Fascial plane blocks have become popular in the past decade. They are widely used, as they look like easy to do, and have an attractive balance between benefits vs risks. Nevertheless, these techniques remain poorly understood due to lack of fundamental anatomical studies and multicenter randomized controlled trials. The purpose of our study was an nalytical assessment of the current state of clinical trials of fascial blocks and their use in clinical practice. We searched for available publications by keywords in Russian and English in PubMed, Elibrary and CyberLeninka systems. At the end of 2024, 1833 sources were found in PubMed using the keyword "fascial block", 276 articles were found in Elibrary, CyberLeninka using the keywords "fascial blocks" and "inter-fascial blocks" in Russian. The first descriptions of the techniques of these blocks and the first results in English were published in the late 90s of the 20th century, but most publications, including in Russian, have been publicized in the last 9-10 years. Few articles provide anatomical justification of fascial blocks. Most of the articles are devoted to the different techniques in clinical practice. Minimal complications and adverse events are reported. We found despite the widespread in the clinic, interfacial blockades remain poorly understood. Complications and adverse events are not well described. Additional studies are required, including randomized multicenter studies.

Relevance. The problem of radicular pain in the cervical spine is a huge socio-economic problem [1]. One of the most common causes of pain in the upper limbs and shoulder girdle is a herniated disc in the cervical spine, the symptoms of which usually affect the quality of life, functionality and sleep [2]. Purpose of the study. Improving the treatment results of patients with cervical radiculopathy by using epidural analgesia (EA) with glucocorticosteroids (GCS). Materials and methods. The study involved 110 patients with an established diagnosis of discogenic radiculopathy of the cervical spine. Patients were divided into two groups. The study group underwent epidural interlaminar injections of a local anesthetic solution and glucocorticosteroid at the cervical spine level, the control group underwent neurosurgical treatment of discogenic radiculopathy. The intensity of the pain syndrome according to the CRS, ODI, and the short form of the McGill questionnaire was assessed immediately after treatment, one month, three months, and six months after treatment. Results. The average intensity of the pain syndrome according to the NRS before treatment in the study group was 8.04 ± 1.19 points, according to ODI 42.56 ± 2.10%, according to the short form of the McGill questionnaire 48.44 ± 5.21 points. In the control group, the indicators were as follows: NRS 8.18 ± 1.27 points, ODI 42.63 ± 2.62%, and the short form of the McGill Questionnaire 49.20 ± 5.38 points. By the end of the sixth month of observation, the pain level according to NRS in the study group was 2.64 ± 1.17 points, ODI - 14.28 ± 2.56%, and the McGill Questionnaire - 24.78 ± 3.09 points. In the control group, by the end of the sixth month of observation, the pain level according to NRS was 3.07 ± 1.26 points, ODI 14.70 ± 2.47%, and the short form of the McGill Questionnaire 25.12 ± 2.66 points. Conclusion. When comparing interventional treatment of radiculopathies on the cervical spine and surgical treatment, our results show comparable effectiveness of the two treatment methods. However, with interventional treatment of radicular pain, the patient does not require long-term rehabilitation and prolongation of the sick leave in comparison with surgical treatment.

