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№1' 2018
ANESTHESIOLOGYInternational Medical Journal, Vol. 24., Iss. 1, 2018, P. 80−84.
POSTOPERATIVE ANALGESIA OF GERIATRIC PATIENTS WITH MULTIPLE TRAUMA
Kharkiv National Medical University, Ukraine
Age−related anatomical and functional changes in the elderly people affect the severity of the course of traumatic disease (TD) at polytrauma. To determine the efficacy and safety of nalbuphine for postoperative analgesia in geriatric patients with polytrauma we examined 31 patients over the age of 60 with the presence of skeletal polytrauma. All patients received as a postoperative analgesia with 10 mg nalbuphine. The study was conducted on the 1st, 3rd, 5th and 7th day after the operation. The level of pain was determined by the visual analog scale (VAS), the concentration of stress markers, the mediators of the systemic inflammatory response (SIR), and the parameters of the system of regulation of the aggregate blood state (RABS). The daily requirement for analgesics, the frequency of their administration, the side effects of the analgesia preparation, the duration of effective analgesia were taken into account. After 3 days of the postoperative period, there was a significant decrease in the need for anesthesia before its complete absence on day 7. Against a background of the administered doses of nalbuphine, its serious side effects, such as respiratory depression, were not observed. Nalbuphine reduced the intensity of stress reactions, without affecting at the same time the severity of SIR. During the first 5 days there was a tendency to hypercoagulation, the maximum was on the 1st day after the operation. At the end of the study, the level of soluble fibrin−monomer complex normalized in 38.7 % of patients and in 64.5 % −− antithrombin−III. Our results suggest that nalbuphine is not associated with the etiopathogenetic links of pain syndrome, but only with interruption of nociceptive impulses. However, nalbuphine does not cause such dangerous side effects as respiratory depression.
Key words: analgesia, geriatric patients, multiple trauma, cyclooxygenase inhibitor, visual analog scale, nalbuphine.