Журнал «Медицина неотложных состояний» 6 (61) 2014

Summary. The study analyzed the intensity of pain in patients with colorectal cancer. Pain syndrome accompanied by the release of hormones delta- cells of islets of Langerhans of the pancreas, in particular the somatostatin which acts a mediator of pain. Objective of the study was to examine the intensity of pain in patients with colorectal cancer, depending on the hormonal response of the organism and its treatment by chemical neurolysis epidural. When studying the dynamics of somatostatin in the pre- and postoperative period, we estimate the intensity of pain from the quantitative characteristic of the hormone. Were analyzed postoperative analgesia standard narcotic analgesics in group I patients and epidural analgesia with chemical neurolysis patients in group II study. So, using our method of epidural chemical neurolysis as effective treatment of pain in patients with cancer, we were able to study the physiological response of the body to pain.

Introduction. Severe pain leads to a pathological condition in which the disturbed body's ability to adapt to new conditions of life. Pain causes activation of neuroendocrine and sympathoadrenal systems, accompanied by the release of neurotransmitters, hormones and bioactive substances, mediators of pain, including essential takes somatostatin. Somatostatin - hormone delta -cells of islets of Langerhans of the pancreas, as well as one of the hormones of the hypothalamus. According to the study authors, the dynamics of somatostatin can be studied as a marker of pain. Therefore , the study of the dynamics of somatostatin probably reflects the state of pain impulses in patients with colorectal cancer. The object of the study was to investigate the intensity of pain in patients with colorectal cancer according to the dynamics of somatostatynunu and its treatment by epidural chemical neurolysis.

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

I (n = 49) - control group, which consisted of general anesthesia to a standard stages and postoperative pain relief in accordance with the "Standards organizations and career-oriented protocols provide emergency care to patients with surgical disorders of the stomach and chest". In the early postoperative period for the purpose of pain in the study group were injected narcotic analgesics. II (n = 55) - a core group of studies in which the scheme was supplemented epidural analgesia chemical neurolysis. In the postoperative narcotic analgesics for the purpose of anesthesia is not used.

The level of somatostatin levels were determined by solid ELISA ELISA (enzyme - linked immunosorbent assay, ELISA) in serum. Used commercial kits firms Human Somatostatin, SS ELISA Kit (USA).

The intensity of pain was assessed preoperatively, 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 to 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 groups 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 at 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 administered in 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 0,5% bupivacaine solution at a dose of 30 mg + Promedolum 2% to 10 mg.

Results and discussion. In the study we found wavelike dynamics of somatostatin. Preoperative period characterized by rising levels of somatostatin on (p = 0,000155) 34,45 % in group I and in the study (p = 0,000537) 34,25% in group II of normal values, confirming the homogeneity of the groups on admission to the hospital. Induction phase characterized by the increase (p = 0,000748) of the index in I group at 17,29 % and (p = 0,00571) and 21,2% in group II with respect to physiological values. Early surgical approach, we noted that the level of somatostatin took a negative trend growth (p = 0,000329) in group I patients to 50,91 % and in group II at (p = 0,000466) 16,79 % compared to normal values . The main stage of the operation in group I marked lack of dynamics studied parameters, which remained above normal for (p = 0,000843) 51,16 % and in group II patients for (p = 0,000547) 25,95%. When patients transferred to NICU somatostatin increased (p = 0,000974) in 26,45% of patients in group I and at (p = 0,000833) 9.29% in group II compared with physiological values. 1 night study somatostatin levels in group I grew up on (p = 0,000897) 22,33% with respect to the physiological norm. While , as in group II it 1 day early postoperative somatostatin level was recorded within physiological values and remained so until 28 days study, determined using the proposed technique EHN as an effective protection of pain in patients with colorectal cancer III-IV stage. After 2 days early postoperative period was kept negative trend to higher levels of somatostatin on (p = 0,00158) 17.45% in group I than normal . 3 era was characterized by the absence of the dynamics of the studied parameters in the I group. On the 5th day of somatostatin levels in group I patients exceeded (p = 0,0088) at 9,7% limit of the physiological norm, and 7 days at 9,25% (p = 0,0049). On day 14 the level of somatostatin started I fell in the study group to the limits of physiological norm.

We describe the dynamics of somatostatin evidence of its role in the development of pain. However, the use of different methods of anesthesia, we note the difference in the study groups in terms of mediator in early surgical approach. During the main phase of surgery somatostatin remained elevated in both groups of patients, indicating a physiological response of the organism to surgical stress. However, since day 1 of early postoperative levels of this mediator in group II took marked physiological values and remained so for subsequent phases of the study. While both group I patients somatostatin levels remained elevated for at least 5 days early postoperative period and decreased to normal values only on day 7 of the study. This fact confirms the effectiveness of the chosen method of epidural chemical neurolysis eliminated for pain in patients with colorectal cancer stage III-IV.

Conclusion. The level of somatostatin characterized wavelike dynamics during the main phase of the operation and after the transfer of patients to NICU as in I, and in group II patients, confirming the role of somatostatin in the development of pain. However, in the study group II since 1 day early postoperative period, we noticed a positive downward trend (p = 0,00876) of somatostatin, which remained within the physiological norm for the next stages of the study. The dynamics of neurotransmitter in the study group was explained using epidural chemical neurolysis as an effective protection of pain in patients with colorectal cancer stage III-IV. While both the I group during this period somatostatin levels remained elevated (p = 0,00658) with respect to the physiological norm. The level of somatostatin in the study group reached a value standards only 2 days early postoperative period, indicating the pain impulses in group I of the study. The study of hormonal and biochemical active substances in patients with colorectal cancer stage III-IV with pain, allowing you to choose an effective method of pain relief in the early postoperative period.