Postoperative analgesia in cardiac surgery patients
Abstract
The problem of postoperative analgesia does not lose its relevance. Most experts use multimodal analgesia, however, many questions concerning a choice of drugs entering into these schemes remain
controversial. The paper presents evaluation of data devoted to analgesia in early postoperative period in cardiac surgery patients, as well as experience of research conducted in the Petrovsky National
Research Center of Surgery in administration of various opioid and non-opioid analgesics. It is shown
that various combinations of analgesic drugs help to reduce the total dose and minimize the adverse
effects of the used components and their accumulation. We demonstrated the importance of routine
use of pain assessment scales and incentive spirometry to assess the intensity of pain and effectiveness of its relief during treatment. We also discovered that the high doses of strong opioids used in patient-controlled analgesia, lead to a large number of adverse effects and hamper early activization of them. We managed to prove the importance of the appointment of non-narcotic analgesics
prior to extubation of the trachea, before activation of the patients. We showed the safety of short
course of nonselective NSAID in the multimodal analgesia regimens. After concomitant thoracic and
abdominal operations and according to individual indications can be used high epidural analgesia.
Due to positive experience of application of transdermal analgesic systems, and this area requires further investigations. After transfer from the ICU to the surgical department analgesia is still actual and
can be carried out mainly with the help of tablet or other non-injectable forms of drugs (preferably the
combination of multiple analgesics with mutually potentiating effect).
Keywords:multimodal analgesia in cardiac surgery patients, opioid analgesics, non- steroidal anti-inflammatory drugs, acetaminophen, nefopam, transdermal analgesic system, epidural analgesia
Clin. Experiment. Surg. Petrovsky J. 2016. № 4. Р. 67–76.
Received: 13.10.2016. Accepted: 13.11.2016.
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