Faculty of Dentistry named after Prof. A. M. Ganichkin

AuthorID: 937324 

6-8, L’va Tolstogo str., Saint Petersburg, 197022 

ten888oleg@mail.ruhttps://orcid.org/0009-0007-9352-7627ЗверевП. В.ZverevP. V.

Зверев Павел Васильевич, клинический ординатор кафедры онкологии ФПО 

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 

Zverev Pavel V., Resident of the Department of Oncology of the Faculty of Postgraduate Education 

6-8, L’va Tolstogo str., Saint Petersburg, 197022 

pavelzv1@yandex.ruhttps://orcid.org/0000-0002-6365-9748ХряпаА. А.KhryapaA. A.

Хряпа Александр Александрович, кандидат медицинских наук, зав. отделением анестезиологии-реанимации № 2 научно-клинического центра анестезиологии и реаниматологии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 

Khryapa Alexander A., Cand. of Sci. (Med.), Head of the Department Anesthesiology and Intensive Care № 2 of the Scientific and Clinical Center for Anesthesiology and Intensive Care

6-8, L’va Tolstogo str., Saint Petersburg, 197022 

khryapa_aa@mail.ruhttps://orcid.org/0000-0002-6380-137XБагненкоС. Ф.BagnenkoS. F.

Багненко Сергей Фёдорович, доктор медицинских наук, академик РАН, ректор 

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 

Bagnenko Sergey F., Dr. of Sci. (Med), Academician of the RAS, Rector 

6-8, L’va Tolstogo str., Saint Petersburg, 197022 

Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. ПавловаРоссияPavlov UniversityRussian FederationПервый Санкт-Петербургский государственный медицинский университет им. акад. И. П. ПавловаРоссияPavlov UniversityRussian Federation20251402202618461420Copyright © Захаренко А.А., Тен О.А., Зверев П.В., Хряпа А.А., Багненко С.Ф., 20262026Захаренко А.А., Тен О.А., Зверев П.В., Хряпа А.А., Багненко С.Ф.Zakharenko A.A., Ten O.A., Zverev P.V., Khryapa A.A., Bagnenko S.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/2683ЦЕЛЬ

ЦЕЛЬ. Оценить эффективность инфильтрации зон троакарных ран местным анестетиком (ИМАЗТР) как компонента мультимодальной аналгезии при плановой лапароскопической резекции толстой кишки по поводу колоректального рака.

МЕТОДЫ И МАТЕРИАЛЫ

МЕТОДЫ И МАТЕРИАЛЫ. Проведен проспективный анализ 24 пациентов, рандомизированных на 2 группы. Основная группа (n=13) получала ИМАЗТР на фоне общей анестезии, контрольная группа (n=11) – общую анестезию в сочетании с торакальной эпидуральной анестезией (ТЭА). Первичной конечной точкой была интенсивность боли в покое по визуальной аналоговой шкале (ВАШ) в течение 2 недель после операции. Вторичные конечные точки включали интенсивность боли при движении/кашле, длительность госпитализации, время до восстановления функции кишечника, потребность в дополнительной аналгезии и частоту осложнений.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Выявлены статистически значимые различия в интенсивности боли в покое на 4, 6, 8 и 12 часов после операции (p=0,01), а также при движении/кашле на 2 (p=0,03), 4, 6, 8 и 12 часов (p=0,01) в пользу контрольной группы. Пиковое значение ВАШ в основной группе составило 4,65±2,03 балла (6 часов), в контрольной – 1,91±1,63 балла (2 часа). Значимых различий по вторичным конечным точкам, включая показатели боли в остальные сроки наблюдения, не выявлено.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Метод ИМАЗТР продемонстрировал сопоставимую с ТЭА эффективность в контроле послеоперационной боли в рамках пилотного рандомизированного исследования.

The OBJECTIVE was to evaluate the efficacy of local anesthetic infiltration of trocar sites (LAITS) as a component of multimodal analgesia in patients undergoing elective laparoscopic colorectal resection for colorectal cancer.METHODS AND MATERIALS. A prospective analysis of 24 patients randomized into two groups was conducted. The study group (n=12) received LAITS in addition to general anesthesia, while the control group (n=12) received general anesthesia combined with thoracic epidural analgesia (TEA). The primary endpoint was the intensity of resting pain assessed using a visual analog scale (VAS) over 2 weeks postoperatively. Secondary endpoints included pain intensity on movement/coughing, length of hospital stay, time to return of bowel function, need for supplemental analgesia, and incidence of surgical complications.RESULTS. Statistically significant differences were found in resting pain intensity at 4, 6, 8, and 12 hours postoperatively (p=0.01), as well as in pain on movement/coughing at 2 (p=0.03), 4, 6, 8, and 12 hours (p=0.01), favoring the control group. The peak VAS score in the study group was 4.65±2.03 points at 6 hours, compared to 1.91±1.63 points at 2 hours in the control group. No significant differences were observed in secondary endpoints, including pain scores at the remaining time points.CONCLUSIONS. In this pilot randomized clinical trial, the LAITS method demonstrated comparable efficacy to TEA method in controlling postoperative pain.

