Premedication during chemotherapy in a broad sense is required for everyone starting a cycle, because it allows you to speed up subsequent recovery. In a narrow sense, premedication is necessary when using a small number of specific anticancer drugs that cause life-threatening complications already during administration. The second indication is a mandatory treatment option, and the first is available to very few patients in the proper amount.
- What is chemotherapy?
- Premedication and preparation for chemotherapy
- Improving liver function before chemotherapy
- Prevention of blood clots
- Chemotherapy course prices
What is chemotherapy?
For patients, chemotherapy is any antitumor treatment, while formally it is assumed that only cytostatics are used without hormonal, targeted drugs and immuno-oncological agents.
Chemotherapy kills cells, malignant and normal, a single dose of a cytostatic is not the maximum effective amount of medicine, but a mass of a chemical reagent that allows one to maintain some balance between possible effectiveness without intolerable toxicity.
Before entering into widespread practice, an antitumor drug is comprehensively tested in a clinical trial, which involves patients suffering from advanced cancer who have undergone more than one course of chemotherapy. The effect of the drug on the life expectancy of patients and the range of adverse reactions are being studied. The drug receives approval for use if it prolongs life by several weeks, but only with a minimal percentage of severe toxicity.
The introduction of an anticancer drug into clinical practice does not stop its study in observational studies, where side effects are scrupulously calculated; it should be noted that the effectiveness of the drug is often increased because it is used not only on patients deprived of prospects, as in a clinical trial, but also on primary patients .
Preparations for local anesthesia
Local anesthetics are drugs from the group of neurotropic drugs that completely or partially block the flow of signals along nerve fibers from the site of painful manipulation or surgery to the central parts of the nervous system.
The peculiarity of the action of drugs is related to their spectrum of action. They suppress the transmission of signals along myelinated type A nerve fibers, which transmit feelings of pain, smell, and temperature. Tactile sensations are carried out through type B fibers, and anesthetics do not affect them. Therefore, when using local anesthesia, the patient does not feel pain, but feels the touch of the doctor and the surgical instrument.
Local anesthetic drugs are divided into 3 groups depending on the duration of action:
- short-acting - the effect lasts 30-50 minutes, these include Novocain;
- average duration - up to 90 minutes, these are drugs Lidocaine, Trimecaine, Ultracaine;
- long-acting – the effect lasts more than 90 minutes, typical for Bupivacaine.
Local anesthetic drugs affect the electrochemical processes of ion exchange in nerve endings. Medicines work effectively in an alkaline environment and tissues rich in lipids, which include nerves. But the analgesic effect decreases with severe tissue inflammation, which is associated with a transition of pH to the acidic side.
The effect of local anesthetics is enhanced by drugs that affect vascular tone. Therefore, they are often combined with adrenaline to prolong the effect. This allows you to reduce the dose of pain medication and avoid toxic reactions.
Premedication and preparation for chemotherapy
Special medicinal preparation - premedication requires a few drugs, as a rule, already at the “first drop” they threaten either a severe allergic reaction or a difficult to tolerate whole complex of symptoms - a syndrome.
For example, preparation for intravenous drip administration of taxanes begins 12 hours in advance, when the patient takes a huge dose of hormones that prevent a severe hypersensitivity reaction, which in the first clinical trial led to the death of 2% of patients.
Before the administration of irinotecan, to relieve the cholinergic syndrome with painful diarrhea, fainting, profuse sweating, leakage of tears and saliva, toxicity-reducing and long-known drugs are administered. In clinical studies, the syndrome was observed in every 11th patient; before the introduction of mandatory premedication, such patients could not receive the necessary treatment.
These are special cases of drug preparation for the use of cytostatics; in a broad sense, every patient needs preparation for chemotherapy. If in the first cycle we can limit ourselves to the prophylactic use of antiemetics, then in all subsequent cycles it is possible to prevent adverse reactions, based on the experience of the initial use of the drug combination and taking into account the consequences, including forced malnutrition.
