Non-opioid multimodal analgesia in the immediate postoperative period

Objective. To increase the effectiveness of postoperative multimodal analgesia using contact LED exposure with Russian BASI bracelets emitting in blue range 470 ± 10 nm and including magnesium sulfate in the multimodal postoperative analgesia protocol.

Material and methods. To achieve the goal set in the work, the effectiveness of contact LED blood irradiation in blue range of 470 ± 10 nm at the microcirculation state was analyzed in patients of the main group (n = 46) in the immediate postoperative period. We studied the percentage of oxygen, as well as the acid-base state of venous blood before and after contact LED exposure. In the comparison group (n = 42), patients did not have contact LED blood irradiation in the immediate postoperative period.

To study the effectiveness of contact LED blood irradiation at blood coagulation parameters, a series of coagulograms of blood samples taken from patients of both groups was done: once (before surgery) in the preoperative period and once in the immediate postoperative period up to 6 hours, because after 6 hours, anticoagulant therapy was administered according to the protocol. Coagulological testing was performed using Sysmex CA-560 apparatus (Japan). The acid-base state of venous blood was evaluated using Gem Premier 3000 apparatus manufactured by Instrumentation Laboratory.

Research results. Coagulation tests revealed a positive effect of contact LED blood irradiation in patients of the main group. This effect was manifested in the stable trend of shifts towards moderate hypocoagulation in postoperative hemostatic parameters in all studied stages, what indicates the prevention of possible complications like thromboembolism in the postoperative period.

Conclusion. Contact LED blood irradiation in blue range 470 ± 10 nm prevents thromboembolism in the postoperative period and allows to achieve pain relief without narcotic analgesics on the first day after the surgery.

1. Ushakov A. A. Practical physiotherapy = Ushakov A. A. Prakticheskaya fizioterapiya: rukovodstvo dlya vrachey. 3-e izd., ispr. i dop. M.: Meditsinskoye informatsionnoye agentstvo, 2009. 700 s. (In Russ.)

2. Kehlet H., Dahl G. B. The value of «multimodal » or «Balanced analgesia » postoperative pain treatment. Anesth Analg. 1993; 77 (5): 1048–1056.

3. Kehlet H., Wilmore D. Multimodal strategies to improve surgical out com. Am J Surg. 2002; 183 (6): 630–641.

4. Osipova N. A., Beresneva V. A., Petrova V. V., et al. Experience in the use of peripherally acting analgesics in the system of comprehensive protection of patients from surgical trauma = Osipova N. A., Beresneva V. A., Petrova V. V. i dr. Opyt ispol’zovaniya analgetikov perifericheskogo deystviya v sisteme kompleksnoy zashchity patsiyentov ot operatsionnoy travmy. Anesteziologiya i reanimatologiya. 2002; (4): 23–26. (In Russ.)

5. Choi J., Yoon K., Um D. Intravenous magnesium sulfate administration reduces propofol infusion requirements during maintenance of propofol-N20 anesthesia. Anesthesiology. 2002; 97 (5): 1137–1141.

6. Dabbagh A., Elyasi H., Razavi S. Intravenous magnesium sulfate for post-operative pain in patients undergoing low limb orthopedic surgery. Acta Anaesth Scand. 2009; 53 (8): 1088–1091.

7. Dickenson A. H. A cure for wind up: NMDA receptor antagonists as potential analgesics. Trends Pharmacol Sci. 1990; 11 (8): 307–309.

8. Angst M. S., Clark J. D. Opioid-induced hyperalgesia. Anesthesinology. 2006;. 104 (3): 570–587.

9. Chia Y. Y., Liu K., Wang J. J., et al. Intraoperative high dose fentanyl induces postoperative fentanyl tolerance. Can J Anaesth. 1999; 46 (9): 872–877.

10. Smolnikov P. V., Shiryaev V. S., Musikhin L. V., et al. Low-intensity laser therapy in geriatric practice of anesthesiology and resuscitation = Smol’nikov P. V., Shiryayev V. S., Musikhin L. V. i dr. Nizkointensivnaya lazernaya terapiya v geriatricheskoy praktike anesteziologii – reanimatologii. Lazernaya meditsina. 2015; 19 (4): 8–11. (In Russ.)

11. Sokolov A. Encyclopedia of drug safety = Sokolov A. Entsiklopediya lekarstvennoy bezopasnosti. M.: Kron-press, 2000. 828 s. (In Russ.)

12. Khosrovyan A. M., Musikhin L. V., Shiryaev V. S., et al. Intravenous laser irradiation of blood in patients in the postoperative period – dynamics of microcirculation parameters = Khosrovyan A. M., Musikhin L. V., Shiryayev V. S. i dr. Vnutrivennoye lazernoye oblucheniye krovi u patsiyentov v posleoperatsionnom periode – dinamika pokazateley mikrotsirkulyatsii. Lazernaya meditsina. 2011; 15 (1): 4–12. (In Russ.)

13. Karandashov V. I., Aleksandrova N. P., Ostrovsky E. I. Influence of optical radiation of the blue range on hemocirculation in patients with chronic arterial insufficiency = Karandashov V. I., Aleksandrova N. P., Ostrovskiy E. I. Vliyaniye opticheskogo izlucheniya sinego diapazona na gemotsirkulyatsiyu u bol’nykh khronicheskoy arterial’noy nedostatochnost’yu. Lazernaya meditsina. 2018; 22 (2): 10–13. (In Russ.)

14. Koshelev V. N., Semina E. A., Kamalyan A. B. Comparative assessment of the effectiveness of percutaneous and intravascular laser irradiation of blood = Koshelev V. N., Semina E. A., Kamalyan A. B. Sravnitel’naya otsenka effektivnosti primeneniya chrezkozhnogo i vnutrisosudistogo lazernogo oblucheniya krovi. V sb.: Klinicheskoye i eksperimental’noye primeneniye novykh lazernykh tekhnologiy: sbornik mezhdunarodnoy konferentsii. Moskva-Kazan’, 1995. S. 395–397. (In Russ.)