The effectiveness of multimodal analgesia in ophthalmic patients during glaucoma surgeries

Background. The work covers the results of multicomponent general anesthesia with ophthalmic surgeries in order to improve the quality of intraoperative and postope­rative analgesia, and to reduce the number of complications associated with anesthetic management in the postoperative period. Surgery for glaucoma belongs to operations with mo­derate pain syndrome. A number of studies have demonstrated that multimodal perioperative analgesia can reduce pre- and postoperative hyperalgesia. Materials and methods. The study included patients aged 19–42 years who underwent glaucoma surgery. For the comparative analysis, the patients were divided into groups taking into account the type of analgesia: group 1 (n = 20) — preventive administration of meloxicam during premedication, anesthesia was performed by retrobulbar block and sedation with propofol. Anesthesia with meloxicam was continued in the postoperative period according to the scheme of pre-emptive analgesia; group 2 (n = 24) — ­anesthesia was performed according to the scheme previously adopted in our clinic (premedication of diazepam + fentanyl), intravenous anesthesia using propofol with preserved spontaneous breathing and bolus injection of fentanyl du­ring potentially painful stages of intervention. Postoperative ­analgesia was done by intramuscular injection of ketoprofen at the request of patients.The groups were comparable by sex, age and clinical manifestations of the disease. According to their physical status, all patients corresponded to class I–III of the American Society of Anesthesiologists (ASA). We stu­died the pain level on Vi­sual Analogue Scale (VAS) (twice: 6 and 12 hours after surgery) and recorded complications within 24 hours after surgery. Results. Six and 12 hours after the surgery, the severity of the pain syndrome according to VAS was less than 3 in 90 and 85 % of group 1 patients, respectively, in group 2 — 45.8 and 58.3 %. Postoperative nausea and vomi­ting were detected in 5 % in group 1 with the use of multimodal analgesia as compared to 33.3 % in group 2 (controls). The development of arterial hypertension in the postoperative period in group 1 was noted in 15 % of patients vs. 45.8 % in group 2. Arterial hypotension was detected only in patients of group 2, and the incidence of this complication was 37.5 %. There were no cases of arterial hypotension in patients of group 1. Conclusions. Тhus, the use of multimodal analgesia involving premedication with meloxicam, anesthesia in combination of retrobulbar block and administration of propofol, and postoperative analgesia with meloxicam according to the scheme of anticipatory analgesia, makes it possible to increase the efficacy and control of anesthetic management during ophthalmic surgeries for glaucoma. The use of meloxicam in premedication and postoperative period allows you to achieve adequate postoperative analgesia, and without the use of narcotic analgesics. The administration of meloxicam as a component of multimodal anesthesia makes it possible to significantly reduce the risk of such postoperative complications as postoperative nausea of vomiting, development of arterial hypotension and hypertension, which is especially important in ophthalmic surgery, as the above complications cause an increased risk of suprachoroidal hemorrhage.