Аннотация
Objective. Purpose of the study: to select an effective method of pain relief by conducting a cost-effectiveness analysis of regional blockade methods for postoperative pain relief during robot-assisted total hysterectomy.Methods. A prospective study of female patients (n=101), with physical status ASA I-II, who underwent laparoscopic robot-assisted total hysterectomy under multicomponent general anesthesia. In random order, patients were randomized into three groups: the first group (CON, n=40) - control, where no blockade was performed, the second group (TAPB, n=30) - a blockade of the transverse abdominis muscle, the third group (QLB, n= 31) – blockade of the quadratus lumborum muscle was performed. After blockades and tracheal extubation, patients were transferred to the recovery room, where pain was assessed using a visual analogue scale (VAS) at 1 and 2 hours after surgery. Postoperative nausea and vomiting (PONV) was assessed using a categorical scoring system. We also assessed: mean arterial pressure, heart rate, patient satisfaction with analgesia and level of well-being (questionnaire).The criteria for the effectiveness of pain relief methods were: the number of patients (%) in the group whose pain level according to VAS was up to 4 points, in whom the change in mean arterial pressure was no more than 20% of normal, the number of patients (%) in the group who did not have PONV and the level of well-being is satisfactory and the number of patients (%) who are satisfied with the anesthesia and analgesia performed.The cost of treatment in the recovery room and the cost of analgesia, including the cost of blockade methods, and the cost of an hour of treatment in the recovery room were calculated. The cost-effectiveness ratio was calculated using the ratio of the cost of an hour of treatment in the recovery room and efficiency criteria, where the most effective method is the one with the lowest coefficient. To identify the level of costs or cost savings to achieve one additional unit of efficiency, an analysis of “incremental cost effectiveness” was carried out.Results. There were no differences in demographic characteristics, duration of surgery, or analgesic consumption during the intraoperative period. Stable hemodynamics were noted in the groups where blockades were performed; the level of pain in the first hour after surgery was lower in the QLB group (p<0.05). PONV was noted more by patients in the first group. Patient satisfaction with treatment in the recovery room was high in the TAPB group and, accordingly, the degree of patient well-being was higher than satisfactory. The cost of an hour of treatment in the recovery room was more expensive in the QLB group, TAPB was slightly less expensive, the costs of the first group were 63% less. From the point of view of cost efficiency, TAPB is more optimal, since each unit of efficiency requires less costs, i.e. 535.6 tenge/unit.Conclusions. In terms of cost-effectiveness per unit of success, ultrasound-guided TAVR is the most acceptable and technically simple to perform.Key words: transversus abdominis plane block, quadratus lumborum block, robot-assisted total hysterectomy, cost-effectiveness, clinical and economic analysis.