Выбор периоперационной мультимодальной схемы анальгезии у пациентов со стенозом позвоночного канала

Анестезиология и реаниматология. 2017. Т. 62. № 4. С. 275–281.

Тимербаев В. Х., Генов П. Г., Долгашева Н. С., Ефанов А. А., Гринь А. А., Rebrova O., Афонасьев М. Г.

Material and methods. 122 patients had been scheduled for elective lumbar fusion in 2010-2016 was enrolled in a prospective study. Group K (n=19) underwent postoperative analgesia on-demand. Group PMA (n=21) was given preventive multimodal analgesia (PMA) including ketoprofen, paracetamol and morphine. At PMA+PG (n=20) and PMA+N (n=20) groups pregabalin and nefopam were used respectively; at PMA+E (n=22) epidural ropivacaine with morphine was combined; at PMA+I (n=20) continuous wound infiltration by ropivacaine with ketorolac was administered. Results and conclusions. Postoperative analgesia on-demand is not adequate during 5 postoperative days. PMA results in significant pain reduction during 3 postoperative days, enhancement of patient satisfaction, quicker recovery after surgery and fewer days of hospital stay. Patients receiving pregabalin or nefopam as well as epidural analgesia does not lead to better postoperative pain relief than at PMA, but shows a trend to increase the rate of adverse reactions. Wound infiltration with PMA is followed by significant pain relief during 6 postoperative hours, decrease in opioids consumption, rate of adverse reactions and duration of hospital stay (compared to PMA group).

Keywords: choice, spinal stenosis, multimodal analgesia, стеноз позвоночного канала, схема анальгезии, мультимодальное обезболивание