The effectiveness of multimodal non-opioid strategy of anaesthetic support in the early postoperative period of patients operated due to the colorectal cancer pathology

Abstract

Introduction. Implementation of modern programs of perioperative and postoperative support for patients with colon and rectal cancer in order to ensure their accelerated recovery after appropriate surgery (Enhanced Recovery after Surgery – ERAS) provides opportunities for practical implementation of anaesthetic support protocols with full or minimal opioid use strategies in the early postoperative period. Objective of the study. To evaluate the effectiveness of multimodal non-opioid strategy of anaesthetic support in the early postoperative period of patients operated due to the colorectal cancer pathology.  Materials and Methods. The study was conducted on the basis of Transcarpathian Regional Clinical Oncology Dispensary at the Department of Tumor Surgery during 2019-2020. The formation of the study sample was provided among patients with diagnostically confirmed pathology of colorectal cancer and the need for resective surgery. The protocol of general anesthesia in the study group and the comparison group was identical, the difference of anaesthetic support within the study group was based on the the implementation of additional components of preemptive and preventive analgesia, while in the comparison group pain relief effect in the postoperative period was provided by the use of opioids. The intensity of pain during movements in the postoperative period was evaluated by the NRS scale. Additionally, the recovery of peristaltic bowel movements and the period of their development on a certain day after surgery, as well as the levels of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in the early postoperative period were also recorded. Results of the study and their discussion. Monitoring of pain intensity indicators according to the NRS scale revealed a pronounced prevalence of postoperative pain of medium and high intensity levels in the comparison group at 2 (among 68% of patients) and 8 hours (among 80% of patients) after surgery, while the prevalence of pain with similar intensity in the group of non-opioid anaesthetic support strategy 2 hours after surgery was observed in 28% of patients, and 8 hours after surgery – in 20% of patients. On the 1st and 2nd day after surgery, the pain intensity values recorded in the study group and the comparison group were characterized by a statistically significant difference: 5,14±2,53 vs. 6,32±2,09 (p<0,05) and 4,17±1,92 vs. 5,49±2,02 (p<0,05) respectively. Statistically lower systolic and diastolic blood pressure values, as well as heart rate levels were observed in the study group 2 (p<0,05) and 8 hours (p<0,05) after surgery, as well as at the 2nd (p<0,05) and the 3rd day (p<0,05) after surgery compare with the control group. Restoration of peristalsis in the study group was registered at 1,7±1,1 days after surgery, while in the control group at 3,5±1,2 days after surgery. Conclusions. The use of non-opioid multimodal anesthesia with the implementation of preemptive and preventive analgesia principles helps to reduce the prevalence of medium and severe intensity pain in early postoperative period, to maintain optimal levels of SBP, DBP and heart rate, and to accelerate the recovery of peristaltic bowel movements compared to the results obtained with the use of classical protocols of general anesthesia during the surgical treatment of patients with colorectal cancer and their postoperative support.