лапароскопияколоректальный ракместная анестезияанестезия троакарных ранмультимодальная аналгезияпослеоперационный болевой синдромлечение болиlaparoscopic surgerycolorectal cancerlocal anesthesiatrocar site anesthetic infiltrationmultimodal analgesiapostoperative painpain managementReferencesЗахаренко А. А., Тен О. А., Зверев П. В. Эффективность местной анестезии зоны токарных ран при коррекции послеоперационного болевого синдрома в колоректальной онкохирургии: обзор литературы. Вестник хирургии имени И. И. Грекова. 2024. Т. 183, № 2. С. 68–75. https://doi.org/10.24884/0042-4625-2024-183-2-68-75.Zakharenko A. A., Ten O. A., Zverev P. V. et al. The effectiveness of local anesthesia of the trocar wound area in the correction of postoperative pain syndrome in colorectal oncosurgery. Grekov’s Bulletin of Surgery. 2024;183(2):68–75. (In Russ.). https://doi.org/10.24884/0042-4625-2024-183-2-68-75Etzioni D. A., Cannom R. R., Madof R. D. et al. Colorectal procedures: what proportion is performed by American board of colon and rectal surgery-certified surgeons. Dis Colon Rectum. 2010. Vol. 53, № 5. P. 713–720. https://doi.org/10.1007/DCR.0b013e3181d32084.Etzioni D. A., Cannom R. R., Madof R. D. et al. Colorectal procedures: what proportion is performed by American board of colon and rectal surgery-certified surgeons. Dis Colon Rectum. 2010;53(5):713–720. https://doi.org/10.1007/DCR.0b013e3181d32084.Gan T. J., Habib A. S., Miller T. E. et al. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014. Vol. 30, № 1. P. 149–160. https://doi.org/10.1185/03007995.2013.860019.Gan T. J., Habib A. S., Miller T. E. et al. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30(1):149–160. https://doi.org/10.1185/03007995.2013.860019.Kim J. H., Lee Y. S., Shin H. W. et al. Effect of administration of ketorolac and local anaesthetic infiltration for pain relief after laparoscopic-assisted vaginal hysterectomy. J Int Med Res. 2005. Vol. 33, № 4. P. 372–378. https://doi.org/10.1177/147323000503300402.Kim J. H., Lee Y. S., Shin H. W. et al. Effect of administration of ketorolac and local anaesthetic infiltration for pain relief after laparoscopic-assisted vaginal hysterectomy. J Int Med Res. 2005;33(4):372–378. https://doi.org/10.1177/147323000503300402.Ekstein P., Szold A., Sagie B. et al. Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period. Ann Surg. 2006. Vol. 243, № 1. P. 41. https://doi.org/10.1097/01.SLA.0000193806.81428.6F.Ekstein P., Szold A., Sagie B. et al. Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period. Ann Surg. 2006;243(1):41. https://doi.org/10.1097/01.SLA.0000193806.81428.6F.Fearon K. C. H., Ljunggvist O., Meyenfeldt M. et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005. Vol. 24, № 3. P. 466–477. https://doi.org/10.1016/J.CLNU.2005.02.002.Fearon K. C. H., Ljunggvist O., Meyenfeldt M. et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466–477. https://doi.org/10.1016/J.CLNU.2005.02.002.Gustafsson U. O., Scott M. J., Hubner M. et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS) society recommendations: 2018. World J Surg. 2019. Vol. 43, № 3. P. 659–695. https://doi.org/https://doi.org/10.1007/S00268-018-4844-Y.Gustafsson U. O., Scott M. J., Hubner M. et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS) society recommendations: 2018. World J Surg. 2019;43(3):659–695. https://doi.org/https://doi.org/10.1007/S00268-018-4844-Y.Carmichael J. C., Keller D. S., Baldini G. et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American society of colon and rectal surgeons and society of American gastrointestinal and endoscopic surgeons. Dis Colon Rectum. 2017. Vol. 60, № 8. P. 761–784. https://doi.org/10.1097/DCR.0000000000000883.Carmichael J. C., Keller D. S., Baldini G. et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American society of colon and rectal surgeons and society of American gastrointestinal and endoscopic surgeons. Dis Colon Rectum. 2017;60(8):761–784. https://doi.org/10.1097/DCR.0000000000000883.Brown L., Gray M., Griffiths B. et al. A multicentre, prospective, observational cohort study of variation in practice in perioperative analgesia strategies in elective laparoscopic colorectal surgery. Ann R Coll Surg Engl. 2020. Vol. 102, № 1. P. 28–35. https://doi.org/10.1308/RCSANN.2019.0091.Brown L., Gray M., Griffiths B. et al. A multicentre, prospective, observational cohort study of variation in practice in perioperative analgesia strategies in elective laparoscopic colorectal surgery. Ann R Coll Surg Engl. 2020;102(1):28–35. https://doi.org/10.1308/RCSANN.2019.0091.Macías A. A., Finneran J. J. Regional anesthesia techniques for pain management for laparoscopic surgery: a review of the current literature. Curr Pain Headache Rep. 2022. Vol. 26, № 1. P. 33–42. https://doi.org/10.1007/S11916-022-01000-6.Macías A. A., Finneran J. J. Regional anesthesia techniques for pain management for laparoscopic surgery: a review of the current literature. Curr Pain Headache Rep. 2022;26(1):33–42. https://doi.org/10.1007/S11916-022-01000-6.Bharti N., Kumar P., Bala I. et al. The efficacy of a novel approach to transversus abdominis plane block for postoperative analgesia after colorectal surgery. Anesth Analg. 