Efficiency of Pain Relief during and after Reconstructive Surgery for Gunshot Wounds of Extremities
Background. Given the military situation that has developed in our country, the number of wounded the pain assessment becomes important, because erroneous assessment of pain leads to inadequate dosing of central, peripheral and combined analgesics. This can lead to overdose, loss of control of the dynamics of the process, the impossibility to estimate the effectiveness of various pharmacological groups. Objective: to improve pain assessment and pain management during postoperative reconstructive surgery for gunshot wounds of the extremities. Materials and methods. Patients were divided into two groups: group 1 consisted of the patients after reconstructive surgery on the upper limb; the group 2 included the patients with reconstructive surgery on lower limbs. Each group consisted of two groups: 1) the patients received general anesthesia during reconstructive surgery after gunshot wounds of limbs; 2) the patients with regional anesthesia catheter for prolonged regional anesthesia during reconstructive operations after the gunshot wounds of the extremities. The total number of the patients studied was 179 (one hundred seventy nine). The group I included 99 patients: subgroup 1 consisted of 32 patients, subgroup 2 consisted of 67 patients; group II contained 80 patients: subgroup 1 — 15 patients, subgroup 2 — 65 patients. The patients were selected without comorbidity. The pain and anesthesia efficiency were assessed in all patients immediately prior to the surgery on the table, during the surgery, immediately after surgery on the table and up to 4 days after intervention by two scales that have been combined in one for convenience of a doctor: 1) Visual Analogue Scale (VAS); 2) Neuropathic Pain Scale (NPS). Results. The patients with general anesthesia during reconstructive surgery for limb gunshot wounds and total score ranged from 0 to 10.5 points did not need medications for pain relief, from 10.5 to 19.5 points needed non-steroidal anti-inflammatory drugs for anesthesia, from 19.5 points to 30 points needed narcotic analgesics administered once or narcotic analgesics in addition to the non-steroid anti-inflammatory drugs. The patients with regional anesthesia during reconstructive surgery after limbs gunshot wounds under ultrasound guidance with the establishment of a catheter for prolonged regional anesthesia and total score ranged from 0 to 10.5 points did not need medications for pain relief, from 10.5 to 30 points needed solution of 1% lidocaine 400 mg injected into the catheter for prolonged regional anesthesia, which provided effective analgesia in the postoperative period. These patients did not require additional medications for pain relief.
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