BACKGROUND: Effective management of postoperative pain in thoracic surgery is a critical task, as insufficient postoperative analgesia can lead to serious complications, including atelectasis, pneumonia, and chronic pain. Despite advances in pain management techniques, uncertainty remains for the optimal analgesia technique. Paravertebral block (PVB) is considered an effective analgesic technique for video-assisted thoracoscopic surgery (VATS); however, it requires a high level of expertise and carries certain risks. In recent years, the erector spinae plane block (ESPB) has gained popularity as an alternative regional anesthesia technique, but data on its efficacy remain controversial. Further research is needed to compare the advantages and disadvantages of these methods. AIM: To compare the analgesic efficacy of ESPB and PVB in the perioperative period following VATS wedge lung resection in patients with oncological diseases. MATERIALS AND METHODS: A single-center prospective randomized controlled study was conducted on 45 patients aged 18–75 years who underwent VATS biopsy or wedge lung resection. Patients were randomized into two groups: ESPB (n=22) and PVB (n=23). The primary endpoints included pain intensity in the intraoperative and postoperative periods, assessed using the numerical rating scale (NRS). Pain was evaluated at rest and during coughing, along with hemodynamic changes. RESULTS: Pain intensity according to the NRS was minimal in both groups during the first 3 hours after extubation. However, a statistically significant difference was observed from the 4th hour, with lower pain scores in the PVB group (p0.05). Pain during coughing was also lower in the PVB group for up to 48 hours postoperatively. No significant differences in fentanyl consumption were found between the groups (p=0.72). Anesthesia execution time was shorter in the ESPB group (p0.05). Hypotension requiring vasopressor support was more frequent in the PVB group. Despite statistically significant differences, pain scores did not exceed 4 points within 48 hours in both groups, suggesting comparable effectiveness of the two blocks for this type of surgery. CONCLUSION: The findings indicate that ESPB and PVB provide comparable postoperative analgesia following VATS lung resection. ESPB demonstrated technical simplicity and shorter execution time, whereas PVB provided a more pronounced analgesic effect during coughing. Given the shorter execution time, ESPB may be preferable in cases where PVB is associated with a high risk of complications.

Background: Despite advances in surgical approaches and various treatment regimens, postoperative mortality after pancreatic surgery remains high (3.8%). Lactate levels and base excess show metabolic changes in the body and are useful prognostic markers of in-hospital mortality.Objective: To evaluate the prognostic significance of lactate levels and arterial base excess in patients after pancreatic surgery. Materials and methods: We retrospectively analyzed a database of patients who underwent pancreatic surgery (n=134) between 2019 and 2023. The patients were grouped: group 1 (n=11) for the patients who died in the hospital in the postoperative period and group 2 (n=123) for the patients discharged from the hospital.Results: In group 1, the lactate level at the time of admission was significantly higher than in group 2: 5.61 (2.51-11.13) mmol/L and 1.84 (1.33-2.98) mmol/L, respectively, P<.001. Changes of this parameter on day 1: 3.60 (2.41-4.24) mmol/L in group 1 and 2.27 (1.72-3.64) in group 2, P<.001. On day 2: 2.55 (1.43-3.54) mmol/L in group 1 and 1.40 (1.16-1.92) mmol/L in group 2, P=.001. On day 3: 1.85 (1.57-2.91) mmol/L in group 1 and 1.24 (1.14-1.54) mmol/L in group 2, P=.002. The base excess was also higher in group 1 compared with group 2: −7.50 (−10.75-(−5.40)) mmol/L and −4.00 (−5.30-(−2.35)) mmol/L, respectively, P=.001. Changes of this parameter on day 1: −5.20 (−6.90-(−1.40)) mmol/L in group 1 and −2.70 (−4.00-(−0.80)) in group 2, P=.002. On day 2: −1.90 (−7.00- (−1.40)) mmol/L in group 1 and 1.62 (−0.80-3.50) mmol/L in group 2, P=.006. On day 3: −1.25 (−8.00-2.3) mmol/L in group 1 and 2.55 (0.80-3.80) mmol/L in group 2, P=.027. The area under the receiver operating characteristic curve (AUROC) for relationship between lactate level and death was 0.833, 95% CI: 0.704-0.962, P<.001. The cutoff point value was 2.5 mmol/L, whereas sensitivity and specificity were 81.8% and 69.1%, respectively. The AUROC for relationship between base excess and death was 0.801, 95% CI: 0.657-0.945, P=.001. The cutoff point value was −6.6 mmol/L, whereas sensitivity and specificity were 72.7% and 84.6%, respectively. When comparing the AUROC values, we found no significant differences (P=.520). Conclusions: Arterial blood lactate and base excess are equally good at predicting in-hospital mortality in patients undergoing pancreatic surgery.