Preparation requires an individual approach, because it takes into account what happened to a particular patient during the previous treatment, the loss of his body, the speed of recovery and tissue repair reserves, not forgetting concomitant diseases. General standard approaches such as “everyone is the same” are also appropriate, but of little use; in our Clinic, an individual program of preparation for chemotherapy is developed for each patient.
What is operated under local anesthesia in mammology?
The mammary glands are located superficially, they do not have muscles and large nerve trunks. Breast tissue is loosely located; in young women, glandular tissue predominates, which is replaced by fatty tissue with age. Therefore, for numerous manipulations and operations, local anesthesia can be used.
In mammology, anesthesia is used to perform invasive diagnostics, which include breast tissue biopsy. To do this, a local anesthetic is injected with a thin needle into the area of the intended puncture. After 10-15 minutes, the doctor can take breast tissue for examination without fear of causing pain to the patient.
Local infiltration anesthesia in mammology is used for small, minimally invasive operations. A woman can undergo puncture of a breast cyst after preliminary infiltration anesthesia. A similar approach can be used when removing small benign breast tumors.
In men, anesthesia is used during surgery for type 1 gynecomastia, when the size of the gland is still small. Infiltration of tissues increases hydrostatic pressure in them, thanks to which the doctor can easily separate pathological tissues from healthy ones.
Improving liver function before chemotherapy
All anticancer drugs damage liver cells to varying degrees. The patient may be a carrier of factors that aggravate toxic damage: age-related changes, hereditary diseases and underlying liver disease, negative eating behavior with fat deposition in the liver parenchyma, and chronic diseases that require long-term medication.
Clinical manifestations of hepatotoxicity are variable, ranging from changes in blood biochemistry to liver failure.
After toxic hepatitis is established, chemotherapy should also change:
- in grade 1, regular blood test monitoring is sufficient;
- at grade 2, the dose of the drug is reduced;
- at grade 3-4, treatment is stopped.
To relieve the manifestations of drug toxicity, symptomatic therapy of liver complications and support of organ function with heptral and ursodeoxycholic acid (UDCA) drugs involved in the metabolism of hepatocytes are carried out; sometimes there is a need for replacement therapy with albumin. The results of symptoms are assessed by biochemical blood parameters, and therapy may take several months.
But you don’t have to wait for hepatotoxicity, because there is a real opportunity to maintain the health of hepatocytes, delay or significantly reduce the manifestations of toxic hepatitis. You will be told how this is done after the examination in our clinic.
Types of local anesthesia
Several types of local anesthesia are used in surgical practice, but some of them already have historical significance. The main methods of pain relief are the following:
- superficial anesthesia - pain sensitivity is suppressed after the anesthetic comes into contact with the surface of the tissue, most often used to anesthetize the mucous membranes. The anesthetic solution is applied by lubrication or irrigation, the effect lasts for 10 minutes;
- infiltration anesthesia - anesthesia by impregnation, or infiltration of tissue layers with a local anesthetic. The technique allows you to control the depth and width of the drug injection, depending on the intended incision. The medicine is injected carefully first into the subcutaneous area until the lemon peel effect appears, then the needle is gradually moved inward and an additional dose of the drug is injected;
- anesthesia according to Vishnevsky is an improved version of the infiltration method. A weak anesthetic solution is injected layer by layer under high pressure. A tight creeping infiltrate forms in the tissues. It spreads through the interfascial spaces and disrupts the conduction of impulses along the nerves passing through them. After cutting the wound, the liquid gradually flows out of the wound, so there is no risk of its absorption into the systemic circulation and the development of toxic reactions;
- conduction anesthesia is the essence of the method in anesthetizing a specific area of the body innervated by the nerve trunk. An anesthetic drug is injected into the tissue around the nerve; the technique is used for operations on the limbs;
- spinal anesthesia - the analgesic effect is achieved by injecting an anesthetic drug under the choroid of the spinal cord, the main place of drug administration is the lumbar region, and pain sensitivity in the pelvic organs and lower extremities disappears. But tactile sensitivity does not suffer;
- epidural anesthesia is a type of anesthesia in which a local anesthetic is injected into the space over the dura mater of the spinal cord, and a puncture is also performed in the lumbar region. Sensitivity is lost after 15-20 minutes, but the effect lasts for 3-4 hours. The use of this type of anesthesia allows you to resume activity early after surgery;
- bone anesthesia is a type of anesthesia in which an anesthetic solution is injected into spongy bone. Currently, it is practically not used; previously it was used for operations on the limbs.
