OBJECTIVE

To analyze an effect of variants of multimodal analgesia (MMA) on the liver functional status and endogenous intoxication (EI) markers in patients operated on for gynecological cancers after neoadjuvant chemotherapy.

MATERIAL AND METHODS

The effectiveness of MMA variants was analyzed in a prospective randomized study including 122 patients aged 36-76 years after neoadjuvant chemotherapy. The patients were divided into two groups. Group 1 (n=59) received anesthesia with sevoflurane with epidural analgesia (EA); group 2 (n=63) received intraoperative TAP block. Analgesia was maintained by infusion of lidocaine, magnesium sulfate, microdoses of fentanyl, NSAIDs. The groups were divided into subgroups A and B. In subgroups A of both groups, remaxol was used as part of MMA 2 hours before the surgery, intraoperatively and in first 3 days after the surgery, in order to reduce the manifestations of EI and hepatopathy. In B subgroups, remaxol was not used. Biochemical parameters, such as total (TCA) and effective (ECA) concentrations of albumin, albumin binding capacity (ABC), C-reactive protein (CRP), and liver enzymes, were determined in all patients.

RESULTS

The premorbid background in all patients was characterized with EI, intensification of the systemic inflammatory response, and hepatopathy. The dynamics of the studied parameters depended on the MMA variant throughout the study. Significant elevation of TCA and ECA was observed in subgroups with remaxol, indicating a significant decrease in EI, and lower consumption of opioid analgesics in the perioperative period.

CONCLUSIONS

Remaxol as part of MMA decreases manifestations of hepatopathy and EI and reduces consumption of opioid analgesics in the intra- and perioperative periods.