BACKGROUND: The possibility of reducing doses of narcotic analgesics during the perioperative period is widely discussed in modern scientific literature. This direction is called opioid-free anesthesia and is used in abdominal surgery, oncology, gynecology, and other areas. Publications on the use of opioid-free anesthesia in thoracic surgery are scarce. OBJECTIVE: To evaluate the analgesic effectiveness of intravenous lidocaine infusion as a component of anesthesia in thoracic surgery. MATERIALS AND METHODS: Ninety patients who underwent open lobectomy or pneumonectomy were examined. Depending on the analgesic component, patients were divided into three groups: group 1 (n=30) received intravenous infusion of lidocaine, group 2 (n=30) received epidural block, and group 3 (n=30) had fentanyl infusion. Blood pressure, heart rate, cortisol, and blood serum glycemia levels were measured. The intensity of postoperative pain syndrome and the need for promedol, tramadol, and sanitation fibrobronchoscopy were assessed. Arterial hypotension and frequency of postoperative nausea and vomiting were recorded. The length of stay of the patients in the intensive care unit and hospital was recorded. RESULTS: Cortisol levels did not differ between groups (p=0.26). The glucose level in the epidural block group was significantly lower than that in other groups (p=0.011). A significant increase in mean blood pressure and heart rate was observed in the opioid analgesia group (p 0.001). The lowest severity of pain 6 h after surgery was observed in the epidural blockade and lidocaine groups (p 0.001). Perioperative hypotension was more common in the epidural analgesia group (p=0.045). The incidence of postoperative nausea and vomiting was higher in the opioid anesthesia group (p=0.004). In the fentanyl infusion group, sanitary fibrobronchoscopy was more often required to eliminate atelectasis (p=0.039). The number of bed days spent in the ICU was significantly higher in the opioid analgesic group (p=0.002); however, no significant differences were noted between the groups regarding the number of days spent in the hospital (p=0.228). CONCLUSION: Opioid-free anesthesia based on intravenous lidocaine infusion, as a component of anesthetic management in thoracic surgery, provides sufficient perioperative stability of hemodynamic and neuroendocrine status, has a pronounced analgesic effect, with less opioid consumption on the first day after surgery, and helps reduce the length of stay in the intensive care unit and hospital.

BACKGROUND: A pressing issue still remains the reduction of opioid analgesic dosages as a part of anesthesiological support, due to the wide range of complications they cause. An alternative to opioids is opioid-free anesthesia, including the use of lidocaine, which can influence the activity of cytokines, which reflects the advisability of its use in order to prevent an increase in the content of inflammatory markers in the postoperative period. In the domestic and foreign scientific literature, the issue of the dependence of the level of inflammatory markers on the use of non-opioid anesthesia in comparison with opioid anesthesia is relatively little studied, especially in the field of thoracic surgery. AIM: Our aim was to conduct a comparative analysis of the content of cytokines as markers of inflammation during anesthesia using intravenous lidocaine infusion, intravenous fentanyl infusion and a combination of intravenous fentanyl and epidural anesthesia. MATERIALS AND METHODS: A single-center, prospective, randomized study was conducted among 90 patients with a verified diagnosis of lung cancer who underwent video-assisted thoracoscopic (Vlobectomy. Depending on the method of anesthesia, patients were divided into 3 groups of 30 people: in the 1st group, lidocaine was administered, in the 2nd group, fentanyl was administered, and in the 3rd group, fentanyl was administered in combination with epidural anesthesia. The main result of the study was the assessment of the concentration of cytokines in the blood serum (interleukins - IL-2, IL-6, IL-10, as well as tumor necrosis factor α — TNF-α) using an enzyme-linked immunosorbent assay. An additional outcome was a laboratory assessment of the concentrations of glucose and cortisol in the blood serum (the analysis of these indicators was performed to assess the adequacy of anesthetic management in the intraoperative period). Statistical analysis of the results was carried out using the Python v.3.0 programming language in Jupiter Notebook. RESULTS: Analysis of IL-6 content showed a significant difference in favor of group 1 already at the end of the operation (H=10.366691, p=0.0056); 1 day after the end of the operation, the difference in the indicator between the groups increased (H=65.603614 , p 0.001) with the lowest value in group 1. The level of TNF-α at the end of the operation did not reflect significant differences between the groups (H=0.578241, p=0.748922), however, after 24 hours, changes made it possible to note positive dynamics also in group 1 (H=12.928289 , p=0.001558). Similar results were recorded for IL-10 [(H=1.325812, p=0.515352) and (H=9.11072, p=0.010511)] and IL-2 [(H=5.185739, p=0.074805) and (H=23.420171, p=0.000008)], respectively. CONCLUSION: Our results showed that opioid-free anesthesia based on intravenous lidocaine infusion positively correlates with serum concentrations of IL-2, IL-6, IL-10, and TNF-α in patients undergoing thoracic surgery. Serum levels of these cytokines may be indicators of inflammatory responses and may have clinical implications for selecting appropriate anesthesia for patients with lung cancer. In addition, data regarding IL-2 are new and may be associated with tumor progression and the occurrence of distant metastases.

