DOI: https://doi.org/10.15674/0030-59872016270-74

Perioperative multimodal analgesia in orthopedic and trauma patients for minimal invasive surgical intervention

Oleksandr Buryanov, Yuriy Sobolevskiy, Taras Omelchenko, Ruslan Babochkin, Mariya Andreeva

Abstract


The goal: to evaluate the effectiveness of the proposed method of perioperative multimodal analgesia with complex use of non-opioid analgesics only of central and peripheral actions during minimally invasive surgical procedures compared with the conventional scheme of multimodal analgesia using opiate analgesics and adjuvant preparations.

The methods: patients aged from 18 to 65 years (33.6 years) were divided into two groups. Main group (89 patients): non-narcotic analgesics of central and peripheral actions (dexketoprofen and paracetamol) were used in the complex multimodal analgesia. Comparison group (61 patients): opioid analgesics (Promedolum) were used. Efficacy was assessed after recovery of active movements and sensitivity in lower extremities (on average 4 hours after spinal anesthesia) using following criteria: pain intensity on a visual analogue scale before and 1 and 6 hours after the administration of analgesic, required total duration of anesthesia, the mean duration of analgesia, the effect of the drug on the patient’s state of health and occurrence of side effects.

Results: it was shown that the rate of occurrence of analgesia in both groups had no differences, but its duration in the study group was higher — (8.1 ± 1.9) h against (5.7 ± 1.6) h in the comparison group. This fact proves prolonging effect of the analgesic action of the combination of paracetamol and dexketoprofen. The absence of side effects typical for opioids in the main group was proved, but in comparison group these side effectes were observed in almost every fifth patient. The average duration of use of painkillers was also different. The need for analgesics in the main group of patients was in the range (3.2 ± 1.0) days, and it was higher in the control group (4.3 ± 1.9) days.


Keywords


multimodal analgesia; dexketoprofen; paracetamol; minimally invasive surgical procedures

References


Gupta A, Favaios S, Perniola A, Magnuson A, Berggren L. A meta-analysis of the efficacy of wound catheters for post-operative pain management. Acta Anaesthesiol. Scand. 2011;55(7):785–796, doi: 10.1111/j.1399-6576.2011.02463.x.

Lohman D, Schleifer R, Amon JJ. Access to pain treatment as a human right. BMC Medicine. 2010;8:8, doi: 10.1186/1741-7015-8-8.

McNicol ED, Schumann R, Haroutounian S. A systematic review and meta-analysis of ketamine for the prevention of persistent post-surgical pain. Acta Anaesthesiol. Scand. 2014;58(10):1199–1213, doi: 10.1111/aas.12377.

Mhuircheartaigh RJ, Moore RA, McQuay HJ. Analysis of individual patient data from clinical trials: epidural morphine for postoperativepain. Br. J Anaesth. 2009;103(6):874–881, doi: 10.1093/bja/aep300.

McDaid C, Maund E, Rice S, Wright K, Jenkins B, Woolacott N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review. Health Technol Assess. 2010;14(17):1–153, doi: 10.3310/hta14170.

Pavy TJ, Paech MJ, Evans SF. The effect of intravenous ketorolac on opioid requirement and pain after cesarean delivery. Anesth. Analg. 2001;92(4):1010–1014.

Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst. Rev. 2013;7:CD008307, doi: 10.1002/14651858.CD008307.

Visentin M, Zanolin E, Trentin L, Sartori S, de Marco R. Prevalence and treatment of pain in adults admitted to Italian hospitals. Eur. J Pain. 2005;9(1):61–67.

Moore RA, Derry S, Aldington D, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Sys. Rev. 2011;9:CD008659, doi: 10.1002/14651858.CD008659.pub3.

Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur. J Pain. 2005;10(4):287–333.

Young A. Buvanendran A. Recent advances in multimodal analgesia. Anesthesiol. Clin. 2012;30(1):91–100, doi: 10.1016/j.anclin.2011.12.002.




Copyright (c) 2016 Alexandr Buryanov, Yuriy Sobolevskiy, Taras Omelchenko, Ruslan Babochkin, Mariya Andreeva

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