Hyperalgesia in the Treatment of Patients in the Acute Period of Traumatic Brain Injury

I.L. Kuchyn

Abstract


In the intensive care of severe traumatic brain injury (TBI), analgosedation is an important component. The objective of the study was to determine if continuous fentanyl infusion during analgosedation in patients with traumatic brain injury has an impact on the emergence of hyperalgesia. Materials and Methods. 20 measurements of mechanical pain threshold by von Frey monofilaments were carried out in 11 patients. Simultaneously, we have estimated dynamics of neurological status, indicators of the cardiovascular and respiratory systems, as well as fixed daily dose of fentanyl. To assess the presence and the strength of connection between the signs, we have used rank correlation. Results and Their Discussion. In 7 patients response to stimulation occurred only when we applied pressure forces 100 and 180 g, 8 patients required pressure force 26 or 60 g. When assessing the correlation using Spearman coefficient, we have found a strong inverse relationship between daily dose of fentanyl and pressure force that caused stimulation (r = –0,8, p < 0.05). Thus, high doses of fentanyl were associated with reduced pain threshold, which is probably associated with the development of central hyperalgesia. Conclusions.The use of high fentanyl doses for analgosedation in patients with TBI can lead to the development of hyperalgesia. Further studies are needed to find optimal combinations of analgesics and sedative drugs for analgosedation to reduce the dose of opiates.


Keywords


traumatic brain injury; analgosedation; opiates; hyperalgesia

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DOI: https://doi.org/10.22141/2224-0586.1.64.2015.79575

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