Background: 90% of C-sections are supported by spinal anesthesia, which is complicated by arterial hypotension in 60%-80% of cases. The perfusion index seems to be a significant prognostic tool for arterial hypotension. Objective: Тo confirm the value of perfusion index in predicting arterial hypotension associated with the spinal anesthesia. Materials and methods: The study included 105 female patients who underwent С-section under spinal anesthesia. A decrease in mean arterial pressure by ≤ 20% was considered as arterial hypotension. Baseline perfusion index was assessed with a pulse oximeter. Results: 68 patients (64.8%) developed arterial hypotension in the intraoperative period. In 37 (35.2%) parturient women there were no significant changes in blood pressure. A cut-off threshold of 3.1 with 75% sensitivity and 75% specificity was obtained with the ROC analysis. Arterial hypotension developed in 29.4% (n = 15) of parturient women with a perfusion index < 3.1 and in 72.2% (n = 39) of parturient women with a perfusion index > 3.1. Conclusions: We can use the perfusion index threshold of 3.1 to identify parturient women with an increased risk of arterial hypotension associated with the spinal anesthesia for C-section. The arterial hypotension rate is significantly higher in women with an initial perfusion index > 3.1 compared with those with an initial perfusion index < 3.1.

The authors analyzed studies on the issues of perioperative analgesia in hip and hip joint surgery. Based on the analysis, modern recommendations are presented regarding the choice of optimal anesthetic techniques for proximal femoral fractures and hip arthroplasty. Early surgical intervention in older patients contributes to the restoration of the supporting function of the limb, enables rapid rehabilitation, and reduces the risk of life-threatening complications. This requires pain relief for preoperative preparation and high-quality intraoperative and postoperative pain relief, allowing early rehabilitation of the patient. The review included materials from recent congresses, and webinars of the European Society of Regional Anesthesia Pain Treatment. According to many authors, ileofascial blockade is the method of choice for preoperative anesthesia for proximal femoral fractures. Variants of the blockades of the branches of the lumbar and sacral plexuses in various anatomical spaces and plane blocks are considered. In addition, recommendations of the PROSPECT group (Procedure Specific Postoperative Pain Management) on the use of various technologies in the perioperative period are considered based on data from multicenter randomized trials and meta-analyses in relation to a specific procedure. The effectiveness of new approaches to the branches of the lumbar plexus was also considered, for example, suprainguinal ileofascial blockade and blockade of the pericapsular nerves. Anesthesiologists have used relatively new and traditional tools available to reduce pain and speed up postoperative recovery for patients with injuries and undergoing surgery for the proximal femur. Although the effectiveness of not all of them is confirmed by evidence-based medicine, clinical practice shows a positive effect on their use.

