Журнал «Медицина неотложных состояний» 8 (55) 2013

Introduction. Pathophysiological pain always accompanies the release of mediators of pain, among which is the importance of histamine. The cause of pain is the accumulation of histamine in the tissue fluid that bathes the nerve endings. Histamine - the main mediator of pain. In the blood is released by granulocytes and damage, easily moving into the plasma. Accordingly, the study authors, the dynamics of the level of histamine can be studied as a marker of pain. Therefore, the study of the dynamics of the level of histamine probably reflects the state of pain impulses in patients with colorectal cancer.

The goal of the study was to investigate the intensity of pain in patients with colorectal cancer according to the dynamics of the level of histamine and its treatment by epidural chemical neyrolizysu.

Materials and methods. In order to solve this problem on the basis of the Kharkiv Regional Clinical Cancer Center conducted a clinical study. It was attended by 104 patients. Among them: 43 (41,34%) men and 61 (58,65%) female. The average age of the patients was 63,3±1,2 years. In all patients at admission was present chronic pain - pain for 6 months. The presence of colorectal cancer stage III-IV according to Dukes C.E. (1956), it was determined histochemically. Patients underwent surgery with organ lymph node dissection D₂-D₃. The patients were divided into two groups of the study.

I (n=49) - control group, which included general anesthesia to his standard stages and postoperative pain relief in accordance with the "Standards organizations and career-oriented protocols provide emergency care to patients with surgical pathology in the abdomen and chest." In the early postoperative period for analgesia in this study group were injected narcotic analgesics. II (n=55) - the main group study in which the scheme was supplemented epidural analgesia chemical neyrolizysom. In the postoperative narcotic analgesics for pain relief were not applied.

The level of histamine in the blood was determined by fluorometric method to modify the Shore VV Menshikov. Fluorometric measurements were performed on the fluorescent fluorometer «Hitachi» (Japan).

The intensity of pain was evaluated in the preoperative period of 1 day, 2 day, 3 day, 5 day, 7 day, 14 day and 28 day.

In the early postoperative period in patients I (n=49) of the control group for analgesia was administered at a dose of narcotic analgesics 0,25-0,35 mg/kg for seven days.

Patients II (n=55) of the main study group during the first day was administered epidural bupivacaine 0,5% solution at a dose of 30-40 mg conventional method. Defined area of ​​analgesia, duration of anesthetic. On the second day 30 minutes after administration of 40 mg of 0,5% bupivacaine solution was injected 30º alcohol solution in a volume of 4,71±0,29 ml. Over the next 5 days was estimated effect of the chemical neyrolizysu. During these 5 days was injected into the epidural space: 0,5% solution of bupivacaine in doses of 20 mg at different multiplicity depending on the intensity of pain revmoksykam + 1%-15 mg intramuscularly, the night was administered bupivacaine 0,5% solution at a dose of 30 mg + Promedolum 2%-10 mg.

Results and discussion. In the study we found wave-like dynamics of histamine. The initial period was characterized by an unambiguous increase (p=0,000336) histamine levels relative to normal values ​​in both groups researches at 18,18%, which confirmed the identity of this indicator in the study group. During the induction of histamine levels in group I patients not significantly increased (p=0,0051) at 9,09% and at exactly (p=0,000742) 21,81% in group II relative to the physiological norm. However, early surgical approach histamine levels in both study groups was around normal values, which are likely to be associated with general anesthesia. The main stage of the operation marked increase (p=0,000318) histamine in group I patients at 27,27% compared to normal values, while in group II, he remained on the upper limit of normal (0,55±0,99 mg/ml ). After transfer to Department of Anesthesiology and Intensive Care, we found a negative trend (p=0,000146) level of histamine in the study group I at 34,54% and unreliable dynamics (p=0,00124) 9,09% in group II compared to physiological norm. 1 night histamine levels in group I patients increased (p=0,000717) at 41,81% compared to normal. However, in group II are from 1 day to 28 days, inclusive, N rate level accepted normal values, which undoubtedly characterized the positive effect of projective techniques developed chemical neyrolizysu in patients with colorectal cancer stage III-IV. These facts also confirmed further dynamics of histamine on postoperative day 2. In group I kept histamine previously shown a negative trend to increase (p=0,000514) at 34,54% compared to normal values. In the group II studies, he remained at the level of physiological norm. On day 3 we found increased level of histamine (p=0,000179) at 36,36% in group I in relation to the physiological norm. Despite the variability index in group II, the study did not exceed the limit of normal values. 5 night histamine levels increased (p=0,000333) at 29,09% in group I patients compared with normal values, indicating the body's response to pain impilsatsiyu. We found 7 days after surgery histamine levels increased (p=0,00564) by 10,9% and (p=0,00964) 16,36% on day 14 relative to the norm, which confirmed the presence of pain. At the 28 day histamine levels were within the normal range in both groups researches, indicating attenuation of pain impulses.

Conclusion. We describe the dynamics of the reaction reflects the level of histamine in response to acute pain. Uniformity study groups in terms of histamine kept only 1 day postoperative period. In group II the level of this indicator was within the physiological norm until the last stage. While both group I patients histamine levels remained elevated up to 14 days, taking the maximum value is 1 day postoperative period. This indicates considerable pain impulses in patients with standard anesthesia and its absence in the use of epidural chemical neyrolizysu.