Stopping of a pain syndrome, taking into account extensiveness and injury of modern operative measures, is topical issue of maintaining the patient in the postoperative period. Not stopped pain syndrome serves as the reason of various physiological reactions which have extremely negative effect on the current of the postoperative period, increase the probability of postoperative complications and are the reason of a delay of the patient in a hospital. Competently picked up scheme of anesthesia in the postoperative period allows to make active early the patient that is prevention of pulmonary and tromboembolic episodes. The modern anesthesiology is able to offer a wide range of means of fight against postoperative pain.
Pain is the unpleasant feeling or emotional experience connected with the available or probable damage of fabrics, or described by the patient terms of similar damage. It is important that pain is not always associated with visible damages of fabrics, that is the patient can feel pain even in lack of the obvious reason of its emergence. It is easier for Bol to warn what to treat therefore intra-and postoperative anesthesia has to have preventive character. Use of the scheme is "on demand" inadmissible, in view of high risk of synchronization of pain and complication of its structure. Existence of pain in the preoperative period lasting more than one month is risk factor of its synchronization and demands holding the relevant activities within preoperative preparation and intraoperative maintaining. The depression and the insufficient nutritive status also have an impact on forming of a chronic postoperative pain syndrome that needs to be considered when planning anesthesiology providing and postoperative maintaining.
The assessment of a postoperative pain syndrome is carried out on the basis of use of various tests and scales of assessment. The greatest distribution was gained by the visual and analog scale (VAS), a simple digital scale and a simple verbal scale. As the reference tool serves VAS. It is provided in the form of the continuous monotonous scale which is not graduated from the patient and graduated from 0 to 10 cm from the medic. By means of the cursor the patient specifies pain which he feels, on a reverse side of a ruler the intensity is noted.
Strategy of treatment of pain has to be developed and begun in the preoperative period (prevention or anticipation of a pain syndrome).
Principles of treatment of a pain syndrome:
Multimodality (impact on various links and processes of forming of a pain syndrome);
Broad use of regional and neuroaxial blockade in the absence of contraindications to their carrying out;
Sufficiency (the patient should not feel the pain limiting him activity);
Safety (minimum possible dosages of medicines and minimum necessary invasion when performing regional and neuroaxial blockade are used).
The significant role in postoperative anesthesia is played by use of regional anesthesia. When planning perioperatsionny anesthesia it is necessary to recognize that this or that type of regional anesthesia has to be used in all cases when it is not contraindicated. The simplest and available method is infiltration of edges of a wound solution of local anesthetic. Also blockade of cross space of a stomach and a vagina of a direct muscle of a stomach, the prolonged blockade of neuroplexes, juxtaspinal and epidural blockade can be used.
When using in treatment of a postoperative pain syndrome of medicamentous therapy, it is reasonable to be guided by the step scheme of treatment of a pain syndrome on WHO:
Step of I: Non-narcotic (paracetamol, to nefopa, NPVS and others);
Step of II: Weak drugs, in combination with analgetika of a step of I;
IIIa step: The strong drugs accepted orally (clean agonists: morphine, oxycodone, hydromorphone; selective agonists: buprenorphine; agonists antagonists: nalbufin);
IIIb step: The drugs entered in the invasive way.
At severe postoperative pain or breakthrough pains (strengthening of pain against the background of reception of analgetics) therapy needs to be begun with invasive administration of strong drugs (IIIb Step) for the purpose of stopping of an acute pain and prevention of forming of a chronic pain syndrome. In the subsequent treatment can be continued both without their use, and with further use of strong opioids. Certainly, also regional ways of anesthesia, usually in combination with medicamentous have to be whenever possible used.