Coronary artery bypass grafting (CABG) is one of the most frequently performed procedures in modern cardiac surgery because it is indicated in most patients with coronary artery disease. Currently, there are no standard methods for regional anesthesia in cardiac surgery. The purpose of this review was to describe the available techniques for regional anesthesia in post-CABG. Studies published in the databases PubMed, The Cochrane Library, Google Scholar, Russian science citation index were included. Techniques reported in the literature were local blockade of the postoperative wound with local anesthetics in the anteromedial chest wall (parasternal-intercostal plane blocks), anterolateral chest wall (interpectoral plane blocks, serratus anterior plane block), and posterolateral chest wall (erector spinae plane block, thoracic paravertebral block, retrolaminar block, rhomboid intercostal block). Numerous studies demonstrate that the use of regional anesthesia as a component of multimodal anesthesia after coronary artery bypass grafting significantly improves pain relief. Blockade of the peripheral nerves of the chest wall under ultrasound guidance can be considered not only as an alternative to epidural anesthesia when not indicated or not feasible. It also contributes to early tracheal extubation, reduced duration of mechanical ventilation, adequate pain control, and a decrease in the need for narcotic analgesics, reduced postoperative nausea and vomiting, and reduced length of stay in the intensive care unit. Further research is needed to determine the optimal technique for performing interfascial blockades of the chest wall post-CABG, which would require data on the effectiveness, safety, and dosing regimen for each specific blockade.

BACKGROUND: Hip joint surgery is a highly traumatic surgical intervention. Currently, the anesthesia service in the clinic of H. Turner National Medical Research Center uses either prolonged epidural block with catheter placement in the lumbar spine at the LIII–LIV level or prolonged intravenous analgesia as the main method of pain syndrome treatment after hip joint surgery. Moreover, the potential of prolonged psoas compartment block has not been considered until recently. AIM: To evaluate the effectiveness of prolonged psoas compartment block for pain control in the early postoperative period after hip surgery in comparison with traditional methods of pain control. MATERIALS AND METHODS: This study analyzed the results of postoperative analgesia in 14 children after 15 surgeries in the hip joint, including 3 patients with prolonged psoas compartment block, 9 with prolonged epidural block, and 3 who received postoperative analgesia with systemic analgesics. One patient with bilateral congenital hip joint dislocation was anesthetized with prolonged psoas compartment block after the first operation for the first time and with prolonged epidural block after the second similar operation but on the other leg for the second time. Analgesia efficacy was assessed using the Wong–Baker scale, FLACC behavioral scale, and visual analog scale. RESULTS: All three patients with prolonged psoas compartment block required an addition of butorphanol tartrate (tramal) for good analgesia. Additional administration of opioid analgesics was not needed when a prolonged epidural block was initiated. CONCLUSIONS: Due to the continued need for additional administration of butorphanol tartrate, when prolonged epidural block was available, the use of prolonged psoas compartment block in children for pain relief in the early postoperative period after hip surgery was not considered appropriate.

Adequate postoperative pain management remains a challenge. We discuss pathophysiology of pain after cardiac surgery and describe in detail multimodal and regional anesthesia, their advantages and disadvantages.

One of the newest methods of interfacial blocks is the erector spinae plane (ESP) block, which is considered to have been first described by Forero in 2016. Given its simplicity and safety, the ESP block is used for postoperative analgesia during surgery on the abdominal organs, chest, breast, and spine and in the treatment of chronic pain. This study aimed to describe the historical aspects of the origin of the blockade of back-straightening muscles and the possibilities of its application in clinical practice. Articles published from January 2023 to April 2023 in PubMed (MEDLINE), Cochrane Library, and RSCI databases were searched by two independent researchers. The date of the last search was April 10, 2023. A total of 546 studies were identified, of which 68 were included in the review. Analysis and synthesis methods were used to construct the conclusion based on the information obtained. The history of the blockade of back-straightening muscles began in 1994 when Professor B.M. Rachkov and Professor V.M. Kustov received a patent Method for treatment of pain in the pathology of the spinal cord and spinal column. The blockade technique proposed by M. Forero was nearly identical to the RachkovKustov method with respect to the direction of needle insertion and the injection site of the local anesthetic solution. The mechanism of action of the ESP block has not been definitively established. Data on possible complications and side effects of the ESP block are presented. Therefore, we have every reason to state that the Russian scientists Professor B.M. Rachkov and V.M. Kustov discovered the blockade of back-straightening muscles and not the Canadian Professor M. Forero. Further studies are needed to determine specific indications and evidence of the efficacy of the blockade of back-straightening muscles in comparison with other regional methods of anesthesia.

