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The objective was to compare the efficacy and safety of morphine in neuraxial blocks during knee arthroplasty.Materials and methods. A retrospective analysis of 60 medical histories of patients who underwent total knee arthroplasty for the period from 2017 to 2019 was performed. All patients were operated under general anesthesia with mechanical ventilation in combination with epidural or spinal analgesia with opiates. Patients of the 1st group (n=20) after catheterization of the epidural space at the level of L1–2 were injected with a morphine solution 1% – 0.3 ml epidurally. Patients of the 2nd group (n=20) were injected with a morphine solution 1% – 0.01 ml intrathecally at the level of L3–4. Patients of the 3rd group (n=20) underwent standard combined anesthesia: general anesthesia with mechanical ventilation and epidural analgesia at the level of L1–2 with a solution of 0.2% ropivacaine in the form of an infusion of 6 ml/hour. All patients received infusion of 0.2% solution of ropivacaine epidurally 6 ml/hour at the level of L1–2 in the postoperative period.The incidence of nausea, vomiting, pruritus, headache and the level of postoperative pain syndrome were assessed on a numerical rating scale 6 hours after the end of the surgery.Results. The level of pain syndrome in patients who received intrathecal and epidural analgesia with morphine was equally low, while in patients who received epidural analgesia with ropivacaine, the level of pain syndrome was statistically significantly higher, which required the additional prescription of non-steroidal anti-inflammatory drugs and/or narcotic analgesics parenterally. The frequency of nausea, vomiting, pruritus and headaches was maximum in the 2nd group, significantly lower in the 1st, while in the 3rd, pruritus did not occur.Conclusion. The use of morphine in neuraxial block in knee arthroplasty has a positive effect on the quality of anesthesia and postoperative pain relief.

Objective. To assess the overall and disease-free survival rates in patients with EGFR-mutated lung adenocarcinoma, who underwent surgery after achieving the objective response to tyrosine kinase inhibitor (TKI) therapy.Material and Methods. The overall and disease-free survival rates were analyzed in 18 patients with EGFR-positive lung adenocarcinoma, which was inoperable at presentation due to locally advanced disease or the evidence of distant metastasis. In accordance with the clinical standards, patients were recommended for TKI therapy. Surgical resection was performed after achieving the objective tumor response to TKI therapy. The control group included 23 patients with EGFR mutation-positive lung adenocarcinoma, who did not undergo surgery after receiving TKI therapy.Results. The study revealed a statistically significant effect of surgical resection on the overall survival (OS) in patients with EGFR mutation-positive stage III–IV lung adenocarcinoma after response to TKI therapy (p=0.004). However, there was no statistically significant effect on the disease-free survival (DFS) (p=0.40). There was a tendency to increase in the median OS in patients of the study group (46 months) compared to that in patients of the control group (26 months). Surgery in the study group was characterized with some technical difficulties associated with severe fibrosis. However, this did not affect the duration of surgery and the volume of blood loss.Conclusion. Tumor resection in patients with EGFR mutation-positive stage III–IV lung adenocarcinoma is feasible and safe, but requires highly qualified team surgeons in well-equipped medical centers. Our study revealed that the combination of EGFR-TKI and tumor resection provided better PFS and OS than EGFR-TKI alone. However, further studies are required.

The pain and pain syndrome remain to be serious problems of clinical medicine and surgery as one of its aspects. The positive correlation was found out between the type of surgery and post-operative pain in abdominal, thoracic and orthopedic surgeries. Materials and methods. Results of a questionnaire survey in 130 patients were analyzed; from 2015 to 2017 all those patients had lobectomies for lung cancer using video-assisted thoracoscopic or open accesses in the Thoracic Department of Petrov National Medical Research Center of Oncology. The intensity of pain and life quality in the post-operative period were assessed using visual analogue scales, the Wong-Baker FACES pain rating scale, verbal rating scales, and McGill pain questionnaire. In order to assess life quality, the non-specific questionnaire of SF-36 was used in the cancer patients and those enrolled in the clinical studies of EORTC QLQ-C30 including the special module of QLQ-LC13 for lung cancer patients. The obtained results were analyzed and it was found out that intensity of pain was statistically significantly lower in video-assisted thoracoscopic access versus thoracotomy (U = 678.00; p < 0.05). When using the questionnaires of SF-36 (U = 8,742.50; p < 0.05) and EORTC QLQ-C30 (U = 3,759.00; p < 0.05) and the special module of QLQ-LC13 for lung cancer (U = 4,243.00; p < 0.05), the obtained data also indicated the better life quality and functions, reduction of pathologic manifestations versus open surgical access. Conclusion: Reduction in the pain intensity and higher life quality were typical of surgeries with use of video-assisted thoracoscopic technologies versus classical open access.