[Modern approaches to the components of multimodal antinociceptive protection in patients with ovarian cancer].

OBJECTIVE: The aim was to analyze the effectiveness of the inclusion of a stress-limiting metabolic component into multimodal anesthesia (MMA) in patients operated for ovarian cancer.

METHODS: A randomized study of the effectiveness of several variants of MMA was conducted in 65 patients with ovarian cancer 55.6±10.3 years old. Prior to the operation, a two-sided TAR block was performed. Anesthesia was maintained by sevoflurane. Analgesia was realized with lidocaine, magnesium sulfate, fentanyl, and nonsteroidal anti-inflammatory drugs. The patients were divided into 2 groups. In the 1st ( n =36) group, in order to expand the stress-limiting capabilities of MMA, before surgery, intraoperatively and in the next three days, Remaxol was included. In the 2nd ( n =29) group, Remaxol was not used. Biochemical parameters were studied: POL/AOS, stress and antistress reactions, the content of C-reactive protein, haptoglobin and liver enzymes.

RESULTS: Before the operation, the examined patients revealed dysregulation of the antioxidant system, endogenous intoxication (EI), intensification of the systemic inflammatory response, and fermentopathy. The results obtained in the groups depended on the nature of the MMA used. In the group where Remaxol was used as a metabolic component of MMA, there was a change in the dynamics of antistress reactions, characterized by a directed intergroup vector of increased resistance, with a predominance of the development of long-term adaptation processes, allowing to prevent the formation of disorders in the POL/AOS system, to reduce the concentration of acute phase proteins, fermentopathy.

CONCLUSION: The introduction of Remaxol into MMA improves the quality of antinociceptive protection, promotes regression of POL products, and prevents the progression of hepatopathy and EI, contributing to the development of stress-limiting mechanisms of long-term adaptation in patients with ovarian cancer in the intra and near perioperative period.