BACKGROUND: Paravertebral anesthesia is an old regional anesthesia technique, with a history of more than 100 years. Generally, paravertebral anesthesia is used in adults as a strong analgesic tool for pain treatment. Paravertebral anesthesia is not a simple way of inducing regional anesthesia, as it has several complications. Paravertebral anesthesia has been a serious contraindication in pediatric surgery. At present, technical progress in ultrasonography permits the use of paravertebral anesthesia successfully in children in orthopedics and traumatology practice by discovering new possibilities for the surgical treatment of pain. AIM: This study aimed to assess the current state and near-term prospects of using paravertebral anesthesia as a significant component of anesthesia in pediatric orthopedics and traumatology. MATERIALS AND METHODS: Study data were obtained from public scientific sources, which were searched in the PubMed, Crossref, Google Scholar, Scopus, and RSCI databases without language restrictions. The depth of the information search was 90 years (up to 1932). In this study, analysis and synthesis based on the information obtained were used to build an analytic conclusion. RESULTS: Various case reports and case reviews have described the experience of using thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology, as well as reconstructive surgery and revealed that thoracic paravertebral anesthesia (in combination with general anesthesia) is currently the method of choice, competing with the thoracic epidural block and the high back straightening muscle block. CONCLUSIONS: Paravertebral anesthesia as the psoas compartment block with the ultrasonography control is the most reliable and suitable method of regional anesthesia for pelvis orthopedic surgery.

BACKGROUND: Bleeding at the puncture site during neuraxial blocks is a potentially dangerous complication, and its risk is significantly increased in patients receiving antithrombotic therapy. CLINICAL CASE DESCRIPTION: Patient S. (aged 60 years) was admitted to the department of vascular surgery (Vladivostok). He was diagnosed with Leriches syndrome, for which he took 100 mg of aspirin and 75 mg of clopidogrel. On January 12, 2022, combined spinal-epidural anesthesia was performed, and the epidural space was punctured on the fourth attempt. However, massive bleeding was observed from the puncture site. Intraoperatively, before the great vessels were clamped, 100 units/kg of heparin (8000 units) was administered. After the operation, the epidural puncture site was revised: the sticker was soaked with hemorrhagic discharge and removed, and a new sticker was applied. On January 12, 2022, nadroparin calcium 9500 IU anti-Xa/ml 0.3 mL was given two times a day in the ICU. On the same day, intensive bleeding was noted in the area where the epidural catheter was located. This was treated locally with cold and two doses of fresh frozen plasma. On January 13, 2022, magnetic resonance imaging of the lumbar spine showed the spinal cord without displacement and compression, the puncture area had no signs of bleeding, the epidural catheter was removed, and the patient was discharged for outpatient treatment on day 7. CONCLUSION: To reduce bleeding risk in neuraxial blockade, the recommendations for preparing for surgery patients receiving anticoagulant and antiplatelet therapy must be followed, and the pharmacokinetics of antithrombotic drugs must be taken into account. If puncture and catheterization of the epidural space are technically difficult, manipulation should be abandoned.

AIM: To compare the effectiveness of postoperative analgesia by methods of epidural blockade (EB) and rectus sheath block (RSB) in the early postoperative period in patients who underwent pancreatic surgery. MATERIALS AND METHODS: A retrospective analysis of inpatient case histories of patients after pancreatic surgery at JSC Ilyinsky Hospital for the period from 2019 to 2021 (n=92) was conducted. For the study, 78 cases were selected, which were divided into two groups: the first group (n=46) received EB with a local anesthetic in the postoperative period, and the second group (n=32) underwent RSB followed by the introduction of a local anesthetic solution. RESULTS:The level of pain on the visual analog scale was statistically significantly higher in the first group on day 1(1.07 [0.501.80] and 0.48 [0.081.13], respectively, p=0.013) and day 2 (0.82 [0.251.33] and 0.33 [0.060.75], respectively, p=0.021), and no differences were found on day 3 (p=0.060). The frequency of additional use of opioid analgesia did not differ between the study groups (day 1, p=0.233; day 2, p=0.570; and day 3, p=0.092 The use of norepinephrine infusion in the early postoperative period (p=0.842), daily and cumulative water balance (day 0, p=0.851; day 1, p=0.883; and day 2, p=0.319; day 3, p=0.718; and cumulative balance, p=0.707), and verticalization time (p=0.800) also showed no significant difference.). Orthostatic reactions during early mobilization were noted significantly more often in the EB group than in the RSB group (n=10, 21.7%; n=1, 3.2%, respectively; OR 8.333, 95% CI 1.00866.667, p=0.042). The appearance of the first stool was more common in the EB group (3 [24] days vs. 4 [35] days in the RSB group, p=0.027). No statistically significant difference was found between the groups in the development of infectious complications (p=1.000), gastrostasis (p=0.144), in-hospital mortality rate (p=0.460), ICU days (p=0.305), and lengths of stay (p=0.776). CONCLUSION: The data obtained in the study show the comparability of the use of analgesia methods, such as EB and RSB in patients who underwent pancreatic surgery.