2011. Vol. 112, № 6. P. 1504–1508. https://doi.org/10.1213/ANE.0b013e3182159bf8.Bharti N., Kumar P., Bala I. et al. The efficacy of a novel approach to transversus abdominis plane block for postoperative analgesia after colorectal surgery. Anesth Analg. 2011;112(6):1504–1508. https://doi.org/10.1213/ANE.0b013e3182159bf8.Čustovic S., Pandža H., Delibegovic S. Effect of local anesthesia on the postoperative pain after laparoscopic appendectomy. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2019. Vol. 29, № 1. P. 65–71. https://doi.org/10.1089/lap.2018.0452.Čustovic S., Pandža H., Delibegovic S. Effect of local anesthesia on the postoperative pain after laparoscopic appendectomy. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2019;29(1):65– 71. https://doi.org/10.1089/lap.2018.0452.Gluck O., Barber E., Feldstein O. et al. The effect of subcutaneous and intraperitoneal anesthesia on post laparoscopic pain: a randomized controlled trial. Scientific Reports. 2021. Vol. 11, № 1. P. 1–8. https://doi.org/10.1038/s41598-020-80130-6.Gluck O., Barber E., Feldstein O. et al. The effect of subcutaneous and intraperitoneal anesthesia on post laparoscopic pain: a randomized controlled trial. Scientific Reports. 2021;11(1):1–8. https://doi.org/10.1038/s41598-020-80130-6.Inan A., Sen M., Dener C. et al. Local anesthesia use for laparoscopic cholecystectomy. World J Surg. 2004. Vol. 28, № 8. P. 741–744. https://doi.org/10.1007/S00268-004-7350-3.Inan A., Sen M., Dener C. et al. Local anesthesia use for laparoscopic cholecystectomy. World J Surg. 2004;28(8):741–744. https://doi.org/10.1007/S00268-004-7350-3.Zhang H., Du G., Liu Y. et al. Overlay of a sponge soaked with ropivacaine and multisite infiltration analgesia result in faster recovery after laparoscopic hepatectomy. World J Gastroenterol. 2019. Vol. 25, № 34. P. 5185–5196. https://doi.org/10.3748/wjg.v25.i34.5185.Zhang H., Du G., Liu Y. et al. Overlay of a sponge soaked with ropivacaine and multisite infiltration analgesia result in faster recovery after laparoscopic hepatectomy. World J Gastroenterol. 2019;25(34):5185– 5196. https://doi.org/10.3748/wjg.v25.i34.5185.Molfino S., Botteri E., Bagi P. et al. Pain control in laparoscopic surgery: a case-control study between transversus abdominis plane-block and trocar-site anesthesia. Updates Surg. 2019. Vol. 71, № 4. P. 717–722. https://doi.org/10.1007/S13304-018-00615-y.Molfino S., Botteri E., Bagi P. et al. Pain control in laparoscopic surgery: a case-control study between transversus abdominis plane-block and trocar-site anesthesia. Updates Surg. 2019;71(4):717–722. https://doi.org/10.1007/S13304-018-00615-y.Ergin A., Aydin M. T., Ciyiltepe H. et al. Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial. Int J Surg. 2021. Vol. 95. P. 106134. https://doi.org/10.1016/J.IJSU.2021.106134.Ergin A., Aydin M. T., Ciyiltepe H. et al. Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial. Int J Surg. 2021;95:106134. https://doi.org/10.1016/J.IJSU.2021.106134.Duffield J. A., Thomas M. L., Moore J. W. et al. Intraperitoneal local anesthetic instillation and postoperative infusion improves functional recovery following colectomy: A randomized controlled trial. Diseases of the Colon and Rectum. 2018. Vol. 61, № 10. P. 1205–1216. https://doi.org/10.1097/DCR.0000000000001177.Duffield J. A., Thomas M. L., Moore J. W. et al. Intraperitoneal local anesthetic instillation and postoperative infusion improves functional recovery following colectomy: A randomized controlled trial. Diseases of the Colon and Rectum. 2018;61(10):1205–1216. https://doi.org/10.1097/DCR.0000000000001177.Boulind C. E., Ewings P., Bulley S. H. et al. Feasibility study of analgesia via epidural versus continuous wound infusion after laparoscopic colorectal resection. The British Journal of Surgery. 2013. Vol. 100, № 3. P. 395–402. https://doi.org/10.1002/BJS.8999.Boulind C. E., Ewings P., Bulley S. H. et al. Feasibility study of analgesia via epidural versus continuous wound infusion after laparoscopic colorectal resection. The British Journal of Surgery. 2013;100(3):395– 402. https://doi.org/10.1002/BJS.8999.

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