Pain in surgical interventions large and medium trauma
One of the main causes of postoperative complications is considered a surgical stress response — a complex of changes in neuroendocrine, metabolic and inflammatory nature, evolving as a result of surgical trauma. Surgical stress response becomes the main cause of perioperative dysfunction of various organs and systems (pain, catabolism, impaired immunity and hemostasis dysfunction lungs, gastrointestinal tract, and cardiovascular system). The assessment of the intensity of postoperative pain during surgery various traumatic for subsequent development of recommendations for the prevention and treatment is an important issue.
The purpose of the study is — to examine the intensity of postoperative pain in surgical interventions in various traumatic conditions multidisciplinary surgical clinic.
To estimate the intensity of postoperative pain used visual analogue scale of pain intensity.
Observation lasted from 0 hours to 72 hours of the postoperative period, inclusive.
Assessment of the intensity of postoperative pain was conducted in three groups: group 1 (n = 68) — the average trauma surgery, group 2 (n = 82) — large trauma, group 3 (n = 23) — surgery for gunshot wounds of abdominal and retroperitoneal space. Groups 1 and 2 were matched by sex and age. The third group consisted of 100% of men aged 28 to 62 (average 36,6 ± 3,33).
Postoperatively, patients in all three groups were divided into subgroups based on various schemes analgesia: using epidural anesthesia and epidural anesthesia without. Additionally, the group was divided into subgroups: intramuscular or promedola promedola with deksotoprofenom.
Ropivacaine infusion rate selected individually depending on the intensity of pain and blood pressure (reduction allowed no more than 20-25% of the original). In the amplification of pain in all groups assigned the additional administration of non-steroidal anti-inflammatory drugs.
During surgery large traumatic average pain intensity on a visual analogue scale in groups without the use of epidural anesthesia is in the range of severe pain; for epidural anesthesia — the range of average pain intensity.
Starting epidural anesthesia after injury is less effective — the duration of preservation increases postoperative pain compared with ispolzovnii epidural analgesia as part of a multimodal anesthesia during surgical benefits, followed by a continuation in the postoperative period. This can be attributed to the launch of the mechanisms of central sensitization. Danoe assertion proved significantly when assessing pain in patients with gunshot wounds, where the epidural began significantly Pozdneev injury. Use the nonsteroidal anti-inflammatory drugs significantly effective as a component of routine postoperative analgesia only during surgery without the use of secondary traumatic epidural.
We have also studied the need for additional doses of nonsteroidal anti-inflammatory drugs because of significant pain syndrome. For additional demand we have been more than double the administration of drugs over specified group designated plan analgesia for 72 hours after surgery. Significant proportion of additional analgesia in all groups studied is the need to find ways to further optimize postoperative analgesia, in particular, use of preventive anesthesia. Additional administration of non-steroidal drugs protivovopalitelnyh required in all groups of patients. Unscheduled anesthesia was necessary more often with epidural anesthesia, which started in the postoperative period, compared with the beginning of anesthesia to opertsii at close to trauma surgery. Significant proportion of additional analgesia in all groups studied is the need to find ways to further optimize postoperative analgesia, in particular, use of preventive anesthesia.
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Любошевский П. А. Хирургический стресс-ответ при абдоминальных операциях высокой травматичности и возможности его анестезиологической коррекции: автореф. дис. … д–ра мед. наук: 14.01.20 / П.А. Любошевский. – Ярославль, 2012 . – 21 с.
Осипов С.А., Сравнительная оценка действия местных анестетиков в сочетании с морфином при их эпидуральном введении / С.А. Осипов, И.В. Червякова, В.Е. Киселевич и др. // Анестезиология и реаниматология. – 1993. – № 1. – С. 70 – 73.
Breivik Н. Postoperative pain management / Н. Breivik // Bailliere's Clinical Anaesthesiology. – 1995. – V. 9. – P. 403 – 585.
Campiglia L. Pre-emptive analgesia for postoperative pain control: a review / L. Campiglia, G. Consales, A.R. De Gaudio // Clin. Drug Investig. – 2010. – Suppl 2. – Р. 15–26.
Carr D. Acute pain / D.Carr, L. Goudas // Lancet. – 1999. – V. 353. – P. 205 1– 2058.
Chauvin M. Postoperative patient management. Pain after surgical intervention / M. Chauvin // Presse Med. – 1999. – V.28. – P.203 – 211.
de Leon Casasola. The effects of epidural bupivacaine morphine and intravenous PCA morphine on bowel function and pain after radical hysterectomies / de Leon Casasola , D. Karabella, М. Lema // Anesth Analg. – 1993. – V.76. – P.73.
Dolin S. Effectiveness of acute postoperative pain management: I. Evidence from published data. / S. Dolin, J. Cashman, J. Bland // Br.J.Anaesth. – 2002. – V.89. – P.409– 423.
Gottschalk A., Sharma S., Ford J., et al. The role of the perioperative period in recurrence after cancer surgery / A. Gottschalk, S. Sharma, J. Ford, et al // Anesthesia & Analgesia. – 2010. – Vol. 110, N 6. –P. 1636–1643.
Harmer M. The effect of education, assessment and a standardised prescription on postoperative pain management. The value of clinical audit in the establishment of acute pain services / M. Harmer, K. Davies // Anaesthesia. – 1998. – V.53. – P.424 – 430.
Kehlet Н. Postoperative pain / Н. Kehlet, J.B. Dahl // World J.Surg. – 1993. – V.17. – P.215–219.
Neugebauer E. Recommendations and guidelines for perioperative pain therapy in Germany / E. Neugebauer, H. Wulf // Langenbecks Arch Chir Suppl Kongressbd. – 1998. – V.115. – P. 666 – 671.
Shipton E.A. Pain acute and chronic / E.A. Shipton. – New York : Oxford University Press, 1999. – 378p.
Tuman K. Effects of anaesthesia and analgesia on coagulation and outcome after major vascular surgery / K. Tuman, R. McCarthy, R. March // Anesth.Analg. – 1991. – V.73. – P.696 – 704.
Vadivelu N. Preventive analgesia for postoperative pain control: a broader concept. / N. Vadivelu, S. Mitra, E. Schermer, V. Kodumudi, A.D. Kaye, R.D. Urman // Local Reg Anesth. – 2014. – Vol. 7. – Р. 17–22.
Yeagcr М. Epidural anaesthesia and analgesia in high risk surgical patjents / М. Yeagcr, D. Glass, R. Neff, F. Brick Johnsen // Anesthesiology. – 1988. – V.73. – P. 729 – 736.
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