An accidental intrathecal tranexamic acid injection is a rare but extremely unpleasant case, which can lead to severe complications, including death. This review aimed to describe the clinical, pathophysiological changes and outcomes occurring in patients with unintentional tranexamic acid subarachnoid injection during spinal anesthesia. The review includes studies published in PubMed, The Cochrane Library, Google Scholar, and the Russian Science Citation Index databases. There were 31 reports (27 literature reports and 4 own observations) of unintended tranexamic acid administration during spinal anesthesia, including 12 cases in traumatology and orthopedics, 11 cases in cesarean section, and 8 cases in urology and general surgery. Typical signs and symptoms reported by the authors include severe pain in the lower back, buttocks, and lower extremities, seizure syndrome, marked tachycardia and arterial hypertension, and ventricular arrhythmias. Ten (32.1%) patients recovered without any consequences and six (19.4%) patients required long-term rehabilitation after hospital discharge due to severe neurological deficits or cognitive impairment. Of 11 females, 9 died during cesarean section and 4 of 12 patients died in traumatology and orthopedics. Overall, 15 (48.4%) patients had a fatal outcome. An unintentional subarachnoid tranexamic acid injection is a catastrophic event with extremely high patient risk and is accompanied by high mortality, especially in obstetric practice. Intensive care should include intravenous propofol or sevoflurane inhalation in the case of unintentional intrathecal tranexamic acid injection, and cerebrospinal fluid lavage is promising. Developing a formalized protocol for intrathecal administration of local anesthetic solutions is advisable to avoid errors associated with accidental drug administration not intended for spinal anesthesia.

Статья посвящена 175-летию первой анестезии, проведенной Н.И. Пироговым 14 февраля (по старому стилю) 1847 г. Кратко рассмотрены события, предшествовавшие этой дате и последовавшие за ней. Рассказано о достижениях гениального хирурга Н.И. Пирогова, послуживших основой для возникновения и развития новой медицинской науки в России — анестезиологии. Отмечена удивительная способность Н.И. Пирогова использовать очень похожую на современную анестезиологическую терминологию в своих трудах на основе термина «анестезия» и его производных.

Background Chronic neuropathic pain is a common occurrence, its prevalence ranges from 7 to 10% of the total population. Currently, the only official document that includes neuropathic pain is the International Classification of Headaches Disorders (ICHD-3), in which this type of pain is associated with traumatic brain injury and neuralgia. Until now, there has been no generally accepted terminology and classification of chronic neuropathic pain.Objective To provide the current terminology, classification and additional characteristics of neuropathic chronic pain.Results The review of modern terminology and classification of neuropathic chronic pain describes the terms included in the concept of chronic peripheral and central neuropathic pain, identifies pain subtypes, as well as its additional characteristics such as the intensity of neuropathic pain, the severity of suffering and disability.Conclusions Thus, the presented recent classification of chronic neuropathic pain is an exhaustive list of the most common neuropathic pain syndromes. The inclusion of classification into clinical practice will help to draw attention to the problem of treatment of chronic neuropathic pain by WHO members, carrying out epidemiological studies and making a correct diagnosis, and therefore the appointment of adequate treatment methods.