Prevention of blood clots
Every cancer patient has a risk of thrombosis, and with chemotherapy this risk increases ninefold. Today, the prevention of thrombotic complications is included in the standard of preoperative preparation and management of the patient after surgery. It is not always possible for a patient to receive the necessary treatment during chemotherapy, since prescribing anticoagulants is not within the scope of the oncologist’s professional capabilities and also requires regular monitoring of indicators.
If an examination and a visit to a specialist are necessary to prescribe anticoagulants, then during chemotherapy there are no obstacles to the mechanical prevention of blood clots with stockings and bandages. In addition to the “ancient” methods, during chemotherapy, hardware pneumatic compression and venous pumps are possible; after a previous thrombosis, a special clot catcher is installed in a large vein - a high-tech vena cava filter.
Is it painful to do local infiltration anesthesia?
When performing anesthesia, a standard disposable syringe with a thin needle is used. Whether local anesthesia is painful depends on your general pain threshold. The patient feels the moment of the first puncture of the skin and a slight feeling of fullness when the drug is administered. After the medication begins to act, sensitivity disappears. The doctor checks how effective the injection is by tapping the skin. In response, there is a feeling that the injection site has become woody.
After the end of anesthesia, sensitivity gradually increases, and a slight tingling sensation may appear. If anesthesia was performed for surgery, pain in the wound area begins to bother you, which can be reduced with the help of non-steroidal anti-inflammatory drugs.
Chemotherapy course prices
- Consultation with a chemotherapist— RUB 6,900.
- Carrying out intravesical chemotherapy (without the cost of drugs) - 26,400 rubles.
- Carrying out intraperitoneal chemotherapy (without the cost of medications) - 24,100 rubles.
- Immunotherapy (without the cost of medications) - 19,000 rubles.
- Intrathecal chemotherapy - 26,600 rubles.
- Carrying out hyperthermic intraperitoneal chemotherapy - 352,000 rubles.
- Carrying out chemotherapy using an infusion pump for 1 day (without the cost of medications) - 22,600 rubles.
- Carrying out anti-PD-1 therapy - RUB 423,500.
Euroonco clinics specialize in the treatment of all known malignant tumors; we have brought together oncology professionals and doctors of other specialties. Ask your oncologist what can be done in your case before and after the course.
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Bibliography:
- Somonova O. V., Antukh E. A., Elizarova A. L., et al. / Practical recommendations for the prevention and treatment of thromboembolic complications in cancer patients // Malignant tumors: Practical recommendations RUSSCO #3s2, 2018 (vol. 8).
- Tkachenko P. E., Ivashkin V. T., Mayevskaya M. V. / Clinical recommendations for the correction of hepatotoxicity induced by antitumor therapy // Malignant tumors: Practical recommendations RUSSCO #3s2, 2022 (vol. 8).
- Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines // Chest Am Coll Chest Phys.; 2012
- Khorana AA, Kuderer NM, Culakova E., et al./ Development and validation of a predictive model for chemotherapy-associated thrombosis// Blood 2008; 15.
Implementation in dentistry
Factors considered as indications for premedication include:
- Preparation for long operations of increased complexity requiring the use of general anesthesia;
- Fear and anxiety observed in patients who previously suffered from pathologies of respiratory and cardiac functions;
- The likelihood of fainting;
- Diagnosed autonomic abnormalities, as well as changes in physical parameters;
- Carrying out implantation, which involves replacing missing root elements with titanium rods.
